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PM Pediatrics
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Dr. Christina Johns
Senior Medical Advisor, PM Pediatrics

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My Experience at work on many a July 4 over the past 20 years

Working holidays in acute care is pretty interesting, because each one sort of has its own flavor. There are a few universals:

  1. People get sick 24/7.
  2. Regular offices are closed, so people seek care in emergency departments or urgent care offices.

But there are some curious general volume trends to each holiday:

  1. Thanksgiving: busy early in the morning, then quiet later in the day.
  2. Christmas Eve: same as Thanksgiving.
  3. Christmas Day: roll of the dice; can be quiet or jam packed busy.
  4. New Year’s Day: typically pretty busy the whole day.
  5. The day AFTER any holiday: HOPPIN’.

July 4 is a bit unusual in that it’s just pretty steady. Not usually overflowing with patients because it’s not flu season, but there are some fevers to be checked out, injuries to manage, and wheezing to treat. Since it’s coming right up this week, I’d be remiss if I didn’t share my “frequent flyer” list of common Independence Day reasons for visits in pediatric emergency medicine or urgent care.


The range of burns I’ve seen on July 4 is fairly wide. Kids burn their hands and feet from grabbing or stepping on hot sparklers, which can reach temperatures of over 1000 degrees F. Even worse, when people try to step up their fireworks game and light more powerful devices, face and eye burns can result, some of which can be very serious. Please, leave the fireworks to the professionals and don’t use illegal fireworks at all. There’s no clearer way for me to say this.

Kids also get a variety of burns from hot grills: older kids tend to grab the grate with bare hands, or drop them, grazing the side of their leg, etc. I really recommend that a “safe zone” is created around a hot barbecue grill where no child is allowed to enter, thereby decreasing the chances for any grill-related injury. Check the food temperature, too. While mouth burns from hot food are sometimes minor and nearly all heal very quickly, they can be painful and have unpleasant downstream effects like dehydration due to discomfort.


I love it when children assist with party food prep, but I love it less when a hand gets cut from helping to slice the watermelon. I know I’m stating the obvious, but supervision and teaching kids how to use a knife safely is really important, and an exciting day like the fourth of July may not be the best day to teach them.

Additionally, I’ve seen feet and legs cut from sharp objects in lakes and rivers, even from the sharp edges of seashells. Wearing water shoes and really checking out the water that your child may be swimming in as best as you can will help avoid some of these common cuts, many of which require stitches. Who wants to miss the fireworks display because they’re sitting in my room 7 getting their laceration sewn up?

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Fireworks can really be loud, loud enough to rupture an eardrum. Some people are more sensitive than others to loud noises, but I will tell you that most BABIES are very sensitive, so I’m always surprised when people bring their little ones to the fireworks. Especially for children under one year of age, I recommend watching the display from the volume-controlled comfort of your own home. At the very least, please put noise-cancelling headphones on your young child to minimize this risk.

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A lot has been written about this topic and I’m guessing that many people think twice before they eat potato salad at a July 4th picnic. With good reason: leaving food out for more than 2 hours or so increases the likelihood of contamination with E. Coli or Salmonella. Also, good handwashing can be compromised at these events, so the spread of these stomach bugs can be “enhanced” by this factor as well. Keep this in mind if you are attending a holiday BBQ or picnic, and at least bring a large bottle of hand sanitizer and encourage liberal use throughout the day. Ask how long food has been out before you serve yourself a helping.

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Notably, I see patients with complaints related to fluid loss and heat related symptoms quite frequently on July 4 due to the many local parades in everyone’s community.

It’s usually hot and without hydration along the parade route, and so kids (who have less of a fluid reserve than adults) are more likely to get dehydrated and feel dizzy and faint due to lack of fluid. If your child is participating in a holiday parade, make sure there is a plan to address this before the parade even starts.

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For reference, here’s some data from the Consumer Product Safety Commission, as reported by the Insurance Journal:

Of the injuries in 2016 that were linked to fireworks, CPSC reported these 10 facts:

  • Of the fireworks-related injuries sustained, 61 percent were to males, and 39 percent were to females.
  • Children younger than 15 years of age accounted for 31 percent of the estimated 2016 injuries.
  • Thirty-nine percent of the estimated emergency department-treated, fireworks-related injuries were to individuals younger than 20 years of age.
  • Young adults 20 to 24 years of age had the highest estimated rate of emergency department-treated, fireworks-related injuries (4.9 injuries per 100,000 people).
  • Children younger than 5 years of age had the second highest estimated rate (4.4 injuries per 100,000 people).
  • There were an estimated 900 emergency department-treated injuries associated with sparklers and 400 with bottle rockets.
  • There were an estimated 1,300 emergency department-treated injuries associated with firecrackers. Of these, an estimated 47 percent were associated with small firecrackers, an estimated 4 percent with illegal firecrackers, and an estimated 49 percent with firecrackers for which there was no specific information.
  • The parts of the body most often injured were hands and fingers (an estimated 33 percent); head, face, and ears (an estimated 20 percent); legs (an estimated 18 percent); eyes (an estimated 9 percent); and arms (an estimated 8 percent).
  • Sixty-nine percent of the emergency department-treated injuries were burns. Burns were the most common injury to all parts of the body, except the eyes, where contusions, lacerations, and foreign bodies in the eyes occurred more frequently.
  • Approximately 92 percent of the victims were treated at the hospital emergency department and then released. An estimated 7 percent of patients were treated and transferred to another hospital or admitted to the hospital.

July 4 is really a fun holiday for many reasons: the weather, the universality of its celebration, the delicious all-American food, and the beautiful light show. I hope for everyone that this year it will be a safe one, too. I’d love to be proved wrong on the steadiness of the busy day in acute care.


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