Michael Macknin, MD

Cleveland_Clinic_Host: Welcome to our Online Health Chat with Dr. Michael Macknin. He will be answering a variety of questions about toy safety and creating a safe environment for infants and children this holiday season and beyond.

Dr. Macknin is an expert on child safety and enjoys educating parents on the dangers children may face at home, and how to create the safest home environment for their loved ones. He is a regular advocate in the community on car seats, sun, and toy safety.

Dr. Macknin is board-certified in pediatrics and has been at Cleveland Clinic since 1982. During his 25+ years of service, Dr. Macknin served as Chairman of the Department of General Pediatrics for 14 years. He also directed general pediatric medical student clerkships for over 20 years.

Recognized as one of the Best Doctors in America and Top Docs by his peers, we are thrilled to have Dr. Macknin here today for this chat.

Safe Toys Basics

fitzie123: I am not a parent and really have no clue how to choose toys for friends or family. Where do I begin?

Speaker_-_Dr__Michael_Macknin: First you should begin by purchasing toys or games from a reputable dealer. Some smaller stores even have sales people that will discuss the child’s age, interests and skill level with you to help you determine the appropriate toy.

Second, it is not wise to purchase second-hand or used toys. These may have been recalled or may even be unsafe.

Finally, if you are going to purchase online, make sure that you purchase from source that are reputable and you know are vigilant about removing recalled toys or games from their inventory.

2SammieKids: Are there different things to look for in a toy that change according to the age of the child?

Speaker_-_Dr__Michael_Macknin: Make sure to follow the age recommendations suggested by the manufacturer of the toy. The toys should be appropriate for your child’s age, ability and skill level. Toys should also be clearly marked if they have small parts and you do not want to buy toys with small parts for a child under 3. If the toy is for an older child, it is important that the child under the age of 3 is not allowed to play with that toy.

To be sure of a toy’s size, use a small parts tester that can be found on the web. An empty toilet paper roll can be used also, but the diameter is a bit larger than a small parts tester. If the part fits into the cylinder, don’t let the child play with the toy.

AliciaB: What kind of safety issues are there for toys/games and older children? I understand about choking hazards for little kids, but what would be unsafe for an older child?

Speaker_-_Dr__Michael_Macknin: Sharp points and edges are dangerous for children under the age of 8. Avoid toys with strings or straps longer than 7 inches as these may pose a strangling hazard. The bottom line is: read all the labels on the toys and follow the safety recommendations.

GrammaVirginia: Many toys state ‘with parental supervision’. What exactly does this mean?

Speaker_-_Dr__Michael_Macknin: Parents or caretakers need to ‘actively supervise’ children playing. This is more than just being in the same room as the child. It is important to keep your child where you can see him or her, within reach and that you can give the child undivided attention.

kels1780: Should we look for toys that are made in America?

Speaker_-_Dr__Michael_Macknin: I am assuming that your question concerns the safety of toys made in America versus other countries. To answer that - again purchase from a reputable dealer/manufacturer and retail outlet.

In the US - all toys are to meet safety standards. There was a Child Safety Protection Act passed in 1995 that states all toys imported or manufactured in the United States must comply with this act.

dominosally: What should I do about toys that we already have in the home? How should I inspect them?

Speaker_-_Dr__Michael_Macknin: Ensure that toys are in good repair and there are no broken parts. Children should not play or have access to toys that have straps, strings or cords longer than 7 inches because this can pose the risk of strangulation. If toys have small parts, parts that move, electrical or battery power, any cords or wheels, parents or caretakers must actively supervise the play.

Lollipops: What is the frequency of toy related deaths? Is one age more vulnerable than another?

Speaker_-_Dr__Michael_Macknin: Hospital emergency rooms nationwide treat approximately 217,000 toy-related injuries yearly. The average number of deaths related to toy-related injuries for children under the age of 14 is approximately 15. The most frequent cause of death related to toy injuries is choking on a small part.

One good web site that links you to others concerning child safety is:

Protection Means Prevention

Cleveland_Clinic_Host: Dr. Macknin, is there anything you would like to talk about today?

Speaker_-_Dr__Michael_Macknin: Yes - one of my favorite topics is safety helmets. Never give a bike, skateboard, scooter or rollerblades without a safety helmet as an accompanying gift.

A fantastic web site for everything you would want to know about safety helmets is the Bicycle Helmet Safety Institute.( This site reviews research statistics, design standards, costs, and fitting recommendations.

ClarkeKent: What kind of protective gear is recommended for gifts like bicycles, rollerblades, skateboards/scooters and sleds other than helmets?

Speaker_-_Dr__Michael_Macknin: For rollerblades and skate boards, wrist guards are important and will prevent 6 out of 7 wrist fractures. Helmets are a must because of the possibility of head injuries.

Rollerblade and skateboard safety awareness should include the obvious: Stay away from traffic, skate during daytime hours and skate on smooth surfaces.

RockStar: I have school age children, plus an infant starting to crawl and pull up to standing. How do I keep my older kids toys away from the infant especially when they are left within reach?

Speaker_-_Dr__Michael_Macknin: Children need to be taught to put toys away after playing. This helps not only to prevent falls in the home (have you ever stepped on a Lego part in the dark) but will also keep toys that are meant for older children out of reach of the younger ones.

Toy chests or cabinets are a good idea, but they need to have safety hinges to prevent the lid from closing on a child’s head when leaning over the chest. Some toy chests may need to be retrofitted with this particular type of safety hinge. If that is not possible, remove the lid from the toy chest. Also, make sure that cabinet safety locks are in place and working in your home.

KikiMcD: Do you have any suggestions how to inquire of another parent about toys or items they may have in their house that you do not consider safe? I don’t always want my child to play at their house when they don’t use baby gates etc. I also don’t want my child to play at someone’s home that has guns. What do I say?

Speaker_-_Dr__Michael_Macknin: Checking the safety of friend’s homes before allowing your child to play there is clearly an important issue and difficult to comfortably address. You will probably not get all your concerns answered without tactfully and directly addressing them with your child’s friends’ parents.

Hopefully, your fellow parents will share similar concerns about child safety and understand that these are questions you routinely ask before your child goes to play outside your home.

KennyD: What age is safe for a child to use a trampoline? I was considering one for Christmas. My kids are 6, 9 and 10.

Speaker_-_Dr__Michael_Macknin: It is never safe to use a trampoline. The American Academy of Pediatrics has a position paper that discourages the use of trampolines. It is recommended that trampolines only be used for athletic training such as diving under the strict supervision of qualified individuals.

contond: My 12 year old son wants a pocket knife for Christmas. He plays out in the woods and down by the Creek quite a bit and would also like to learn how to carve. Barring individual personality traits, is a 12 year old enough for a pocket knife?

Speaker_-_Dr__Michael_Macknin: This is a parental judgment. If your son is an extraordinarily mature 12 year old and you feel it is safe for him to use a pocket knife, it would be a reasonable gift. However, close parental supervision particularly while he is learning how to use the knife properly is necessary.

terry: My sons' friends ride dirt bikes, and my sons would like to be allowed to also. Is there someplace I can take them to be trained on these so that I would be more comfortable if I did give permission?

Speaker_-_Dr__Michael_Macknin: You would need to do a search for dirt bike training courses or schools in your local area. Safety instruction is important even for simple bicycle riding. Local bike and dirt bike clubs could also be a great resource.

Holiday Decorations

sussex: When decorating for the holidays – are there any things that should be avoided because of safety issues for children?

Speaker_-_Dr__Michael_Macknin: There are many things to consider. Fire is a huge concern as people decorate homes with real or artificial trees, candles and electric lights. The American Academy of Pediatrics has excellent information. Check out the website at

Computer and Video Games

Klein4Girls: Can you share your thoughts on video games as Christmas gifts?

Speaker_-_Dr__Michael_Macknin: The American Academy of Pediatrics suggests that total screen time is limited to 1-2 hours per day maximum. This is for video viewing, television and computer time.

This is particularly important for children under age 2. A study was done that determined children ages eight to sixteen months old who watched educational videos (such as Brainy Baby and Baby Einstein) for more that one hour per day actually scored 17 points lower on verbal test scores than age matched peers who did not watch educational videos. Cartoon viewing is associated with decreased test scores of approximately 11 points. Reading to the child actually improved the verbal score by 12 points.

GeekMom: Do you have a suggestion on how to limit my child’s computer game time?

Speaker_-_Dr__Michael_Macknin: Again, parents should limit total screen time to 1-2 hours per day. Excessive screen time is highly associated with obesity. Violence depicted on screen has been found to be highly associated with violent behavior in the children exposed to the violence.

Jaybird: What about the new and popular Wii games for children? What is your opinion?

Speaker_-_Dr__Michael_Macknin: It is still recommended to limit total screen time to 1-2 hours per day. That being said, there are several Wii games that promote physical fitness. Keep in mind; this is still not a complete substitute for getting outside, off the couch and throwing a few snowballs.

Remote Control Toys

4HKG: I have some electronic cars that don’t work anymore, or the remote has been lost. Would these be okay to give to some neighbor boys who live across the street that are ages 5-7?

Speaker_-_Dr__Michael_Macknin: As long as the children playing with the toys are the appropriate age (over age 3) and therefore not at risk for choking on small parts, the toys are otherwise in good repair and not on recall lists, they should make fine gifts. There is never any substitute for active supervision of children’s play to ensure their safety.

nelson1980_2: I am getting my niece a battery operated car from a well advertised toy store. Is there anything on it or used to make this that could do her harm?

Speaker_-_Dr__Michael_Macknin: Depending on the age of your niece, make sure that she is old enough to play with a battery operated car because the only concern would be swallowing small parts or playing with the battery.

Car Seats and Booster Seats

contond: What is the current law in Ohio regarding children and car seats/booster seats? How about in Pennsylvania? I know they were trying to change it but I had not heard if it had gone through.

Speaker_-_Dr__Michael_Macknin: Ohio is supposed to vote on a booster seat law this week, but I do not know the current status. The law for car seats states that children under age 4 and less than 40 pounds must be in a car seat in Ohio. The appropriate restraint for all children less than 4 ft. 9 inches is that they must be in a booster seat. This is anywhere in the United States, not just in Ohio.

Also be aware that no person less than 5 feet tall should be in the front seat of the car with an air bag.

Check the web site for further information.

What About Lead?

kels1780: Should we be checking lead content with a home test kit on toys?

Speaker_-_Dr__Michael_Macknin: According to Consumer Product Safety Commission (CPSC), home test kits for lead are considered to be unreliable. It is best to purchase any toys or games from a reputable dealer and check for recalls at

Cleaning Toys

sinclair: What is the best way to disinfect my children’s toys? Some of them cannot be immersed in water and some should not get wet. Some have many, many parts.

Speaker_-_Dr__Michael_Macknin: Great question. It is impossible to completely disinfect toys. For toys that you can use liquid on, 1/2 cup bleach to 1 gallon of water or spray/disinfecting wipes are recommended. After wiping down the toy, it is important to rinse they toy to remove the cleansing agent.

Toys that cannot get wet are another story and I do not have an answer for that question.

Toy Recalls

Megan: What is the best way to stay informed about toy recalls? Especially concerning lead paint or magnets?

Speaker_-_Dr__Michael_Macknin: Most toys are considered safe. When you consider that more than 3 billion toys and games are sold in the U.S. every year and that half of that number are usually sold during the holiday season – it is important to put into perspective that only a small fraction of those toys are actually recalled.

It just seems so dramatic when you hear about a toy recall on the news. Make sure that you always return the product warranty and registration forms that are included with any toys.

You can stay current on toy recalls by signing up for email alerts. The website is Another good website to regularly check about recalls is

kels1780: If a toy is recalled, it's already in the hands of many people; reputable stores are not able to prevent this, what is another way to prevent it?

Speaker_-_Dr__Michael_Macknin: If you would like to become more involved with preventing toy recalls, you may contact the contact the Consumer Product Safety Commission (CPSC) mentioned earlier. The CPSC is in charge of all recalls in the United States.


Cleveland_Clinic_Host: I'm sorry to say that our time with Dr. Macknin is now over. Thank you again Dr. Macknin, for taking the time to answer our questions today.

Speaker_-_Dr__Michael_Macknin: Please remember that balloons are considered the leading choking hazard for young children. Also, keep in mind to clean up after your holiday celebrations to avoid toxic exposures such as alcohol and tobacco in the hands of curious children. Have a safe holiday season!

More Information

This chat occurred in December 2008.

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