When school’s out, the emergency room is in.

Doctors say it’s an unfortunate fact of summer break since kids are spending more time outside playing, climbing and swimming – and not always with full supervision.

“As soon as it gets nice outside, our injury rates go way up,” says Dr. Katherine Hebert, a pediatric emergency medicine physician at the Children’s Hospital of Michigan. “We start seeing fewer fevers and flu-like symptoms and significantly more trauma.”

It’s not that parents aren’t being cautious, because usually they are. But activities that moms, dads and caregivers take for granted as carefree summer fun can be more dangerous than you’d think.

“There are some things that we know to worry about, but I think sometimes we don’t assume the worst with a lot of things. Kids go out and ride their bikes all the time and most of the time they don’t fall off and if they do, they just skin their knee,” she says. “So parents can get a little bit lax on wearing helmets,” for example.

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What else contributes to the surge in broken bones, concussions and other injuries that bring kids to the emergency room this season? Here’s a look at five hidden risks of summer that parents should think about before the kids start celebrating their two and a half months of freedom.

1. Falls

Climbing trees, swinging on monkey bars and awkward trampoline landings all contribute to more kids being seen for breaks, sprains, concussions and other injuries.

“We see a lot of falls off of swings, play structures, monkey bars and trampolines,” Dr. Hebert says.

Kids are also more likely to fall out of windows, since many people open their windows for fresh air on a warm day without thinking about how securely their screens are attached.

“People leave windows open with just screens in them, which kids can easily push on and fall out of,” she says.

2. Pedestrian accidents

With kids out exploring their neighborhoods on foot, bike or scooter, hospitals unfortunately see a range of serious injuries due to pedestrians getting hit by vehicles. Kids must be taught to be extra vigilant – and it goes beyond wearing a helmet.

“They may be riding their bike and doing a great job but they get hit by a car and have a head injury,” Dr. Hebert explains, encouraging adults to also be more aware when driving. “If sidewalks are available, kids should be taught to ride on the sidewalk, not in the street. When they’re learning to ride their bike, you have to keep your eyes out as you’re going past driveways, that people might be turning in or backing out. It comes down to education and supervision so the kids learn the right habits.”

Keep in mind that accidents most often happen close to home.

“They need to be wearing a helmet every time, even if you’re just riding down the block,” she emphasizes.

3. Burns

There’s nothing like making s’mores with the kids under the stars on a summer night, but families must be extra cautious with their fire pits – especially if the kids are playing in the backyard while the fire is burning.

Many kids come to the emergency department with burns from getting too close to a fire pit or tripping and falling onto it, Dr. Hebert says. Fireworks are another serious hazard for kids.

“A lot of these things seem safe, like sparklers, but they heat up to about 1,000 degrees and they can cause significant burns,” Dr. Hebert says, noting that she suffered a burn from a sparkler as a kid. “They sell them at the dollar store so people don’t necessarily think about it or realize how hot they get.”

4. Lawn mower injuries

Having your older kids help out with the outdoor chores can seem like a natural choice, but many teens just aren’t ready to handle the equipment.

“We see a lot of lawn mower injuries, either teens or middle school kids helping mow the lawn that don’t know how to appropriately manage it or kids that are in the yard while their parents are mowing the lawn,” she says. “If the lawn mower goes over a rock or object, it can fly up and hit kids and cause injuries.”

Lawn mowers left unattended are another hazard, and other times young people try to remove something stuck in the mower’s blades and end up getting cut when the blades start spinning again. This has led to amputations of fingers and hands, Dr. Hebert explains.

5. Water danger

As kids flock to water parks and backyard pools, drowning and submersion injuries are a major risk. Drowning is also much more silent than people assume.

“When kids have water injuries usually they’re very silent and nobody knows what’s happening, they’re not able to scream or breathe,” Dr. Hebert says, adding that injuries also happen when people jump or fall into pools. “We see pool injuries that happen and no one even realized that anything was happening. There’s no safe depth of water; things go wrong very quickly. No child should ever be swimming alone.”

When to be seen, prevention tips

If your child is injured, don’t hesitate to head to the emergency room. Red flag signs include acting differently after a fall, passing out, favoring an extremity or difficulty breathing.

“If they’re worried, they should come in,” Dr. Hebert says. “The worst thing that happens is we’re going to reassure you and you go home. If they’re seeming off from their baseline, we should see them.”

Make a safety plan for your family, too, so everyone in the house knows how to call 911 and knows what responsible adults they can go to for help. Parents can also look to healthychildren.org for reliable information, she says.

“Parents know that there are dangers out there but when they’re out having fun, there are a lot of things you’re just not thinking of in the moment; a lot of hidden dangers,” Dr. Hebert says. “Things go right 100 times and the one time they can go wrong it can be hard to prevent.”

For more information on Children’s Hospital of Michigan, visit childrensdmc.org.