Kids Travel Doc
A Pediatrician's Guide to Travel and Outdoor Recreational Activities
Families who vacation together do not necessarily remain together
For most families, travel and vacations are just what the doctor ordered to build family unity, broaden kid’s outlooks, and create memories for tomorrow. But think twice before planning vacations if you’re beset by serious marital problems, one of your children is experiencing a major meltdown or your teenager has his/her own agenda – agendas generally family unfriendly.Vacations tend to remove socially acceptable escape hatches which at home keep anger, hostility, and a slew of other less than noble traits down to a manageable few. At home acceptable “apartheid” exists – ones’ own room, multi-television set, going to a friend’s house, and school, hobby and work schedules. Even two and three year olds know how to escape togetherness when they wish to do be alone.
Vacations catapult families into close quarters: sharing rooms, participating in the same activities – activities invariably boring to some, eating meals together and watching TV on the only set available. Throw in some bad weather, a kid vomiting in the car, a touch of homesickness, parents worried about the cost of the trip or work-related issues and a Richter scale 4 volcano erupts. On some vacations, you may feel like being on a submarine beneath the Arctic ice, no way to abort until the bitter end.
Signs that an upcoming vacation is likely to be memorable rather than miserable include parents who often go out to dinner together and who plan frequent events which include the whole family. Other positive signs are children being at each other throats only some of the time and teenager acting fairly human.
For families in total turmoil, a psychologist/family therapist may already be in the picture. Consider making an appointment with him/her before making reservations.
Children away from home/Homesickness
If you send your child to sleep-away camp, especially for the first time, don’t be surprised if after several days you get a call/email from your neophyte camper demanding that you bring him/her home immediately, that you made a terrible mistake inflicting camp on a child who hates camping, and that you are a bad, inconsiderate parent who enjoys making your child miserable. About 80% of children away from home, especially for the first time, whether in camp, on study programs, or visiting grandparents, experience at least some homesickness.
Here is what you should know:
1. Homesickness is neither new, unusual nor limited to children. (Not that this will help you or your camper feel better.) According to Wikipedia, homesickness is mentioned in the Old Testament (Exodus: “By the rivers of Babylon, there we sat down, yea, we wept, when we remembered Zion.”) and in Homer’s Odyssey, whose opening scene features Athena arguing with Zeus to bring Odysseus home…because he is homesick (“…longing for his wife and his homecoming…”).2. Start preparing kids for “awayness” months before camp time. Arrange sleepovers. Have relatives take them for a weekend. If kids are reluctant, start with all day “aways” from early morning to late evening. This helps build self-confidence. If possible, arrange for a friend of your child to go to the same camp. Previous day camp experience may also help.
3. Acquaint kids with the camp that he/she will attend. Talk about it frequently. Arrange visits, if possible. Some camps have videos. Check with the camp director if there is someone who lives near you who has been to that camp or is going to go.
4. Choose a camp that emphasizes your child’s interests. Go over the program. Explain that children can choose activities they enjoy, whether its basketball, arts and crafts, computers, or theater, for example.
5. Have you child participate in preparing for camp. Discuss the list of items that campers are expected to bring, have them accompany you to buy them, and let them choose colors of apparel. Emphasize “fun items” such as flashlights or swimsuits, for example. Let them help attach names to clothing and choose a favorite blanket, toy or doll to take along.6. Make your child aware of the camp’s policy on communication with parents. Depending on how you look at it, policies are draconian and prison-like, or well thought out psychologically. Generally, campers are severely limited in staying in touch: no cell phones, limited emailing/telephone calls, and few or no visiting days. This helps build self-reliance and helps minimize homesickness, say camp directors.
Children away from home/Homesickness
If you send your child to sleep-away camp, especially for the first time, don’t be surprised if after several days you get a call/email from your neophyte camper demanding that you bring him/her home immediately, that you made a terrible mistake inflicting camp on a child who hates camping, and that you are a bad, inconsiderate parent who enjoys making your child miserable. About 80% of children away from home, especially for the first time, whether in camp, on study programs, or visiting grandparents, experience at least some homesickness.
Here is what you should know:
1. Homesickness is neither new, unusual nor limited to children. (Not that this will help you or your camper feel better.) According to Wikipedia, homesickness is mentioned in the Old Testament (Exodus: “By the rivers of Babylon, there we sat down, yea, we wept, when we remembered Zion.”) and in Homer’s Odyssey, whose opening scene features Athena arguing with Zeus to bring Odysseus home…because he is homesick (“…longing for his wife and his homecoming…”).2. Start preparing kids for “awayness” months before camp time. Arrange sleepovers. Have relatives take them for a weekend. If kids are reluctant, start with all day “aways” from early morning to late evening. This helps build self-confidence. If possible, arrange for a friend of your child to go to the same camp. Previous day camp experience may also help.
3. Acquaint kids with the camp that he/she will attend. Talk about it frequently. Arrange visits, if possible. Some camps have videos. Check with the camp director if there is someone who lives near you who has been to that camp or is going to go.
4. Choose a camp that emphasizes your child’s interests. Go over the program. Explain that children can choose activities they enjoy, whether its basketball, arts and crafts, computers, or theater, for example.5. Have you child participate in preparing for camp. Discuss the list of items that campers are expected to bring, have them accompany you to buy them, and let them choose colors of apparel. Emphasize “fun items” such as flashlights or swimsuits, for example. Let them help attach names to clothing and choose a favorite blanket, toy or doll to take along.6. Make your child aware of the camp’s policy on communication with parents. Depending on how you look at it, policies are draconian and prison-like, or well thought out psychologically. Generally, campers are severely limited in staying in touch: no cell phones, limited emailing/telephone calls, and few or no visiting days. This helps build self-reliance and helps minimize homesickness, say camp directors.
7. Reassure your camper that you will be all right in their absence. Some children worry that parents will become ill or possibly die in their absence and will be unable to pick them up when camp ends. Without dwelling on the subject tell them that you will be OK, what you will be doing in their absence, and that you will be eagerly awaiting their return.
8. Inform your child about homesickness. Explain that feeling sad about being away is normal, that it shows that you care about the people, pets, and possessions you miss. Explain that coping on one’s own is important as you get older, and like school, not always fun, but essential.9. Stand firm if you get an SOS call/email. Remain calm. The vast majority of campers greatly exaggerate their distress and cleverly play on your emotions (“if you really loved me, you wouldn’t make me stay here”). But don’t minimize their distress. They need reassurance that you miss them too, and that they will feel better in a day or two. Bribing – “I’ll get you the cell phone or PlayStation you want if you stay” is counterproductive. It does not make them feel better. And they don’t care that there is nothing for them to do at home or that you have to go to work or that you will lose the money you paid for camp.
10. Ask the camp director for his or her take on your child. Generally kids who place SOS calls need and benefit from camp the most; they are slower to make friends and take longer to get involved in activities. Severe homesickness is rare. Such signs include: frequent crying, keeping to themselves, not participating in activities, having a negative attitude, making frequent visits to the nurse, and eating and sleeping poorly. These are signs of depression and should not be entirely ignored. Yet experience show that the vast majority of such campers get over severe homesickness in a day or two, and go on to enjoy camp. Only about one percent of campers leave camp early. Should it happen, don’t make your child feel like a failure. Focus on the positive. Encourage him/her to try again next year.Children/Sunscreens – an update
To protect your kids from the sun it would be helpful if you were a dermatologist and a chemist. If you are not, you should read this article. (Some readers complained that my previous posting, “The sun does to kids’ skin what tobacco smoke does to adult’s lungs was “unnecessarily scary.” Click here to read it. Facts are facts. )
Here’s the latest:
1. There are basically two types of sunscreens, physical and chemical. Physical sunscreens coat the skin with a “shield” blocking out more than 99% of the sun’s harmful rays. This prevents both tanning and burning. Chemical sunscreens penetrate the skin, settle in the deeper layers, and absorb the sun’s rays. This prevents burning but allows tanning. All tanning is skin damage and is unhealthy for children.
2. For children, choose physical sunscreens, ones containing titanium or zinc oxide. These give the best protection and are least likely to cause reactions. Until recently, only messy products were available. But now such sunscreens are “micronized,” making them virtually invisible on the skin. However, “micronizing” creates particles so small that they can penetrate the skin.
3. Use “messy” physical sunscreens in the form of lotions and creams. Most are white in color, allowing you to see that you covered all exposed skin. Apply liberally to areas prone to burning – ears, nose, back, neck, and shoulders. Other forms of physical sunscreens – wipes, powders, body washes, aerosols and shampoos – have various drawbacks. With all sunscreens, avoid getting into kids’ eyes – it can sting. Use appropriate sunglasses. Never use baby oil in the sun; it enhances burning.4. Avoid chemical sunscreens. Common ingredients in chemical sunscreens are oxybenzone, avobenzone and retinyl palmitate, substances that penetrate the skin and can cause allergic and other reactions. Be leery of products labeled “natural,” “organic” or “child friendly.” Many have not been thoroughly tested for safety.
5. Sunscreens with SPFs of 30 suffice. SPFs (sun protection factor numbers) roughly reflect how well products block ultraviolet (UV) rays. SPFs of 30 block 97% of the rays. SPF 50 blocks 98% of rays. Higher numbers may be counterproductive, containing more chemicals for insignificant increases in protection.6. Choose sunscreens labeled “broad-spectrum.” These protect against both ultraviolet A and ultraviolet B. In the past, many products protected only against UVB, the “burning” rays. It was thought that only these rays caused damage. More recent studies show that UVA rays, the “tanning” rays, also cause damage.
7. Sunscreens are not recommended for infants younger than six months of age. Young Infants readily absorb substances applied to their skin, possibly casing toxic reactions. In fact, sunscreens have not been tested on infants. But, if no other means of sun protection are available, sunscreens labeled as appropriate for infants are less harmful than bad sunburns.8. Sunscreens can no longer be labeled “sweat proof” and “waterproof.” All sunscreens eventually wash off. Labels can only claim products are “water-resistant,” and must specify whether they protect for 40 or 80 minutes of being in water. (The sun penetrates about 12 inches of water.) Excessive sweating counts as time in water. Sunscreens that are not water-resistant must state so on the label.
9. Applying the correct amount of sunscreen is difficult – and expensive. Reapply every two hours. Protection is affected by wind, humidity, environmental temperature, and other factors. A one-year old child wearing a skimpy bathing suit requires about two teaspoons per application. A 7-year old, about four teaspoons. There is little correlation between cost and effectiveness of various brands.10. Additional information. Avoid products containing fragrances – they attract bees. Be leery of products promising “all day protection.” Sunscreens marketed for infants cost more but offer only minor benefits. Store in original containers, in a cool place, and out of sunlight. Exposure to certain plastics, heat, and light can affect ingredients. Many sunscreens stain fabrics. When applying both sunscreens and insect repellents, apply sunscreens first, then repellent. If your child takes medications, antibiotics or ibuprofen, for example, check with your pharmacist or on the web if the two are compatible. Some medications amplify burning.
THE SUN DOES TO INFANTS’ SKIN WHAT TOBACCO SMOKE DOES TO ADULT’S LUNGS
1.The younger the child, the greater the risk. Young children burn rapidly. Their skin contains less melanin to neutralize the sun’s rays. Severe sunburns early in life increase the chances of cancer in later life. Children spend much time outdoors and with increasing longevity have ever more years of exposure ahead of them.2. Rethink your approach to protect children. Existing information, if used consistently, can reduce the risk of sun-related skin cancer by about 80%. There is no such thing as a healthy tan. Tans do not reflect vigor and fitness. Each tan is a mild sunburn and contributes to lifetime damage. Tans provide little protection from subsequent sunburns.
3. Think sun protection every time children go outside. Children less than six months of age should have no sun exposure. Cool weather does not lessen the intensity of the sun. Have an umbrella on your stroller. Minimize outdoor activities between 10 AM and 4 PM. Consider buying a “pop-up” stroller shade with built-in ultraviolet (UV) ray protection. These shades fit over your stroller’s canopy.4. Protection at the beach is especially important. A white cotton T-shirt has a sun protection factor (SPF) of about 7 when dry and 5 when damp; generally, wetness reduces protection by about one-third. (An SPF of 15 is considered minimum protection.) A dry, white polyester polo shirt has an SPF of about 31, but when stretched across the shoulders its SPF drops to about 10.
5. “Sun-proof” clothing is the best defense. Such garments that are reasonably comfortable in hot weather are available. Check the web, stores selling clothing for camping/ outdoors, and, increasingly, stores that sell regular clothing. Many garments have labels stating their SPF number, are loose-fitting, lightweight, come in popular colors, are well vented, dry rapidly when wet, and have SPFs of 50 or more, blocking virtually all damaging rays.
6. Any old hat won’t do. Some straw hats have SPFs of less than 6. Baseball caps shield the forehead and part of the nose from the sun but not the lower face, ears, and neck. Ideally, hats should have a four- to five-inch brim extending around the entire head. But even such hats do not shield the face from UV radiation reflected up from water, sand, concrete, and white-painted surfaces.7. Many vacation-linked activities increase sun exposure. More time is spent outdoors, sometimes at higher altitudes or at beaches. The higher the altitude, the stronger the sun; there is less atmosphere to filter out the damaging rays. Winter vacations in the tropics are sun-intensive. Tans from the previous summer that may provide a small degree of protection are gone, making skin especially vulnerable to rapid burning. About 70% of UV radiation penetrates the top 12 inches of clear water, making swimmers’ backs vulnerable.
8. You need not see the sun to get burned. Sitting in the shade of a building with the sky visible above provides far less protection than sitting under a large, leafy tree. Fluffy white clouds reduce radiation merely 20%. Large beach-type umbrellas are helpful – depending where they are placed. White sand reflects about 50% of the radiation. Water reflects up to 80%. Such radiation is additive to direct radiation. Ideally, sit on ground covered by grass or dirt.
9. Kids with dark/black skin also need protection. While their incidence of sun-related skin problems is low, damage does occur. (Moreover, later in life, problems are rarely looked for, and, if they occur, are more difficult to detect.)10. Remember the sun when driving. Your infant may be in the shade when you start out but your car’s relationship to the sun changes during a trip. Check if your car’s windows screen out UV radiation; some do, others do not. If not, consider removable mesh window shields that do.
Next issues: Using sunscreens correctly; sunglasses for infants.
Hi KidsTravelDoc Reader:
Our website has had a face-lift! (NO, we are not asking for money, so read on!)First, thank you for reading KidsTravelDoc, the source for keeping kids healthy and safe for travel and outdoor recreational activities. We have more than 8,000 subscribers worldwide. And some pediatricians, parents’ groups, and others re-post KidsTravelDoc on their websites, helping us reach more readers.
Hopefully, you’ll agree that our face-lifted website is easier to read and makes it easier for you to locate specific topics. And we’ve added new features. This issue provides A Healthful Hint, a short tip on a single topic: preventing kids from being poisoned accidentally by their grandparents. (Yes, you read that correctly.) The tip is below.
We welcome your feedback and ideas. Please send suggestions to travhealth@aol.com . And, if you wish, provide email address(es) of friends who may enjoy receiving KidsTravelDoc. (We never share/sell email address.)
Thank you for providing me with an audience and allowing me to remain involved with my major interests: medicine, children, journalism, and travel.
Karl Neumann MD, FAAP, CTM
Over the past month we’ve had readers from several different countries including:
- Australia
- Indonesia
- Russian Federation
- Austria
- Ireland
- Singapore
- Bhutan
- Israel
- Slovenia
- Bolivia
- Jamaica
- South Africa
- Bosnia /Herzegovina
- Japan
- Spain
- Canada
- Korea
- Sweden
- Chile
- Latvia
- Taiwan
- China
- Malaysia
- Tanzania
- Cyprus
- Mexico
- Thailand
- Egypt
- Netherlands
- Uganda
- Ethiopia
- New Zealand
- United Arab Emirates
- France
- Norway
- United Kingdom
- Germany
- Pakistan
- United States
- Greece
- Philippines
- Vietnam
- Hong Kong
- Poland
- Zimbabwe
- Hungary
- Puerto Rico
- India
- Qatar
A Healthful HintRemind grandparents to lock up their medications before you send your kids to visit them. In a recent survey by poison control centers, about a third of the calls regarding accidental poisoning in young children came from grandparents.
An increasing number of grandparents are the primary babysitters for their grandkids or take the grandkids for weekends or for travel. Grandparents are at the age when most people take medications, and they have no need to lock them up – until the grandkids arrive. Also, remind grandparents to secure their medications when visiting you. They often carry medications with them and may accidentally leave them where children can find them.
Children/Air Travel/Ear infections/Prevention/Treatment
Should children fly with ear infections and colds?
1. No studies exist to help you make the decision. While saying “no” is prudent, doing so ruins long planned family trips, often unnecessarily. Worse, sometimes it strands families on vacation. The scenario: An infant is cranky and has a fever or an older child complains of an earache. They are seen at a medical facility, a diagnosis of ear infection is made, medication is prescribed, and a delay in air travel is recommended. The delay recommended may be until the pain/temperature subsides, or until a course of antibiotics is completed, which may last five to ten days.2. Ear infections are greatly over diagnosed. Especially in emergency care clinics, the kind often found in resorts. Infants/children are often seen by personnel with limited experience in examining screaming, struggling young children, in removing wax from the ear canals to visualize the ear, and in deciding if there is an infection. In order not to miss infections, inexperienced personnel tend to treat.
3. Air travel-related ear pain is quite common. The source: the Eustachian tube, which connects an air space in the middle ear with the back of the nose. Normally, air passes freely from the air space through the tube and nose to the outside. Problems arise when the tube is blocked by mucus from colds (common in kids) and you fly. As airplanes ascend and descend, air pressure changes. During ascent air, including the air in the middle air expands. The increased volume of air has no place to go. This exerts pressure (pain) on surrounding tissue. During descent, the air contracts, creating a vacuum in the middle ear. The vacuum sucks in surrounding tissue causing pain. The vacuum is more forceful than expansion, hence pain occurs more frequently and is more severe during descent than ascent.4. Ear infections decrease the risk of ear pain during flight. Infection tends to fill the middle ear with pus/fluid, leaving no air to expand/contract, hence no pain. Children with aerating tubes in their ears (to prevent infections) can also fly safely. These tubes connect the middle ear with the outside through the ear canal, bypassing the Eustachian tubes and neutralizing pressure changes.
5. Ear pain during air travel does not appear to cause permanent ear damage in children. It may do so in adults who have other medical issues. Tens of millions of children fly annually. Yet surveys of hundreds of pediatric ear specialists, airline physicians, and pediatricians found no one who was aware of a child whose ears were permanently damaged by ear travel. However, this does not prove it never happens. But if it does, it is an extremely rare event.6. When infants cry during flight, is it because their ears hurt? Older children complain of earaches during air travel, so presumably infants also experience pain. Their Eustachian tubes are narrow making blockage by mucus more likely. But, in fact, surprisingly few infants cry, considering that air travel disrupts their sleep and feeding schedules, they rest in unfamiliar and often uncomfortable positions and, if they are on a parent’s lap, are disturbed every time the parent moves. They do seem to cry more frequently during descent when ears are more likely to hurt, but that is also the time they are most likely to be disturbed.
7. Conventional wisdom says to feed infants during ascent and descent, and often during flight. Such “wisdom” is both true and false. Sucking does help to keep Eustachian tubes open. However, at cruising altitudes the air in the stomach and intestine is already expanded by 20%, the result of air pressure changes. (This is what gives many adults a bloated feeling.) For infants, sucking adds more and unnecessary air and food to the stomach, which may cause fussiness and crying. Feed infants no more often in flight than at home.8. Many commonly used remedies given to children are of questionable usefulness. Oral antihistamines to reduce nasal secretions/congestion are no longer recommended for children under any circumstances. Nose drops/sprays and drinking lots of fluids to loosen secretions and unplug Eustachian tubes are ineffective in children.
9. Preventing ear pain. Pain most commonly occurs during descent. Note that descent may commence before the captain announces it. Ask flight attendants to inform you when descent begins. Keep infants awake during landings. Sleep reduces the frequency of swallowing. Acetaminophen (Tylenol) or ibuprofen (Motrin, Advil) reduces pain. Give about 30 minutes before descent if your child has a history of ear pain while flying.10. Treating ear pain. Administer acetaminophen or ibuprofen. Teach children the Valsalva maneuver: blow firmly, as if blowing your nose, while pinching your nostrils and keeping your mouth closed. Repeat several times. Encourage children to swallow. Older children can chew gum, suck on hard candies, yawn, and move their jaws from side to side, maneuvers that may help open the Eustachian tubes.
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