Kids Travel Doc
A Pediatrician's Guide to Travel and Outdoor Recreational Activities
Seasonal Affective Disorder in Children
A larger dose of sunlight is the antidote for kids who become especially ornery as winter approaches and the hours of daylight dwindle down to a meager few.
1. Sunlight helps minimize being sad and having SAD. Sad (small letters) is having the “winter blues.” SAD (capital letters) stands for Seasonal Affective Disorder, a more serious form of the winter blues. Until recently this condition was regarded with skepticism by mainstream mental health experts. No more. Evidence suggests it does exist – more so in adults but also in children, even young children.
2. The winter blues is feeling gloomy much of the time. Sufferers have less energy and difficulty concentrating, become irritable more easily, need more sleep, and take longer to get up in the morning. In younger children, crankiness and crying spells may occur more often.
3. People with SAD have various degrees of depression. In severe cases, SAD is a debilitating condition, preventing sufferers from functioning normally in their personal and school or professional lives.
4. Seasonality of the symptoms makes the diagnosis. Commonly, symptoms begin in the late fall, become worse as the days grow shorter, peak in January or February, and begin to wane in March and April.
5. The severity of symptoms depends on an individual’s sensitivity to decreased light. The process is complex and poorly understood, involving the body’s sleep/wake cycle, hormones and many other factors. Light enters the body mostly through the pupils of the eyes and then travels to specific points in the brain. The process may be akin to that which causes winter hibernation in some species of animals.
6. The further north you live, the more common the condition. In Canada, Finland, Ireland and the northern United States, 6% to 8% of the population is affected – up to 15% to 20%, if very mild cases are included. While winter blues and SAD occur predominantly in adults, in the United States alone more than one million children are believed to be afflicted. Winter blues and SAD are not seen in the tropics. And cases are rare in the Southern Hemisphere where few people live where winters are long.
7. Winter blues and SAD are more difficult to diagnose in children. Symptoms tend to be milder and, since they occur in the winter months, are often blamed on school-related issues. Signs include being frequently late for school, having difficulty doing homework, experiencing grades dropping as the winter progresses, and avoiding social interactions.
8. An hour of exposure to daylight helps alleviate symptoms. Direct sunlight is best, but overcast daylight is also helpful. Have children walk to school and ask teachers to seat them near windows in classrooms. Let them participate in outdoor winter activities after school and do their homework after dark. Around the house, keep curtains open during the day. Trim tree branches that block light. Place chairs near a window. Rarely, cases may need professional counseling.
9. Electric devices are available which emit specific artificial light to supplement natural light. Learn safety precautions – how far a child should sit from the light, for example. Generally, 30 to 60 minutes of exposure daily relieves symptoms. Rarely, cases may need professional counseling. A good discussion on light therapy is available at the Mayo Clinic.
10. SAD may help explain the popularity of winter vacations in the tropics. People who enjoy such vacations generally give “relaxation” as the main reason. In fact, unknowingly, they may feel better because of longer hours of daylight with plenty of sunshine. However, such “cures” are usually temporary. Symptoms generally reappear soon after vacationers return home.
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Why Travel With Your Children?
Traveling and vacationing with your children are prudent investments into their developing self-assurance.
To write this article, I went to Google (where else?) and typed in “Benefits of family travel.” Within .57 seconds I had a whopping 680,000,000 results. (Full disclosure: not surprisingly, I did not read all the results!) I did scan well over a hundred and read several dozen. Some entries were from scholarly journals; most were practical opinions of pediatricians, teachers, psychologists, travel professionals, and parents.
Here some informative entries:
> Family travel teaches children one important lesson: how to travel. Travel is an ever more important aspect of life and a skill never formally taught. Each year, millions of children travel as “UMs” (airline parlance for unaccompanied minors). We send older kids on teen tours, to visit relatives, and to go to college. Comfort with and willingness to travel often helps adults to compete in the job market.
> The age at which most children will remember traveling is around five years. However, traveling with younger children does have benefits. For example, when they become older, showing them pictures of where they were and what they did makes them feel that they were already part of the family.
> Often, we tell older children that travel to new places will help them see the differences between here and there and us and them. However, the more you travel with kids, the more they begin to see the similarities between cultures and people. When this happens, tolerance and acceptance grow while fear and mistrust start diminishing.
> In a survey conducted in Britain, adults were asked what their happiest childhood memories were. Forty-nine percent said, family vacations. Moreover, about a quarter of the respondents said that those memories helped them get through hard times. Reflecting on joyful times spent together can be extremely powerful in bringing relief when faced with the darker times in life.
> Coordinate your traveling with children’s recent book learning – it literally brings schooling to life. Visit historic sites, seats of government, different cultures, farms if you are a city dweller, and cities if you live in rural areas, for example.
> Don’t fret when children find historical-type destinations “boring” and they tell you that they would rather be swimming. In fact, such places tend to leave positive and lasting impressions. Often later on, you can hear them telling (or boasting to) friends and teachers where they have been.
> Family travel has all kinds of positive attributes for children. However, where you have traveled and vacationed is often used as a sign of snobbishness, especially with millennials. Travel is a more acceptable topic of conversation than other signs of snobbery such as where we live, the cars we drive, and where we went to school.
> Travel and vacationing help children develop their brains, says a psychotherapist. Families together in a pool, walking in the forest, touching tall grasses waving in the wind, or feeling sand between their toes, for example, produce strong social, physical, cognitive, and sensory interactions. Such experiences turn on the “genetic fertilizers” in the frontal lobes of the brain. This enhances functions like stress regulation, attention, concentration, the ability to learn, and improving physical and mental health.
> Never measure the success of vacations by their costs or by how far from home you traveled. More important is how vacations differ from everyday life. My family spends vacations at upscale resorts in the Caribbean and Hawaii. In contrast, I grew up poor. Every summer, my parents pitched a tent next to a small pond in a wooded area behind our home, just out of sight of the house. For a few days we slept in the tent, cooked our meals there, and swam and played with family who came to visit. We went indoors only to use the bathroom. I greatly respect my parents for the vacations they provided me.
> Traveling helps children learn patience. In life, unexpected events are common. When traveling, such events include dealing with bad weather, changes in eating and sleeping patterns, lines at airports and dealing with long car rides – all in the name of having fun. Children, with parents’ help, tend to learn creative ways to occupy their time.
> Family vacations promote curiosity, independence, self-confidence and interpersonal skills. This is further enhanced by the fact that vacations increasingly involve multi-generations: children-parents-grandparents, children-grandparents, or extended families. (Another plus: the grandparents often pick up the tab.)
> Traveling with the family is a gift that keeps giving, returning huge dividends.
(See, “How to plan successful family vacations” at http://kidstraveldoc.com/will-family-vacations-ever-be-all-fun-and-games/ )
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Kids and the Great Outdoors
Kids Playing Video Game Hey, parents! It is time to pry your kids away from their TVs, video games, computers and smart phones – forcefully, if necessary. Ignore their yelling and sarcasm. Then kick them out the front door – literally, if need be. If older kids threaten to report you to child welfare, call their bluff: according to experts, the current cure-all for practically everything that ails kids is merely spending more time in the great outdoors.
1. While wondrous cure-alls come and go, this one is backed by impressive credentials. They include the Harvard Health Letter, The Centers for Disease Control and the American Academy of Pediatrics (AAP), to name just a few. A few of quotes from such organizations: “Letting your children ‘go alfresco’ helps them grow up healthy.” “Children have become ‘dis-connected’ with the outdoors, resulting in physical and mental issues – call it ‘the nature-deficit’ syndrome.’”
2. Do organizations with impressive credentials always get it right? Not necessarily. In fact, some of the support for equating the outdoors with heaven is not based on traditional, evidence-based research. However, the philosophy is worth listening to – while remembering that we tend to exuberantly embrace simple, safe and free cure–alls that promise better health for our children, especially cure-alls that have virtually no known downside. Only time and research may uncover challenges to the current adulation of alfresco.
3. Today’s children are “screen bound.” “The nature of childhood has changed and there isn’t much nature in it.” “Screen time” rates are higher than ever. Children between the ages of 8 and 18 spend half as much time outdoors as they did 20 years ago. On average, preschool children spend 32 hours a week with screen media. The AAP recommends that kids under the age of two years have no screen time, and those older than two watch 1 to 2 hours a day, preferably quality programming.
4. The worst sedentary activity is TV-watching. Children who spend their indoor time watching TV have higher blood pressures than those playing electronic games, involved with computers or texting. TV-watching involves no movement on the part of the child and is often associated with eating, generally foods high in salt and calories.
5. Children are more active outdoors. While kids need not be outside to be active and being outside is no guarantee of activity, indoor living is associated with being sedentary. The younger children start active outdoor recreational play, the more likely they will find ones they enjoy and will continue them as adults.
6. “Green” outdoors may be the best outdoors. Spending time surrounded by trees, grass and plants is superior to being amid buildings, concrete and artificial turf, with the wilderness being the ultimate outdoors. Five minutes of green exercise a day results in improvements in self-esteem and mood. A window view of trees helps hospital patients recover faster than a view of brick walls.
7. Activity should be sufficiently intense to increase heart rates. Brisk walking, biking, or “running around,” for example, have beneficial effects on muscle strength and endurance, bone and cardiovascular health, concentration, memory, and classroom behavior. Children with attention deficit disorders scored higher on tests of concentration after walking through natural surroundings than those walking through residential neighborhoods or downtown areas. Children living in greener neighborhoods maintain lower average body weight.
8. Some children need coaxing to enjoy the outdoors. Others take to it “naturally.” Parents should expose children to various activities, ones appropriate for their ages. Look for activities provided by after-school programs, park departments and neighborhood organizations. Structured play times and activity-friendly environments are conducive to enjoyment. Ideally, children should spend at least one hour a day outdoors.
9. “Nature time” may help family bonding. The natural world seems to invite and facilitate parent-child connection and sensitive interactions. What better way to escape the constant, interrupting beeping of modern life, than spending concentrated time with your child during a walk in the woods?
10. Nature time may be especially important when colder weather tends to keep kids indoors. Less sunshine may cause both “sad” and “SAD”. Sad (small letters) is having the “winter blues.” SAD (capital letters) stands for Seasonal Affective Disorder, a more serious form of the winter blues. Sufferers, including young children, have less energy, difficulty concentrating, become irritable more easily, need more sleep, and take longer to get up in the morning. In younger children, crankiness and crying spells may occur more often. Our next posting, in about two weeks, will be an in depth review of SAD in young children.
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Is global warming harming our children?
Children are in the crosshairs for climate change, says the American Academy of Pediatrics. They are especially susceptible to toxins in the environment and to many of the infectious diseases that spread more readily as the weather becomes warmer.
1. Rising global temperatures decrease air quality. Children spend more time outdoors than adults, breathe in more air per weight, and, due to their age, have more years to breathe in toxins. The toxins, mostly carbon dioxide, emanate from fuels used in cars and power plants. They cause wheezing, coughing and can damage lungs. The younger the child, the more hazardous the toxin.
2. Higher environmental temperatures increase the length of summers. This prolongs the growing season and broadens the geographic area for allergy-causing plants, ragweed, for example, increasing the incidence and severity of allergies and some forms of asthma.
3. Forest fires are especially harmful. They emit fine particulate matter over a much larger geographic area than covered by visible smoke. Global warming increases the number and severity of fires by decreasing rainfall and drying out the underbrush which helps spread fires. The tiny particles reach deep into the lungs. Childhood exposure is associated with decreased lung function, more severe asthma, and chronic bronchitis.
4. The incidence of waterborne infectious diseases will rise. Infectious diarrhea, for example, spreads largely via bacteria, viruses and other microorganisms, found mainly in sewage. The incidence of such illnesses increases following severe storms and floods. (Both drought and floods are associated with climate change.) Increased sewage from runoffs can overwhelm sewage disposal plants, allowing sewage to leak into fresh water reservoirs and into land where vegetables grow.
5. The incidence of insect-transmitted diseases also increases. Warm, standing water from excessive rainfall and flooding creates additional breeding grounds for insects. Milder winters kill fewer insect eggs, allowing the numbers to increase cumulatively every summer. While most insects are merely annoying, some carry potentially deadly organisms which cause malaria, Zika, West Nile, Lyme and dengue, for example.
6. Long-term effects. As atmospheric carbon levels increase, common crops contain less protein and vital nutrients, iron and zinc, for example. Lack of such nutrients impair immune systems, cause cognitive issues, anemia and diarrhea, to mention just a few. Children from poor socioeconomic communities are especially at risk; more likely to suffer from these deficiencies and less likely to have access to dietary supplements to correct them.
7. Complex interactions of climate-warming factors affect young children. Studies suggest that children who spend less time outdoors (to avoid toxic air, for example) exercise less, eat more and are more likely to become overweight and obese. Also, worrisome are the possible effects on developing brains from chemicals necessary to eradicate insects. Likely, both the microorganisms that cause the disease and the insects that transmit them will become more resistant to chemicals used in insecticides. This will require ever more potent chemicals to be used. Some of these chemicals may harm fetuses’ brains when inhaled by pregnant women.
8. Additional factors to consider. “Fracking,” for example, pumps large amounts of chemicals into the ground to extract relatively cheap gas and gasoline. Great for our economy, but possibly harmful for our children. These fuels result in more toxins in the air. Moreover, fracking delays the development of other sources of energy, clean wind and solar power, for example. And some of the chemicals used in fracking may be toxic for the development of children’ central nervous systems.
9. Casualties from global warming-related disasters are usually much greater than stated. Most reports include only immediate deaths and injuries, stemming from drowning, mudslides, falling trees, and the collapse of houses. Not included is the toll from the subsequent lack of electricity, for example. Power outages make healthcare facilities (if, indeed, they survive the disaster), sewage disposal plants and refrigeration virtually useless. People, especially children, become ill and some die from diarrheal diseases from drinking polluted water and eating spoiled food, or from asthma since their ventilators no longer function. Death rates calculated months after disasters are generally much greater than those calculated in the first week.
10. Many young children experience emotional problems from the social turmoil surrounding natural disasters. Children are confused by such events, experience feelings of stress, fear and anxiety, akin to depression and post-traumatic stress syndrome. Especially at risk are children with previous exposure to trauma or pre-existing emotional, developmental, or behavioral disorders.
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Hand washing for children is no longer child’s play
Hey kids, are your parents bugging you about hand washing? Join the club. Some hotshot experts say that many illnesses kids get come from germs on their hands. And they are right. Proper hand washing is important. That means following a long list of do’s and don’ts about soaping, rinsing and drying. What a nuisance! But a lot better than having colds, diarrhea and other icky illnesses.
Here’s what you should do:
1. Ask your parents to set up a child-friendly hand washing station. You may need a slip-resistant stepstool, easily accessible and easy-to-use faucets, soap (preferably liquid), and your own towel. You pick the color of the towel. (In the old days, no one took hand washing so seriously. Some kids just turned on the faucet and fooled around for a minute while the water ran. Often, hands never got wet and soap remained untouched. It wasn’t smart. Lots of kids got sick.)
2. Wash your hands under running water. Teach your parents that washing in sinks or basins of standing water may re-contaminate your hands. Turning faucets on and off between different phases of washing saves water and does not significantly contaminate faucets. Warm water is no more effective than cold water. Water sufficiently hot to kill germs can irritate your hands.
3. Soaping and vigorously rubbing your hands together separates dirt and germs from your skin. Rinsing washes the mess away. So, completely cover your hands with soap lather. Include between your fingers. Then firmly rub your hands together for at least 20 seconds. If you can’t tell time yet, sing “Happy Birthday” twice. (Sing slowly, not as fast as you can.) Then rinse well with running water until all lather is removed.
4. Sometimes nasty germs hide under your nails. Remind parents to keep your nails short, making it easier to clean them. Ask your parents to get you a colorful, easy-to-grip, animal-shaped nail brush. They’re easy and fun to use. Brush nails daily.
5. Ideally, use liquid soap. Child-friendly dispensers are available. Many toddlers are not good at using bars of soap. However, for everyday purposes, soap bars are just about as effective. While soap bars may retain some germs from previous users, this is not a problem if you rinse well. Soaps marketed as “antibacterial” and “antimicrobial” are unnecessary for routine hand washing.
6. For situations when soap and water are unavailable, your parents should carry hand sanitizers containing at least 60% alcohol. Use it at the beach, between you digging in the sand and eating your hotdog, for example. Such sanitizers are almost as good as soap and water when you cover all parts of the hands. Rub hands and fingers together until hands are dry. (Remember “Happy Birthday.”) Re-wash your hands with soap and water when those become available.
7. Approved sanitizers are safe for kids. But avoid getting them into your mouth. Accidentally licking your fingers after a sanitizer is applied is OK; ingesting more is unhealthy. If that happens, tell your parents to call your Poison Control Center. In the US, the number is 1-800-222-1222. (Rarely, teenagers drink sanitizers for their alcohol content. Not a good idea.)
8. Moistened, packaged wipes are not substitutes for sanitizers. Ads claim that such wipes are great for kids’ skin: non-alcoholic, hypoallergenic, and able to kill 99%-plus of germs. However, all that wipes reliably do is get rid of visible dirt, not disease-causing germs, if they happen to be present (like after digging in sand). If alcohol-containing sanitizers make you hands feel dry and itchy, ask your parents to apply aloe-containing cream.
9. And kids, your hand drying techniques really need improvement! Shaking your hands in the air or wiping them against your clothing may leave moisture on your hands. Germs love that. They eat moisture up and thrive. Dry hands until they are really dry. Use single-use, disposable paper towels, when available. Reusable cloth towels, especially when slightly moist from a previous user, also may spread germs.
10. Miscellaneous. Kids: if you are three years old, chances are that you can wash your hands on your own… Remember to use good handwashing techniques everywhere, not just at home… In public restrooms, use a disposable towel to turn faucets on and off and to open doors as you leave… Tell your parents that fun picture books are available online to help make you an expert handwasher… And check out CDC’s Hand Hygiene Guideline for Children
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Helping young children adjust to the heat of summer
Outdoor temperatures are soaring this summer. Children less than four years of age adjust poorly to heat. So how do you keep the little ones hale and hearty?
1. Young children produce more heat per body mass, perspire less, and dehydrate more rapidly and more severely than older children and adults. Perspiring helps the body shed excessive heat. Moreover, hot environments tend to make children cranky, listless and reluctant to drink.
2. Start offering children extra drinks hours before exposure to heat occurs. Encourage them to drink but never force them; that may cause vomiting. If children are happy and active let them decide how much they want to drink. Offer fluids often; every fifteen minutes if necessary. No need to give them sports drinks or electrolyte solutions at this point; plain water is fine. Cold drinks do not appreciably cool children’s bodies.
3. Air conditioning (AC) to the rescue! Not only does AC lower indoor temperatures but, equally important, it decreases humidity. High humidity impedes perspiration. And forget the “new” old wives’ tales about AC: no one becomes sick from going in and out of AC or having cold air blow on them.
4. When AC is not available, cool kids using old-fashioned ways. Fans help cool bodies by reducing skin temperatures, which helps promote perspiration. Fans do not cool rooms and the higher the temperature the less effective fans become. Pools, sprinklers and lukewarm baths help lower body temperatures. Wrap children in lukewarm towels or sheets, if necessary. In some neighborhoods cooling centers open in hot weather.
5. Check the heat index (HI) before going outdoors. The HI calculates how the combination of air temperature and humidity on a given day affect our bodies. The data is placed into one of four categories: Caution, Extreme Caution, Danger and Extreme Danger. (See the table at the end of this article.) Readings are available daily for every zip code. See US National Weather Service at https://www.weather.gov/safety/heat-index A very high HI may be reason to stay indoors or shorten the time spent outside.
6. Young children tend to eat less in hot weather. But so do adults. This is not a problem. Neither is what type of food you give to children. Diet plays little role in staying cool. While fruits and vegetables contain more liquid than foods high in fats and protein, the difference is negligible, especially with the small portions young children eat.
7. Dress children in lightweight, light-colored, loose-fitting cotton garments. Loose-fitting shirts allow wind currents to remove heat from the skin and absorb perspiration. This helps cool the body and helps prevent heat-related rashes. Avoid sunburns. (See my article on sun-protective clothing at http://kidstraveldoc.com/sun-protective-clothing-has-gone-high-tech/)
8. In hot weather, assume that all signs of illness are heat-related. Regardless of the cause of the illness, the early treatment is the same: offer additional drinks and find air conditioning. If symptoms worsen, call your pediatrician or pediatric nurse practitioner. Ask whether it’s time to give electrolyte solutions or seek further medical assistance.
9. Choose tropical vacations with young children in mind. Consider avoiding extremely hot and humid destinations. Children may take a day or two to acclimatize. Increase fluids on arrival and limit time spent outdoors during this period. While serious problems are quite rare, check that your cellphone is operable and that there is a local, readily accessible medical facility, just in case.
10. Other considerations. Some baby carriers and car seats are made of heavy fabrics that increase the heat surrounding infants… Chronic illnesses and certain medications may make young children more susceptible to heat-related illnesses… Little is known about the benefits, if any, of “natural” cures (coconut water, for example).
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