Dr. Karl Neumann's KidsTravelDoc
A pediatrician's guide to travel and outdoor recreational activities
Sunglasses for young children: there is a lot for you to know
Consider making your next baby gift a pair of sunglasses – a gift that is thoughtful, unique, practical, a gentle reminder for new parents to start sun protection early, and, hopefully, a trendsetter that others will follow.
1. Infants’ eyes absorb more harmful ultraviolet (UV) rays than adults. Infants have relatively large pupils, allowing more light to enter. And their lenses contain less pigment to absorb radiation. Moreover, infants tend to look directly into the sun – though reflexes quickly make them blink and look away. Children with fair complexions are especially vulnerable.
2. Children spend more time outdoors than adults. We get a large percentage of our lifetime sun exposure by the time we are eighteen years old. While about 80% of parents acknowledge the importance of wearing sunglasses, more than half of children seldom or never wear them. Damage is cumulative over a lifetime, causing cataracts and other eye problems later in life.
3. Sunglasses and certain hats protect eyelids and skin around the eyes. These areas have delicate skin and burn easily. Using sunscreens is impractical: children won’t hold still for you to apply it, and spray products are not recommended for the face due to risk of inhalation. Sweat, tears, and water can cause sunscreens to seep into eyes, causing burning. Use sunglasses with large lenses and that wrap around toward the ears. This prevents rays from coming in around the glasses. Dress children in sun-protective hats with brims at least three inches (7.5 centimeters) wide and that extend around the head.
4. Sunglasses also protect eyes from injury. Choose ones that are impact-resistant, made of shatterproof polycarbonate, not glass, and have flexible frames. Such frames are less likely to be damaged when children play with them or leave them where they can be stepped or sat on. Impact-resistant glasses are recommended for sports.
5. Be aware of unusual sun exposure. This can occur in cars, for example. Side and back windows may not protect against all radiation. Ask your car dealership about the option of installing transparent UV-blocking window film. Note that the sun may come from different directions as you drive. Check where the sun is when you carry an infant on your shoulder or back. Sunshields are available for strollers and carriages. (Skin- and eye-damaging UV rays may also penetrate window glass in homes, trains, buses and planes.) Infants less than six months should have no sun exposure.
6. Buy sunglasses from reputable stores that sell eyeglasses. Beware of “fun” or “novelty” sunglasses. These are mainly marketed for children’s entertainment or “self-esteem,” or so they can make a “fashion statement.” Such sunglasses are widely available on the web and at variety stores at beaches; they offer little or no UV protection. Rarely such glasses, especially ones with wide frames, may contain lead.
7. Special features to look for. All sunglasses should block 99 to 100 % of UV rays. Children’s sunglasses come in various sizes. (One size fits all adults.) Labels generally state the age range for the glasses. Comfortable fit on the nose and around ears makes children less inclined to remove them. Straps help keep glasses in place – and help prevent loss. Dark lenses are no more protective than light ones; protection results from treatment of lenses. Replace glasses when they become scratched. Good sunglasses need not be expensive. Cost mostly reflects frames, not protection. Polarized lenses reduce glare making wearing them more comfortable. Avoid heavy frames to minimize possible discomfort.
8. Being in the shade of a building while having blue sky directly overhead offers little protection. This is also true of fluffy clouds. Being under a beach umbrella protects from direct sunlight but allows considerable radiation reflected from water and sand. Dirt, grass and concrete reflect comparatively little radiation. Minimize outdoor activities between 10 AM and 2 PM when radiation is most intense.
9. Winter days in snow country are as harmful for eyes as summer days at the beach. Snow reflects up to 85% of direct sunlight; this is additive to the direct sunlight. Many winter activities take place in snow-covered hilly terrain, adding radiation from different angles. Modern winter clothing allows more time spent outdoors. Altitude increases radiation; the higher the elevation, the less atmosphere to filter out harmful rays. Cold weather and the sun low on the horizon offer little protection. Many experts recommend wearing sunglasses year-round when spending extended periods outdoors.
10. Getting young children to wear sunglasses can be a hassle. Most young children seem to enjoy them; they make everything appear more colorful. Other children are hesitant. Try various doses of age-appropriate patience, coaxing, compliments, flattery, rewards/bribery and firmness (e.g., a “no going out without them” rule). Have periods daily when all family members wear sunglasses. Point out other children wearing them. Let older children pick out their own pair. Some children, especially children with special needs (ADHD or autism, for example) may be fearful of sunglasses. Check the websites of organizations devoted to such conditions for tips to help you manage.
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Facts you may not know about protecting your children from the sun
Little darlings, it’s been a long coronavirus winter
Little darlings, it feels like years since the sun ‘s been hereLittle darlings, I feel that the ice is finally melting
Little darlings, it seems like years since the sun ‘s been hereLittle darlings, the smiles are returning to children’s faces
Here comes the sun, here comes the sun, and I say, it’s all right…The Beatles (with editing)
Yes, here comes the sun, and, yes, it is all right – children need to go outdoors to end our winter of discontent – as long as you protect your little darlings from that fireball up in the sky.
1. June is the month when sun protection is often overlooked. The weather tends to be cool, but the sun is directly overhead and shines the most hours. Don’t let cool weather lull you into complacency. Temperature has nothing to do with the sun’s intensity. Also, in June, protective tans from the previous summer have vanished, possibly leaving children more vulnerable to burning. Not that tanning is a panacea. Every tan is skin damage and it is cumulative over a lifetime.
2. The basic concept for using sunscreens is often misunderstood. Sunscreens are not intended to prolong the amount of time that children (and adults) can safely remain in the sun – though in practice this is what often occurs. Sunscreens are meant to protect skin when sun exposure is important, for playground activities, for example, with the place and time of day chosen to minimize exposure.
3. Most experts recommend physical sunscreens for children. These contain zinc or titanium as the active ingredient. They coat the skin, prevent tanning and can be applied just prior to sun exposure. Chemical sunscreens are recommended less often. They contain various chemicals as active ingredients, may permit some tanning, are effective by being absorbed into the skin, and must be applied 20 minutes before exposure. Some of the chemicals may enter the blood stream. This is presently under study as being a possible health issue.
Most parents apply far too little sunscreen and apply it too infrequently. Check labels for how much (often in tablespoons) is needed to cover children of different sizes. Generally, sunscreens with SPFs of 30 are adequate. Using white colored sunscreens helps prevent skipping areas that need covering. The degree and duration of protection is reduced by wind, water, towel drying, and excessive perspiration, for example. Sunscreens should protect against both UVA and UVB radiation.
4. Consider using sun-protective clothing. Such garments cover most of the body, including much of the head, the ears and the back of the neck. This greatly reduces the need for sunscreens. The clothing is lightweight and allows air to circulate, keeping the wearer relatively cool. A rating system, ultraviolet protection factor (UPF), describes the clothing’s effectiveness. The higher the UPF, the greater the protection. Fabrics rated below UPF 15 are not considered protective. UPFs of more than 50 add little additional protection.
5. Infants less than one year of age should be kept out of the sun – with one exception. Infants’ skin is thin and contains little melanin, the substance in the skin that protects from the sun. However, if sun exposure is unavoidable, using sunscreens is safer than risking sunburns. Use the same protective measures as used for older children.
6. No need to purposefully expose children to the sun to maintain healthy bones. True, the sun activates Vitamin D, which is necessary for the body to absorb calcium from food. Calcium is essential to grow healthy bones. However, the time in the sun necessary to absorb Vitamin D is minimal – even when sun-protective clothing is worn. Many foods are fortified with vitamin D.
7. Waterproof sunscreens have yet to be invented. All eventually wash off, usually sooner than later. In the US, products can no longer be labeled “waterproof” or “sweatproof;” they can be called “water-resistant.” Labels are required to state whether the sunscreen remains effective for 40 minutes or 80 minutes when swimming or sweating profusely.
8. Familiarize yourself with the UV Index. In the US, daily readings of sun intensity are available for virtually every zip code. Forecasts include predictions for the next few days and the degree of protection required to minimize skin damage. See https://www.epa.gov/sunsafety/calculating-uv-index-0
9. African-American children need protection too. Children with much melanin in their skin are not immune from sun damage though the incidence is very low. Nevertheless, parents must be vigilant. The darker the skin, the more difficult it is to spot skin abnormalities.
10. Miscellaneous. Don’t confuse SPFs with UPFs… Never leave sunscreens in a parked car in hot weather. Excessive heat rapidly reduces potency… Most sunscreens have expiration dates of three years… The brims of sun-protective hats should be at least three inches (7.5 centimeters) wide and extend around the head… Many medications, including some over-the-counter ones, increase the effects of sun damage. Check with your healthcare providers or on the web.
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The ABCs of children covering their faces in a pandemic
Children two years of age and older should wear cloth face coverings outdoors if other people are nearby, says the US Centers for Disease Control (CDC).
1. Protection may be especially important at the present time. For better or worse, many jurisdictions are loosening restrictions on isolation in order to reopen the economy. That means more children (and adults) will be venturing outdoors – while the virus is still circulating. In some jurisdictions wearing masks outdoors is mandatory, with fines for the “unmasked.”
2. Having your children wear a face covering protects your entire family. Especially during a pandemic, your child may encounter people infected with the virus but showing no symptoms. Yet such people shed the virus into the air when they talk, sneeze and cough. And they may not be wearing face coverings and your child may not observe social distancing. Moreover, very rarely, the opposite occurs. Your asymptomatic child may be the one shedding viruses. Then your child’s face covering protects others.
(Many experts suggest replacing the phrase “social distancing” with “physical distancing.” Distancing is the key word here. Socializing should be encouraged – but at a distance.)
3. Optimal protection calls for wearing the right face covering, wearing it correctly, and wearing it when and where necessary. Traditional masks are not essential. Scarves or other cloth face coverings that fit comfortably and securely over the nose and mouth offer protection. Such face coverings should consist of tightly woven material that allows little light to pass through when held up to a light.
4. All you need to know about facial coverings is on a CDC website. It’s illustrated and a must read. Learn how to make face coverings (surprisingly simple), how to fit them on children, when and how to launder them, and much, much more. See https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/diy-cloth-face-coverings.html
5. Children under the age of two years need not wear masks. Placing masks on this age group can be near impossible. Moreover, wearing face coverings presents a remote risk of choking or suffocating. Generally, infants and toddlers can be adequately supervised outdoors by keeping them in carriages and strollers.
6. Young children react to face coverings in various ways. Some take to them as they take to lollipops – with enthusiasm. Others are reluctant to wear them, probably because they find them uncomfortable and make breathing a bit difficult. And some children become apprehensive when seeing face coverings on their parents. Likely, in those children’s thinking, face coverings make parents “disappear” along with the parent’s facial expressions which convey acceptance and security.
7. Getting young children to wear face coverings is not child’s play. It takes various doses of patience, coaxing, flattery, rewards/bribery and firmness, as appropriate to the child’s age. Have periods daily when all family members wear them. Make sure face coverings fit well but not too tightly. Use material with the child’s favorite cartoon character but be aware that many cartoon character face coverings available online are fun masks intended for children’s parties, not for preventing infections…. Let children see themselves in a mirror wearing one. Place a face covering on the child’s favorite stuffed animal.
8. Make face-covering time less onerous. No need to wear them for routine car drives, for example. Provide children with treats and toys to keep their hands and minds occupied. This also deters them from touching, pulling on, or placing their fingers under their face coverings.
9. During a pandemic, initiate COVID-19 precautions every time children have fever, cough, nasal congestion, vomiting or diarrhea. While every healthy child has these symptoms many times each year, ruling out COVID-19 is difficult. Start strict isolation procedures, including face coverings, immediately. Take temperatures several times a day. Continue precautions until you have spoken to your pediatric health care providers. Let them tell you what to do next. This is the age of telemedicine.
10. Miscellaneous. Many children with special needs (ADHD or autism, for example) are fearful of face coverings. Check the websites of organizations devoted to such conditions for tips to help you manage… Face coverings supplement – not replace – other practices for preventing COVID-19 spread. Continue distancing, frequent hand washing, and leaving home only when essential… Children who are considered high-risk or severely immunocompromised are encouraged to wear professional N95 masks… If you must take your child to a medical appointment, call ahead to see if medical facilities are running on time, and again before entering the door. No need to sit in a small exam room for extended periods.
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Improving child’s handwashing techniques for a pandemic – and beyond
Before the age of COVID-19 handwashing for many children was largely fun and games. They just turned on the faucet and fooled around while their hands never got wet and soap remained untouched. No more. Correct handwashing has morphed into hand hygiene with long lists of fact-based do’s and don’ts.
Here’s what you should know:
1. While hands may be a significant route of transmission of OVID-19 it is far from the main route. So says the US Centers for Disease Control. The main route is via virus-containing droplets that infected individuals discharge into the air when they talk, sneeze and cough. Hand transmission results from touching surfaces that have viruses on them and then touching ones’ mouth, nose, or eyes. Not known is the precise proportion of spread via each route. Some experts speculate that among children, especially young children, the spread via hands may be more important than it is among adults. Children practice poor hand hygiene and have an affinity for touching objects and placing their fingers in their mouths and noses. A study of daycare centers shows that compliance with guidelines for hand hygiene is “low”, says the American Society of Infection Control.
2. Set up a child-friendly hand hygiene station appropriate for a child’s age. That involves a slip-resistant stepstool, and easily accessible and easy-to-use faucets, soap (preferably liquid, see below) and a child’s own towel. (Allow children to choose the color.) Label hot and cold faucets with appropriate pictures. Supervise as necessary. Most three-year-olds can manage acceptable hand washing.
3. Wash hands under running water. Washing in sinks or basins of standing water may re-contaminate 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 disease-causing organisms is irritating to the skin.
4. Soap and vigorously rubbing hands together separates dirt and organisms from the skin. Rinsing washes the mess away. Completely cover hands with lather. Wash between fingers. Firmly rub hands together for at least 20 seconds, the time it takes to sing “Happy Birthday” twice. (Sing slowly.) Rinse well with running water until all lather is removed. Soaps marketed as “antibacterial” and “antimicrobial” are unnecessary for routine hand washing. Many researchers recommend avoiding products that contain triclosan. Widespread use may favor the buildup of organisms resistant to antibiotics.
5. Keep fingernails short to make it easier to clean them. Easy-to-grip, animal-shaped nail brushes that are fun to use are available. Brush daily.
6. Ideally, use liquid soap. Child-friendly dispensers are available. Many toddlers are not good at using bars of soap; the bars slip out of their hands. However, for everyday purposes, soap bars are just about as effective. While soap bars may retain some organisms from previous users, this is not a problem, especially if one rinses well.
7. When soap and water are unavailable, use hand sanitizers containing at least 60% alcohol. Such sanitizers are almost as good as soap and water. Cover all parts of the hands. Rub hands and fingers together as with soap. To be totally safe, rewash hands with soap and water at the earliest opportunity.
8. Approved sanitizers are safe for children. But they should not get sanitizers into their mouths. Accidentally licking fingers after a sanitizer is applied is not believed to be a problem; ingesting more is unhealthy. If that happens, call your Poison Control Center at 1-800 222 1222. (Rarely, teenagers drink sanitizers for their alcohol content.)
9. Moistened, packaged wipes are not substitutes for sanitizers. Ads claim that such wipes are great for kids’ skin: non-alcoholic, hypoallergenic, and kill 99%-plus of germs. However, all that wipes accomplish is getting rid of visible dirt, not disease-causing organism. If alcohol-containing sanitizers make hands feel dry and itchy, apply aloe-containing cream.
10. Improve hand drying techniques. Shaking hands in the air or wiping them against ones’ clothing may leave moisture on hands. This allows organisms to survive and multiply. Dry hands until they are entirely dry. Ideally, use single-use, disposable paper towels. Reusable cloth towels, especially when slightly moist from previous users, also help organisms to survive.
For additional information, see https://www.cdc.gov/handwashing/handwashing-family.html
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Isolating children in a COVID-19 pandemic: A primer
Warning: Becoming lax with isolating your children and teenagers to prevent spreading OVID-19 coronavirus disease can have serious consequences for your family and your community.
True, these age groups are far less likely to become severely ill or die from the disease than adults, says the American Academy of Pediatrics (AAP). “It’s not that they don’t get infected, and it’s not that they don’t get hospitalized. They are. It’s just that the disease is less severe than it is in adults.” Please see an important addendum at the end of the article.
Parents lax in enforcing isolation generally cite the following: children are only mildly sick, if at all; they know no one who has been infected; live in a part of the country with little OVID-19 activity, or, being cooped up at home for extended periods rattles the nerves of all family members. Or parents cite necessity; having to go to work without daycare or school to mind the kids. In these scenarios, young children end up with relatives or neighbors. Teenagers hangout with friends at each other’s houses or play basketball at an outdoor playground. Likely, maintaining a six-foot (one meter) physical distance from each other is not of prime importance. Nor is asking whether other players on the court have family members at special risk for this disease.
“There is increasing evidence emerging about the role of asymptomatic people in the transmission of COVID-19,” says the AAP. How important the role of young children in the spread has yet to be determined. This virus appears to spread more readily than many other viruses but not as readily as measles, for example. Known is that young children are effective transmitters. They may show no or minor symptoms when infected and because of the acute shortage of testing kits virtually none has been tested.
Also, COVID-19 is transmitted via two routes, mostly via tiny water droplets through the air when an infected individual coughs or sneezes and, less often, by touching objects or surfaces where such droplets have landed. Children’ poor hygienic habits promote both such transmissions. They do not cover their noses or mouths when they sneeze or cough, rarely wash their hands unless reminded and supervised, and enjoy touching objects and surfaces and then placing their fingers in their mouths and noses. Some young children drool a lot. Moreover, many adults cannot resist the urge to hug and kiss young children.
* Lower bound of range = number of persons hospitalized, admitted to ICU, or who died among total in age group; upper bound of range = number of persons hospitalized, admitted to ICU, or who died among total in age group with known hospitalization status, ICU admission status, or death.
Next week: The psychological effects, if any, on children and teenagers from social isolation. (Why is it called ”social isolation’’? Let’s change the name to physical isolation.)
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Corona virus #4
Your child has symptoms compatible with early coronavirus disease: mild cough, a runny nose, and a borderline fever. What do you do?
1. Stay calm. As more and more cases of Coronavirus (COVID-9) disease occur around the world, children continue to be infected far less frequently than adults, and when infected, the vast majority show either no symptoms, or mild, common cold-like symptoms. Rough estimates (no statistics available) are that less than two percent of cases occur in young children. Very few pediatric patients have required hospital admission. There have been no known deaths in children under the age of ten years. By comparison, at least 144 children in the U.S. have died after contracting the flu so far this flu season, says the CDC.
2. Familiarize yourself with facts. Yes, your child may have coronavirus (COVID-19) disease. However, the early signs are indistinguishable from those of the common cold and the flu. In fact, chances are that your child’s symptoms are not COVID-19-related. Children in daycare and in the first few years of school have on the average of three or four colds per year, with most of them occurring around this time of the year. Flu is also common at this time of the year, possibly more so this year than in other years. This is unrelated to COVID-19. Having had flu shots reduces considerably the chances of having the flu, but the possibility does exist.
3. Isolate your child promptly. COVID-19, flu and colds are all contagious. You, the parent, can’t differentiate one from the other during the early stages. Why risk spreading any of these viruses to others? Therefore, no daycare or school, no playdates, and no visits from the elderly or the immunosuppressed until you have more information. The main purpose for isolating possible cases of COVID-19 is to protect others.
4. Let experts decide whether your child needs prompt medical attention. Call your child’s pediatric office. Let them make the decision. They are aware of the COVID-19 situation in your community. Give them your observations: Is your child’s nose running continuously, coughing and sneezing a lot, and febrile? Is he or she happy, active, and playful? Make sure the medical personnel are aware of your child’s medical history, if significant, and whether household members have important medical issues.
5. Visiting a medical facility during a contagious disease outbreak can be counterproductive. Will the visit help your child or are you risking having your child pick up an additional respiratory infection? Pediatric medical facilities are ideal places for that. Moreover, unnecessary visits overburden facilities that may already be working at capacity. Generally, children with minimal respiratory symptoms need not be examined. The Rx for such children: No medications. Isolate. Do nothing. Observe carefully. Stay in touch. Call back, even within the hour, if there are changes.
6. However, visits are imperative when children appear ill. Ill means “not being themselves,” being listless, coughing, having fever and drinking less liquids than usual, for example. They could have the flu, for example, a disease that mimics OVID-19. Flu can be diagnosed with a simple test and can be treated.
7. The number of children diagnosed with COVID-19 disease will likely rise rather sharply in the near future. This is not an alarming turn of events but merely the result of more children being tested. Testing kits have been in short supply in many parts of the country and early tests were not totally reliable. Also, testing has been reserved for adults, especially older adults and particularly adults with underlying ongoing conditions. Children have had low priority for being tested because they have mild or no symptoms.
8. However, testing young children for COVID-19 is important. The two main reasons: One: Positive tests will detect asymptomatic children who require strict isolation for two weeks. Two: To help public health researchers better understand the role that children (and adults) play in the spread of COVID-19. Do children who are asymptomatic or have minimal symptoms shed virus? And if so, when and for how long ? Does shedding begin before symptoms appear and/or continue after symptoms disappear. All are possibilities. Such data are essential to formulate sensible recommendations regarding daycare and school attendance. Also unknown is whether becoming infected requires mere casual contact with an infected individual (passing in the school hallway, for example) or more prolonged contact (sitting opposite at a table at lunch, for example). Presently, the only solution is to close schools and daycare facilities indefinitely.
9. Formulate plans on how to handle COVID-19-related disruptions. Schools may close suddenly and unexpectedly which may affect your work schedule. Will babysitters want to watch an infected child? Are there immunosuppressed individuals in your home?. And should an outbreak occur in your community, are you prepared to discuss it with older children. Such events can be stressful for both adults and children. Try to stay calm, and reassure children that they are safe and will continue to be safe in spite of what is happening in the adult world.
10. Miscellaneous. Many health care facilities have established formal telemedicine centers staffed by specially trained personnel to answer questions via telephone or email and, in many cases treat children via COVID-19-related issues… Estimates are that the virus can be detected in the air for up to three hours after it was aerosolized with a nebulizer, up to four hours on copper, up to 24 hours on cardboard and up to two to three days on plastic and stainless steel… Launder washable toys as appropriate in accordance with the manufacturer’s instructions. If possible, launder items using the warmest appropriate water setting for the items and dry items completely… Dirty laundry from an ill person can be washed with other people’s items.
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