Kids Travel Doc
A Pediatrician's Guide to Travel and Outdoor Recreational Activities
Go Take a Hike: An Update
It’s all in the tone of your voice when you tell your children “Go take a hike. ” Are you telling them to leave you alone or are you recommending that they adopt a healthier lifestyle? (Hopefully it’s the latter.)1. Hiking benefits both adults and children. Hiking provides quality togetherness and helps prevents obesity, diabetes, hypertension, and a slew of other health issues. It requires little or no equipment, is a safe activity, and can be performed virtually anywhere, not only in the woods. You can “hike” in amusement parks, malls, and on city streets The earlier kids get acquainted with nature, the more likely they will continue their interest when they grow up.
2. Start kids hiking before they can hike.Carry them on your back, so you can hike and get them used to the outdoors. Start when they are about six months of age, a time when they can hold their heads up. Check that you have an infant carrier comfortable for you and appropriate for the infant’s age and size. (See infant carrier.) Outside, watch for branches and bushes. Protect their eyes from the sun, especially in snow country.3. Don’t bother trying to predict how far, how fast or for how long toddlers will walk.(Toddlers are defined as being between one and three years of age. Then they become preschoolers.) Medically speaking, let them walk as long as they like; no need to limit them. Let them set the pace and direction – which may be slow and in circles. The first few times you go “hiking,” stay close to your house or car. You may hear the “carry me” at any time and, possibly, many times. Don’t go further than you can easily carry kids back.
4. Most four year olds will walk one mile (1.6 kilometers). A rule of thumb: motivated kids will walk/hike one additional mile for each year over four, i.e. three miles (4.8 kilometers) for a six year old. Factor in physical fitness, difficulty of the terrain, and weather. Compliment them on their achievements.5. Keep them motivated. Let them help you pick out snacks for the walk/hike and tell them about what they will see on route. Call for rest stops when you see them dragging and losing interest. Do so before they complain. Let them lead the family. Alternate leaders if there is more than one child.
6. Choose routes interesting to young children. Kids are rarely impressed by historical sites and scenic landscapes and prefer picking flowers to viewing them. They tend to like waterfalls, lakes (especially ones with ducks in them) or into which they can throw stones, and rocks on which they can climb (safely). Ideally, choose routes with attractions close together so you can entice them on with something interesting just ahead. Point out animal tracks and burrowing holes, anthills, and birds’ nests, for example.
7. Provide young kids with backpacks. Wearing backpacks makes them feel part of the group. For toddlers, it doesn’t matter what they carry – a light toy, a small water bottle, their favorite snack, or nothing. For older children on serious hikes, backpacks should weigh no more than fifteen percent of body weight, less for tough terrain, first time hikers, and extremes in temperatures. (This holds for school backpacks too.)
8. Keep kids well hydrated and well fed.Loss of stamina occurs before thirst sets in. Encourage them to drink. Carry drinks they like. Drinking is especially important in hot and humid environments. For children of all ages, even on fairly strenuous hikes, plain water is adequate. Energy drinks and electrolyte solutions are unnecessary. “Trail mixes” consisting of dried fruits, nuts, grains and chocolate are very popular, and available everywhere. These mixtures provide energy, taste good, are lightweight, and are easy to carry, store, and eat.
9. Teach young children to “Hug-a-Tree” if they lose sight of you. If children feel lost they start running in the direction they happen to be facing, greatly complicating reuniting. Supply preschoolers with whistles, when appropriate. Check the many electronic gadgets now available to keep track of children.10. Miscellaneous. Allow kids to bring a friend along. (Adults are boring, friends are cool.) Expensive and sophisticated footwear and clothing add little to the kind of walking/hiking that children do. Have lists of supplies to carry: insect repellent, sunglasses, sunscreens, sun hats, extra clothing, a small first aid kit, and a cellular phone that works where you are hiking.
Necessary Do’s and Don’t’s to Keep Kids Healthy Outdoors
The headline on a recent article in the Wall Street Journal (WSJ) reads, “If You’re a Kid, the Experts Want You to Have a Fun-Free Summer.” To my surprise I am the main ogre (my word) in this article, one who leeches the fun out of kids’ summer pleasures. But, if truth be told, I like the article: the author, Lenore Skenazy, reads my newsletter, the WSJ editors saw fit to print it, and it brought about three thousand extra readers to my website, a record by far. Moreover, the criticism of me is good natured and balanced. What else could I ask for?Skenazy uses my recent article on children playing in the sand at the beach as her “punching bag” and takes issue with the many do’s and don’ts that I recommend to keep kids healthy and safe outdoors. It is her contention that my article is a prime example of how “experts” overemphasize the hazards of everyday childhood activities, in this case outdoor ones.
She quotes me (correctly): “Children playing in the sand are more likely to become ill than children walking on it and the risk of illness increases with digging in the sand, lying on it, and being ‘buried’ in it.” She believes that illnesses stemming from playing in sand, for example, are rare events, tend to be more annoying than alarming, and that the do’s and don’ts I recommend are not likely to eliminate all problems. Moreover, she believes that articles such as mine scare parents unnecessarily, makes parents overprotective, and causes parents to drive their kids crazy – sometimes literally so – with a litany of do’s and don’ts.Skenazy believes in raising “free range” children (what a great term) and writes and lectures extensively on that subject. (See her website here.) She believes parents should allow children to function as independently as possible, keep parental supervision to an age-appropriate minimum, and consciously accept reasonable amount of risks regarding their children’s wellbeing. She further believes that the psychological impact of overprotection is part of the equation on what to let children do/not do. There is no need to be helicopter parents (another great term), who hover over their children, refusing to cut the umbilical cord until kids are off to college – or later.
So it comes down to where parents should draw the line in the sand, (in this case, both literally and figuratively) between the free rangers and the do and don’ters. For me, the free rangers lean too far toward relying on their instincts to make decisions and are a bit uneasy with research and statistics. The free rangers believe that if they and their circle of friends have not encountered a particular issue then that issue occurs too infrequently to fret about.In fact, only recently have there been reliable statistics regarding illnesses and mishaps related to children’s outdoor activities. Problems occur far more frequently than generally believed. Emergency rooms (ERs) in the US record the reason for every visit, including those from children’s outdoor activities. The data are placed into computer databases where researchers, by keying in a few terms, can see how many children have had problems stemming from beach activities, falling out of infant carriers, skateboarding, or being forgotten in cars in hot weather, to name just a few examples.
I recommend that parents move that imaginary line in the sand a bit away from free range and toward the do’s and don’ts. Skenazy is correct that beach sand is not a source of a great number of ER visits, However playgrounds are, 200,000 yearly visits and amusement parks, 9,000 visits, for example. Trampolines alone are the cause of 100,000 visits.So read the litanies of warnings posted at outdoor recreational activities – and, of course, in my newsletter. Follow the advice. Kids will still be able to have fun.
Lyme disease: The ticks are awaiting your children
The US Centers for Disease Control (CDC) recommends that children who spend time in tick-inhabited parks, woods and forests be checked from head to toe for ticks embedded in their skin. Prompt removal of such insects prevents Lyme Disease. If you live in a particularly heavily infested area, check children after they spend time in your yard. In the US, in recent years, about 30,000 cases of Lyme disease were reported annually with many more cases going unreported.1. 2017 may produce a bumper crop of ticks. A relatively warm winter allowed more ticks to survive from the previous season. Changing rainfall patterns permit ticks (and other insects) to thrive, enlarge their geographic habitat, and extend their biting season. Mice populations may also be increasing and for similar reasons. Global warming may be a factor
2. Ticks are not the cause Lyme disease. However, Lyme disease would not exist without ticks. The cause is a bacteria which is found on animals, mostly deer and mice. Ticks transmit the bacteria from animals to humans. Only some animals are able to harbor the bacteria and only some ticks can transmit the bacteria. Ticks differ from most biting insects in that when they bite a person they embed themselves into the skin and remain there for prolonged period3. Know when and where ticks are active. Lyme disease occurs most commonly in rural areas of the northeastern US from Virginia to Maine, northern California, and in the northern Midwest. However, occasional cases are occurring in many new locations in the US and Canada. About 80% of cases occur in May through July. Most state or local health department can provide current information.
4. Ticks thrive in moist, bushy areas with high grass and leaf litter. Teach children not to lie on the ground in such areas and to walk in the middle of paths and trails. Ticks are less common in dry, sandy environments. Ticks attach to people when people brush up against ticks on grass or twigs. Ticks cannot fly or jump. Once on human skin they can crawl anywhere on the body. Dress children in “anti-tick” attire. Light-colored apparel makes it easier to spot ticks crawling on clothing. Long sleeve shirts and long pants tucked into socks helps avoid skin contact.
5. Mosquito repellents are effective against ticks. See our recent posting for applying repellents to young children. http://kidstraveldoc.com/an-update-applying-mosquito-repellents-to-young-children-is-no-fun-and-games-for-parent-or-child/ The repellent most often recommended for this age group is DEET in 20 to 30% concentration. DEET is safe for infants aged two months and older. Wash off when no longer needed. In highly infested areas, apply permethrin 0.5% to clothing. Permethrin is a safe substance that kills ticks on contact and remains on clothing for extended periods, even after laundering.
6. Check children for ticks.Ticks require at least 36 hours to embed themselves into skin to be able to transmit the bacteria into the skin. Have children bathe or shower soon after coming indoors. This helps wash away ticks not yet embedded. Ticks are difficult to see. Some are the size of a pinhead. Use a magnifying glass, if necessary. Check scalps carefully. Lyme disease is never transmitted from person to person.
7. Know how to remove ticks. Use fine-tipped tweezers. Grasp the tick at the skin surface. Pull straight, in a continuous motion. Don’t twist – this can cause the mouth parts to break off and remain in the skin. Never use hot matches, nail polish, or petroleum jelly to remove ticks. Visit a medical facility if part of the tick remains in the skin.8. Save ticks that you remove. Place the tick in a sealable, transparent envelope or jar. Bring it to a medical facility. Experts can determine if a tick is the kind that can transmit the causative bacteria. If yes, a short course of a commonly used antibiotic prevents Lyme disease. If not, there is no reason to treat.
9. Recognize early Lyme disease symptoms. Even thorough examinations can overlook tiny embedded ticks, especially in an uncooperative child. Fortunately, Lyme disease can still be effectively treated when early symptoms appear. Be suspicious of reddish discolorations of the skin that grow to several inches in diameter and then begin clearing at the center, giving the rash a “bull’s eye” appearance. The redness usually develops 3 to 14 days after the bite and at the bite site. Medical treatment is essential. Other symptoms of Lyme disease include fatigue, chills, fever, headaches, and muscle and joint pain. If left untreated, Lyme disease can involve joints, the heart, and the nervous system.
10. Miscellaneous. If children have been in tick-infested areas, wash and dry their clothing at a high temperature to kill any ticks that remain. An informative, illustrated 12-page booklet on Lyme disease is available at http://www.cdc.gov/lyme/resources/brochure/lymediseasebrochure.pdf
Digging in the sand at the beach is no longer fun.
Remember when digging in the sand at the beach was a fun activity for young children, an activity with almost no do’s and don’ts attached to it. Children could dig holes trying to reach China while parents could laze nearby. Sorry. No more. Based on recent findings, only with lots of do’s and don’ts is frolicking in the sand a healthy activity, says the US Environmental Protective Agency (EPA).
1. Call it sand pollution. In fact, digging in the sand was never healthy. In the past, sand pollution was largely overlooked. While health departments monitored water at public beaches and banned swimming when problems became excessive, beach sand was rarely tested, and access to the sand virtually never restricted. Now studies show that children playing in the sand are more likely to become ill than children merely walking on it. And the risk of illness increases with digging in the sand, being “buried” in it, and digging in wet sand.2. Fortunately, most sand-related illnesses are merely annoying. The most common ones are stomach upsets, often with diarrhea, from ingesting bacteria or other microorganisms present in beach sand. Less common are skin rashes, and eye, ear and nose problems. Most illnesses are mild. If medical care becomes necessary tell the staff that your children were at the beach. This helps diagnosis.
3. Younger children are especially likely to become ill. They spend more time digging in the sand, are more likely to get sand in their mouths (eating food items dropped into the sand), less likely to wash their hands, and more susceptible to intestinal illnesses. Teach children to keep their hands away from their mouths. Carry hand sanitizers and use it freely.4. Most beach related illnesses are preventable. For example, when beach water is polluted, keep children out of the sand. The action of tides and waves spreads pollution from the water unto the sand. Information about beach water is often posted on the site or available from local health officials. Also, keep children with open sores and cuts out of the sand. Organisms in the sand can infect wounds. Have them shower after playing at the beach. Keep their fingernails short and brush them often.
5. Look for clues that the sand may be polluted. Sand contamination is highly variable over short distances. Stay away from dirty-looking water, places where water from surrounding hills or streets run across the sand, and where birds and dogs congregate. Be aware that wet sand, the kind best for digging, contains nutrients that enable microorganisms to multiply and survive for longer periods of time.
6. Sand pollution tends to be especially high after heavy rains. Sewage treatment plants “scrub” wastewater before dumping it into the sea. But heavy rainstorms can overwhelm the plant’s ability to treat wastewater; there are no facilities to store it. This results in raw sewage flowing into the water and sand. Wait 72 hours after storms to use the beach.7. Beaches popular with parents of young children are frequently polluted. Parents opt for sheltered water and sand for safety reasons, where there is no high surf or undercurrents. This eliminates waves and other forces which agitate the sand and help flush it clean. This requires closer oversight by parents to avoid illnesses.
8. Dry sand presents problems, too. Children like burying their legs and feet and occasionally, burying their friends up to their necks. Dry sand frequently contains fungi which cause skin rashes. Discourage children from lying directly on the sand. Have them use beach chairs or, at least, a towel or blanket. Have them shower and dry them vigorously after lying in the sand.
9. Walking barefooted is another “don’t”. Have children wear lightweight, ventilated, hard-soled footwear that covers the toes. This helps prevent stubbed toes, lacerations, puncture wounds, and burns from hot sand. Ideally, footwear should be worn for wading in the water.10. Appropriate footwear is especially important at tropical beaches. Sand, on the beach and in the water, may conceal poisonous sea life that may have tentacles, fangs, barbs or spines, for example. Some are able to inject venom into children’s’ (and adult’s) skin or burrow under their skin. Teach children not to touch objects in the sand and water. Poisonous sea life can resemble rocks or seaweed. Jellyfish blend into their background and their tentacles can extend many feet. Coral is a live organism with sharp edges that can lacerate skin. Treating tropical beach injuries requires expertise. Injuries caused by different forms of sea life call for different treatments. Seek medical assistance, when in doubt.
An Update: Applying mosquito repellents to young children is no fun and games – for parent or child
Applying repellents correctly is uncomfortable, messy, time consuming, expensive, and if not done correctly, can result in health issues. Prepare yourself for lots of frowns and complaints.
Before reading this posting, you may want to go to our previous one of this two part series: Can you outsmart mosquitoes? Your kids health depends on it. Please see: http://kidstraveldoc.com/can-you-outsmart-insects-your-kids-health-depends-on-it/
1. The US Centers for Disease Control (CDC) recommends only repellents containing one of the following active ingredients:
- DEET
- Picaridin (known as Icaridin outside the US.
- Oil of lemon eucalyptus (OLE) or PMD. Note: “pure” oil of lemon eucalyptus is NOT recommended. It has not undergone validated testing for safety and efficacy.
- IR3535.
- Para-menthane-diol. These products provide longer-lasting protection.
No repellent bears the name of these ingredients. You must search for the name on the label, says the US Centers of Disease Control.
2. These repellents have been scientifically tested. They are safe for young children when used correctly and are effective against a wide variety of biting insects, including most disease-causing species of mosquitoes, ticks, fleas, and chiggers. They are not effective against bees, wasps and hornets, for example.3. Little is known about the safety and effectiveness of the hundreds of products on the market that do not contain the above ingredients. In the US and in many other countries repellents are not government-regulated. Anyone can concoct a product and call it an insect repellent. Few are tested for safety and effectiveness.
4. And don’t be fooled by terms such as “natural” and “chemical free” on repellents. While they sound child-friendly, in fact, the terms are virtually meaningless. All substances are chemicals. There are good chemicals and bad chemicals. Oil of lemon eucalyptus, for example, is “natural.” However, this doesn’t make it safer/better than repellents formulated in laboratories. (Poison ivy and deadly mushrooms are 100% natural.)
5. Check the lower age limitations and recommended concentrations of approved repellents. DEET, for example, should not be used on infants less than two months of age; oil of lemon eucalyptus, not on infants under 3 years. The skin of young children is especially permeable. DEET is the only CDC-approved repellent that comes in various concentrations; for children, use ones that contain between 20 and 30% DEET.6. Apply repellants correctly. Place the substance on your hands and then rub it on your child’s skin. A thin coat suffices; a thicker coat does not increase protection. No need to place it under clothing; long pants and sleeves reduce the amount of repellent needed. Wash off when no longer needed. Avoid eyes, mouth, wounds or rashes. If accidentally applied to such areas, rinse with soap and water. Apply outdoors or in well-ventilated indoor areas.
7. Use permethrin on clothing. Permethrin helps prevent insects from crawling under or biting through clothing. Once correctly applied, permethrin remains effective on clothing through many washings. Permethrin can also be sprayed on camping gear such as tents.8. Avoid products that combine repellents and sunscreens. While many situations call for both, the intervals of applications, for example, make combination products impractical. Generally, apply the sunscreen at least twenty minutes before sun exposure. Repellents can be applied just before going outside. Repellents may reduce the effectiveness of sunscreens. If both are needed, consider using a stronger sunscreen.
9. Avoid non-repellent items that claim to provide protection. Wristbands are ineffective. Taking vitamin B allegedly reduces itching from bites, causing people to think they are being bitten less. Sound and light devices attract insects to the devices, but then attack people near the devices, possibly increasing risk of being bitten. Products that emit vapors may be harmful if inhaled indoors over prolonged periods of time, especially by children. Outdoors, vapor effectiveness varies depending on wind direction and other factors.
10. Familiarize yourself with one or two repellents. Products come in the form of lotions, creams, gels, aerosols, sticks and towelettes. Read instructions. Contact manufacturers, if necessary; most have websites. Know how long protection lasts; hot weather, perspiration, swimming and other factors tend to shorten duration of effectiveness. Read storage advice. Most products have expiration dates. Using extremely old repellent can cause skin irritation and rashes.Excellent additional information is available at :
- Repellents: Use and Effectiveness (Environmental Protection Agency)
http://cfpub.epa.gov/oppref/insect/
- Insect Repellent Use and Safety (CDC)
www.cdc.gov/westnile/faq/repellent.html
- Choosing and Using Insect Repellents (National Pesticide Information Center)
http://npic.orst.edu/ingred/ptype/repel.html
Can you outsmart insects? Your kids’ health depends on it.
Part l: An update on zapping mosquitoes
You no longer have to visit the Amazon rain forest or equatorial Africa to pick up an exotic tropical disease. Nowadays, Zika, West Nile, Chikungunya, dengue and similar diseases can come to visit your family – at your home. Blame global warming. Believe it! Climate change has arrived! Prepare your defenses. There are no vaccines or medications to prevent these diseases. And there are no medications to cure them.1. These diseases are caused by mosquitoes. Mosquitoes wallow in warmth. A warmer environment enables them to multiply more rapidly, enlarge their habitat, and lengthen their breeding and biting seasons. Milder winters allow more of them to survive to bite you again next year.
2. But it’s not the mosquitoes that are your nemesis. Most mosquito bites are merely annoying. It is the viruses that mosquitoes can harbor that are worrisome. Many mosquitoes that spread diseases in the tropics already exist in North America, Europe and in other temperate climates – but are not (yet?) carrying these viruses. If an infected traveler – even one without symptoms – is bitten by a local mosquito after returning home, that mosquito can spread the disease to subsequent persons the mosquito bites. Rarely, diseases can arrive in this country by an infected mosquito that hitched a ride on a plane or ship.
3. Ridding your neighborhood of mosquitoes is your first line of defense. Repellents are secondary. While repellents are important, applying them correctly and safely, especially on infants and young children, is time-consuming, expensive, messy, not foolproof and may raise health issues. (Our next posting will discuss the use of repellents on children.)4. Know your local mosquitoes. Ask your local health department. Different species of mosquitoes transmit specific diseases. Generally, seasonal biting begins soon after trees begin to bloom and ends with the first frost. Each species has a different time of day for peak biting activity, but it is usually around sunrise and sunset. Stay indoors at such times if a mosquito-borne disease alert is in effect.
5. Check that local authorities eliminate standing water in your neighborhood. Notify them about standing water in empty lots and near uninhabited houses. Generally, insecticides are sprayed to kill larvae in ponds, reflecting pools and other bodies of still water. Sometimes fish are placed in water to eat larvae.6. Insecticides are safe for infants and children. According to the US Environmental Protection Agency, “The chemicals used in approved insecticides, when used correctly, do not pose unreasonable risk to public health and the environment. Insecticides do not cause asthma. Rarely they may cause mild, temporary eye irritation.” Some experts suggest you keep family members with serious respiratory issues indoors during sprayings. Health departments will supply dates and times.
7. Eliminate standing water on your property. Mosquitoes breed in poorly maintained swimming pools and in standing water on tarpaulins covering pools. Empty children’s wading pools at least once a week. Check for standing water in backyard toys, abandoned tires, flowerpots, trashcans, and even bottle caps.8. “Bug proof” your house/apartment. Cover gaps in walls. Use weather stripping under doors. Check bathroom exhausts. Make sure windows and chimneys are properly screened and repair any holes. Remove piles of wet leaves from yards and roof eaves. Air conditioning and fans are effective deterrents; mosquitoes prefer still air. Fans are effective on porches and terraces. Observe similar mosquito precautions when away from home.
9. Be leery of devices that claim to repel mosquitoes. Products that emit vapors may be harmful if inhaled indoors over prolonged periods of time, especially by children. Outdoors, vapor effectiveness varies depending on wind direction and other factors. Sound devices worn around the neck or wrist to scare away mosquitoes are not effective. “Bug lights” are not repellents but do not attract mosquitoes as many ordinary lights do.
10. Miscellaneous. Taking vitamin B or antihistamines may reduce itching from bites, making people think they are being bitten less. Avoid scented soaps, perfumes, and hair spray; these may attract biting insects. Do mosquitoes prefer biting infants? (Maybe they taste sweeter?) In fact, no one knows if infants are bitten more often. If so, it may be because infants are unable to swat them away. Place nets over strollers and playpens outdoors.For the latest information, see https://www.cdc.gov/zika/prevention/controlling-mosquitoes-at-home.html
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