Dr. Karl Neumann's KidsTravelDoc
A pediatrician's guide to travel and outdoor recreational activities
Placing leashes on children: Wise or other-than-wise?
To leash or not to leash children is an oft-raised question. Is it truly nobler to spurn leashes and, perchance, your child will do no wrong? Or is it far wiser to leash them, and avoid a sea of troubles, but suffer the scorn of outraged strangers and the humiliations parental guilt is capable of self-inflicting? – William Shakespeare (updated and misquoted)
While the use of leashes on children seems to be declining, the subject continues to be of great interest. Type “children-leashes” into Google and up come 48 million responses, mostly from parents, educators, pediatricians and psychologists. Many responses are detailed and passionate. Here are some representative ones:
Don’t use the word ‘leash’. Call it a harness, halter, tether – or even an umbilical cord. These sound more humane.”
“Expect strangers to elbow their companions, point a finger in your direction and smile. Expect other strangers to frown in disbelief, with an occasional one telling you, ‘I leash my dog, you leash your kid’ or ‘Next, you’ll teach your child, sit, stay, roll over.’ Say ‘thank you for your advice’ – and do what you think best.”
Likely, children are more comfortable on a leash than walking with their arms yanked above their shoulder and their hands tightly held. Ditto for being shackled into a stroller.”
“Leashes are just what the doctor ordered for children with hyperactivity and sensory issues. Leashes allow them to move about safely while also allowing them to exercise.’
“Leashes save lives – mine. I have a bad back. My daughter is overweight. I am tall and must bend to the side to hold her hand. It hurts. My back hurts even more when she wants to be carried. Fortunately, she loves her leash. Go figure!”
“Leashes are no-brainers for parents with two toddlers. Most such parents have experienced the nightmare of both kids suddenly bolting in different directions with you only able to chase one at a time! Leashes are available that attach two kids to one leash, freeing one hand for other purposes.”
“Our world is not built for toddlers. Even places that are supposedly “for kids,” like zoos or amusement parks are so overstimulating and crowded that a visit there with a toddler is overwhelming. The leash allows you take a wiggly, impulsive firecracker of a human out into a big world that’s designed for predictable adults. But to those who leash: I salute you.”
“I lost my toddler at an airport. When we reunited, the terror in his eyes made me a ‘leasher.’”
“What kind of people are we that we put leashes on our kids? Dogs get more respect. I don’t care how uncontrollable children are. Haven’t these parents heard of books on improving their parenting skills? I feel like running up to these parents and slapping them. Leashes convey an inappropriate message by using physical force instead of words to keep children under control.”
“Leashing approaches child abuse, stunting curiosity, making children objects of ridicule, destroying their self-esteem…”
“Many types of leashes are available. Some can be extended and retracted. Leashes attach to children’s’ wrists, special vests, or backpacks. Some backpacks are shaped as cartoon characters. Check the internet.”
“Parents should ask themselves whether they have well-thought-out motives for leashing. Is it because their children are excessively impulsive or have special needs? Or is it because the parents have anxieties and don’t trust themselves to keep their child safe?”
“Does the leash ‘respect’ the fact that a toddler’s impulse control is not well-developed? Or does the leash ‘disrespect’ the toddler – and emphasizes the child’s subordinate status in the world?”
“My pediatrician suggested I get a leash. I dislocated my son’s arm twice. Dislocation occurs at the elbow when children twist a tightly held arm to go in a different direction.”
——————
My conclusion: All “opinions” on leashing young children are hearsay; I could not find a scholarly study. Using leashes occasionally for short periods of time, to “prevent a sea of troubles” is a reasonable strategy.
Warning: Driving with an unruly child in your car is hazardous
Unruly children may be a greater distraction for a driver who is the only adult in a car than is texting or using a cell phone. Ditto for screaming infants. Undisciplined and unrestrained pets also present safety issues.
1. Distractions – not necessarily involving children – cause almost 80% of crashes. Children are four times as distracting to drivers as are adult passengers, and infants are eight times more. The more kids in the car, the greater the likelihood of problems occurring. In Australia, one in five parents report that actions by a child led to an accident or a “near miss,” with men reporting being distracted more often than women.
2. Routine driving distractions are compounded by screaming infants and misbehaving children. Before setting out, check your fuel supply. Are you going on a route you are unfamiliar with? Frequently having to look at a GPS or stopping to check maps are major distractions. Wondering where you are going to park is a distraction, as is not knowing what you will do after you take the kid(s) out of the car. Honking at friends causes mishaps; don’t do it – even if children ask you to.
3. There are three main types of accident-causing distractions. Tending to children figures in all three – often simultaneously:
● Manual distractions (such as moving your hands from the steering wheel)
● Visual distractions (such as focusing your eyes away from the road)
● Cognitive distractions (such as letting your mind wander away from concentrating on your driving)
4. Be aware of your own mental and physical state when driving. Being angry or upset, having a headache, or being sleep deprived adversely affects driving skills – and probably lowers your threshold for kids getting under your skin. Being conscious of how you feel may help alleviate the negative effects of the kids’ behavior. Adverse effects from medications you take may also impede your ability to drive safely.
5. Prepare yourself mentally to ignore crying infants and older children throwing tantrums. Do not reach into the backseat to tend to children while driving. Reaching requires you to take one hand off the steering wheel, shift your position in your seat, stretch your body, and move your feet from their optimum reaction location. Let children cry until you can safely park the car. Accepting a used candy wrapper from a child in the backseat requires you taking a hand off the steering wheel for about three seconds. In that time, at 30 miles (48 kilometers) an hour, your car travels 130 feet (40 meters).
6. Prepare children for the trip. Do they have to use the toilet or need their diapers changed? (Do you have to use the toilet?) Plan to keep kids occupied with age-appropriate snacks and toys, ones that they are unlikely to drop. Bring their favorite DVD or other game. Point out places that will interest them. Unruly children are more likely to unbuckle their safety seat belts. Devices are available to make it more difficult for them to do so.
7. Place children so that they are visible in the rearview mirror. Inexpensive mirror systems are available so that you can see rear-facing infants in the back seat. Some systems provide wide-angle views and extra lighting. However, viewing them requires taking your eyes off the road. Some safety officials question whether these systems improve safety.
8. Be firm with discipline. Explain the importance of safety for older children. Tell them that excessive whining, tantrums, and roughhousing is unacceptable. If they do misbehave on the way to a movie or their favorite fast food restaurant, turn the car around and go home. No negotiations.
9. Evaluate other drivers before letting them drive your kids. Do nannies and grandparents have both good driving skills and the emotional wherewithal to handle unruly children? Some children take advantage of parent substitutes. A person’s greatest lifetime risk of crashing occurs in the first 6 to 12 months after receiving a license. One in four teenagers admits to texting while driving and 40% say they have witnessed others use cell phones unsafely. The use of cell phones, even hands-free ones, quadruples the risk of crashes. Apps are available that block incoming messages and send automated responses saying you are driving and will answer when you can.
10. Numerous car accidents are caused by unrestrained dogs. Freely roaming pets nudge drivers, sit on drivers’ laps and, rarely, place their paws on the steering wheel. In crashes, unrestrained dogs become projectiles, seriously injuring others or themselves. Moreover, many children like nothing better than riling up their pets. Getting both pets and kid(s) out of the car safely can be problematic. Pets have been killed in traffic or gotten lost while drivers are busy getting a child out of the car.
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“Mom – I think I’m gonna throw up!”
Motion sickness/ Children/ Prevention/ Treatment – An Update
If no one in your family has ever been motion-sick, it’s only because they haven’t yet encountered the right (or is it the wrong?) situation. It may be a storm at sea, an “amusement” park roller coaster that spins in three dimensions simultaneously while you are strapped in upside down, a ride atop a camel or elephant, or space travel. Motion sickness happens on camels and elephants because they sway from side to side as they walk. Astronauts experience it in spite of being screened, trained and medicated to deal with it. (A new source of motion sickness-like symptoms, virtual reality headsets, doesn’t even require motion.)
1. Children two to twelve years of age are especially susceptible. A test is to have children read, draw or play video games in the back seat of a moving car. If that does not make them sick, chances are they will tolerate rides in boats in moderate waves, airplane turbulence, “merry”-go-rounds, and roller coasters. In children, once motion sick, always motion sick. It’s rarely outgrown but may become milder with age. Children are more likely to be susceptible when a parent has it.
2. Motion sickness is rare in infants. Most actually fall asleep with motion. However, consider motion sickness when infants are unusually fussy in moving cars, boats and planes. In cars it may be because infants often face backwards for safety reasons, a position known to increase motion issues. When possible, wait until they are asleep before starting the car.
3. Recognize early symptoms. Children will lose interest in their activities and lie down or curl up in their seat. Next comes “queasiness” – dizziness, paleness, stomachache, sweating, headaches, yawning, and rapid breathing. Take immediate action to avoid the ultimate disaster, vomiting. Symptoms usually disappear promptly when motion stops.
4. Prevent vomiting. Distract kids with singing and word puzzles. Expose them to fresh air, well-ventilated areas, or air conditioning. Have older children breathe slowly and deeply. Tell them to close their eyes and keep their heads still. Separate them from people who are already sick. Avoid sights and odors of food.
A mid-1800 British medical journal states that diets are an unpredictable feature. ‘Cold pork and chutney (a spicy Indian sauce) or corned beef and pickles will sometimes stay down when the daintiest substances the pantry can prepare are promptly rejected.”
5. Air travel. The larger the plane, the smoother the ride. Avoid propeller planes if possible. Opt for window seats; looking out at the horizon helps minimize symptoms. Sitting over the wings or in the middle of the plane (as is often suggested) is not particularly helpful. Recline seats, when possible, and aim air vents, when available, at the child’s face. A cold cloth to the forehead may help.
6. Sea travel. Take cruises on large ships with stabilizers, opt for itineraries and seasons when seas tend to be calm, and choose ships that pull up to docks at ports of call. At some ports, ships anchor outside the harbor and use small boats likely to cause motion sickness to ferry you ashore. Choosing cabins at the center of ships is not very helpful.
7. Carsickness. If possible, raise car seats so that children can see out of windows. Tell older children to focus on distant scenery. Stop frequently and expose children to fresh air. Also stop if children show early symptoms. Keep the car cool and well ventilated. Avoid strong odors. If possible, avoid winding roads and frequent traffic stops. Expert opinion is divided as to whether watching DVDs increases, decreases, or has no effect.
Several thousand years ago, the Chinese observed that children were particularly susceptible to motion sickness. They called it cart-sickness – for obvious reasons.
8. Amusement park rides. Generally, moderate roller coasters are better tolerated than merry-go-round-type rides. Outdoor rides are better than indoor ones. Rides simulating space travel are prone to causing illness; some supply motion sickness bags. Sit facing forward. Ask ride operators if many children become ill. (Generally, they prefer losing a fare than having to clean up a mess.)
9. Preventative medications are generally not recommended for children. Antihistamines – dimenhydrinate (Dramamine) and diphenhydramine (Benadryl), for example – may reduce the incidence and severity of motion sickness but may cause side effects (agitation, drowsiness, and dry mouth for example). Read labels regarding lower age limits, dosage and frequency of administration. Medication by injection is available on cruise ships. Transderm Scop, the most frequently used medication for adults, is not approved for children under the age of 12 years.
10. Other preventative treatments are available – with little scientific evidence of effectiveness. These include small, light carbohydrate snacks along with frequent sips of water, juice or soda before and during travel; doses of ginger; and applying acupuncture or acupressure just above the wrist.
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How to navigate children through a COVID summer
There is more to coping than masking, distancing, and handwashing.
Yes. It’s a dilemma. What’s best for your family? Choose (a) or (b):
(a) The safest place in a COVID pandemic is indoors. Venture out only when absolutely necessary, says the US Center for Disease Control and Prevention.
(b) Spending time outdoors is especially important for children as the COVID pandemic disrupts the structure traditionally supplied by summer activities, says the American Academy of Pediatrics.
My choice? (b).
1. It’s time to consider lifting some restrictions. As of this writing (mid-July 2020), relatively few children have been tested for COVID 19. Therefore, there are few definitive answers. However, evidence is mounting that when compared to adults, children are far less likely to become ill when exposed to the virus, have milder cases, are less likely to transmit the disease to others and are less likely to be asymptomatic carriers. Children appear less likely than adults to be the first case within a household. Little is known as to whether children with underlying, ongoing illnesses need specific protection.
2. Keeping kids shut in for indeterminate lengths of time is unrealistic. No one knows how long this pandemic will last. Optimal quarantining — no visitors, no going to work, no school, no shopping and for young children, not receiving essential immunizations — is almost impossible to maintain.
3. Vaccines and medications to treat COVID-19 may not be “around the corner.” Vaccine development requires numerous steps of testing, and every step can (and often does) lead into a cul-de-sac. Moreover, many vaccines require two or three doses, sometimes given a month or two apart, to yield meaningful immunity. And most medications on the horizon reduce the severity of the illness, but are not cures.
4. Social isolation of children tends to cause family friction. (Physical isolation would be a better term for isolation. Social isolation is what you do not want.
The absence of playmates often results in moody and argumentative children with frequent angry outbursts. Children fear that adults close to them may die. Parents become short-tempered. Parents begin arguing among themselves, worsening the cycle. Adult disputes are best kept from children.
5. Structuring children’s daily routines helps alleviate their anxieties. Arrange rather strict waking, meal and bed times. Assign chores to be done. Plan for age-appropriate reading, exercising, and screen time. Some children enjoy phone conversations with favorite relatives and friends; Zoom-type contacts may work even better.
6. Get children out of the house. Children need physical and mental activity to stay in shape. Most indoor activities are eventually “boring,” involve little or no movement and are often associated with eating – generally foods high in salt and calories. Children are more active outdoors and less likely to dwell on the predicaments that COVID has brought them. Plan moderately strenuous activities — brisk walking, biking, sports that allow for distancing or just “running around.”
7. “Green” outdoors may be the most therapeutic outdoors. Spending time surrounded by trees, grass and plants seems to be superior to being amid buildings, concrete and traffic, with wilderness the ultimate outdoors. Family picnics may be the perfect antidotes for a COVID-spoiled summer: getting outdoors, having fun, exercising, distancing from other people, and bonding the family.
8. Swimming is another reasonably safe outdoor activity. The virus doesn’t spread through water in properly maintained pools, sprinklers, hot tubs or water parks; chemicals kill the virus. Lakes and oceans should be safe; the large volume of water dilutes the virus and respiratory viruses survive poorly in water. Avoid crowding in and around swimming areas. Masks may be removed for short periods in the water if strict distancing is maintained. Discourage yelling and screaming; it increases the emitting of viruses, if present.
9. To hug or not to hug young children? Hugging has benefits beyond expressing affection. It may physically lower levels of anxiety and promote feelings that people care for you. Young children accustomed to being hugged, especially by grandparents, may interpret the absence of hugs as abandonment or punishment. Under ideal conditions the risk of infection from a hug are minimal. Ideal conditions include short hugs, wearing masks, no obvious COVID infection-type symptoms, no chronic illnesses, and not living in a COVID “hot spot.” Children under two years of age should not wear masks but almost never become infected. Kissing is a no-no.
10. Playdates may be a beneficial first step in “opening up” social integration. “Opening up” society and the economy are key words today. It’s being done with restaurants, nail salons and gyms. Is it 100% safe? Probably not. But neither are trips to the playground (US emergency rooms annually treat about 200,000 children ages 14 and younger with playground-related injuries, some serious). Outdoor play dates are safer than indoor ones. And schedule playdates with one other child at a time. Choose a child from a family whose lifestyle you are familiar and comfortable with.
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At what age can your child be left home alone?
A timely issue.The coronavirus pandemic has closed most organized children’s activities for this summer. Concurrently, many parents are resuming work schedules away from home.
1. An unforeseen event should never be the reason for a child’ first time home alone. Often it is. Advanced planning and correctly judging your child’s age-appropriate maturity should be the deciding factors, as maturity varies from child to child. There is no magic age when a child suddenly becomes responsible and mature. (Below you will see how widely recommendations from professionals vary.) A good time to start planning for children to be left home alone is when children are about six years old, even if you have no immediate plans to do so.
2. In the US, some states have minimum age laws for leaving children alone. The laws vary from state to state. In the case where an underaged child experiences a serious mishap in your absence, you could be charged with neglect or abandonment, and prosecuted by the authorities. Punishment may include monetary fines and imprisonment. Many other countries have similar laws.
3. Most eleven- or twelve-year olds can stay alone during the day for up to three hours provided it is a safe neighborhood and there are friendly neighbors to contact for assistance. So says the American Academy of Pediatrics. However, some children are able to remain alone at younger ages, and for longer periods in the evening.
4. Many states have guidelines for parents. The guidelines are mostly formulated by government child welfare agencies. Recommendations vary widely, based mainly on the child’s maturity. The consensus: Some 6-9 years olds can be left alone for very short periods. Some children can get off school buses at age nine without an adult present. Some 11-year-olds can supervise younger siblings for several hours.
5. A survey of child mental health experts makes these recommendations:
- 8 years and under: Should not be left alone for any period of time. This includes leaving children unattended in cars, playgrounds and yards.
- 9 to 10 years: Should not be left alone for more than 1 ½ hours and only during daylight and early evening hours.
- 11 to 12 years: May be left alone for up to 3 hours, but not late at night or in circumstances requiring adult supervision.
- 13 to 15 years: May be left unsupervised, but not overnight.
- 16 to 17 years: May be left unsupervised for up to two consecutive overnight periods.
6. Children should never be coerced, bribed or otherwise talked into staying alone. Children who show anxiety when left alone are more likely to misinterpret situations that are likely harmless and react irrationally. For example, the telephone rings, the child answers, no one is there, and there is a click as the call is ended. This occurs in TV crime shows. A child already uneasy with being alone may react by running outside, for example.
7. Children’s self-sufficiency may provide clues to their readiness. Does he get himself up in the morning and ready for school with minimal parental involvement? Does she remember to do her homework and reasonable chores by herself? Asking age-appropriate “what if” questions and role-playing scenarios can also give you insights. What if the power goes out? The toilet floods? The dog needs to be walked unexpectedly? Can they use the elevator? Can they have other children visit?
8. Provide children with three telephone numbers to call if a problem arises. Your number may be busy, making children uneasy. Post numbers and telephone-related information near an easily accessible telephone. Ideally, choose persons that your child knows well and is comfortable with, live nearby, and are aware that such calls may be coming.
9. Some children become anxious when home alone. A common reason for their anxiety is that you, their parent, may never show up again. (This explains many cases of school phobia.) Children seem to be reassured when you give them a short summary of your day’s activities. Ideally, take children and show them where you go and what you do when you leave home, where you eat lunch, and, importantly, where you park the car or take a bus or train to return home.
10. Call children to assure yourself that they’re OK and to assure them you’re OK. Calls should become less frequent with time as children adjust to being alone. Frequent calls from children about “nonsense” may indicate that they are still apprehensive alone and you should have a talk with them about their concerns. Call children if you will be delayed returning home; some watch the clock for your return. The best scenario: children become annoyed that you are calling them too often. They are comfortable alone.
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Why the rush to teach infants how to swim?
1. Infants don’t have to know how to swim to go swimming. Blame the English language for the confusion. “Swimming” also means “bathing in a body of water.” Do place infants in water soon after birth, if you wish, to acquaint them with it and help them to overcome fears, if any. Start with sprinkling water on them. Choose lukewarm water. Let them splash with their hands. Stay within arm’s reach; infants can go under in split seconds, without making a sound. Try to keep them from swallowing water. For infants, there is a perfect place for all this: your bathtub.
2. Formal swimming lessons for infants younger than one year of age are available – but controversial. Some programs have websites showing infants a few months of age performing aquatic stunts with no adult in sight. The programs claim that the younger the infants, the greater their affinity for water, a “throwback” to their existence in the womb. They will “roll onto their backs, float, rest, and breathe.” In fact, most infants do make hand and feet movements that resemble swimming and do hold their breath underwater for a few moments However, most cannot reliably sustain keeping their head above water or holding their breath if their head slips under the surface.
3. Early swimming lessons do not “drown-proof” infants. They may swim like fish when an adult hovers over them but usually panic when they fall into water unseen. Moreover, their ability to swim may give parents a false sense of security, making parents less vigilant, perhaps increasing the risk of drowning. Also, check that adults hovering over infants are themselves swimmers. Can you, grandma or the nanny swim?
4. A time to start thinking about starting lessons is when your child reaches the “ripe old age” of one year. So says the American Academy of Pediatrics. The Academy once recommended four years. Lowering that age was based on a small study that suggested that an infant’s ability to swim may help survival rates, but very slightly.
5. One-year-olds do not learn to swim in less time than three- or four-year-olds. Nor do they necessarily become more proficient later on. Early lessons do not increase intelligence, concentration or alertness, as some programs claim. Nor is there a relationship between early walking and the ability to swim. Early lessons are fine if they emphasize water safety for parents and provide water-related fun for both parents and infants/toddlers. However, parents rarely make good swimming instructors for their own children. Better to use experienced, certified, child-friendly instructors. The American Red Cross, YMCA and other organizations train and certify instructors. Check the web.
6. Swimming lessons should not be your primary strategy in preventing drownings. True, in recent decades more infants and toddlers had lessons and fewer drowned. However, according to experts, the decrease was mostly due to adults becoming more aware about water-related safety measures: fences around pools, appointing designated “child-watchers” at picnics near bodies of water, and wearing flotation devices, for example.
7. Children should take swimming lessons at ages five or six, even if they already swim. By this age children can be taught basic water survival skills such as floating, treading water, surfacing from under water, propelling themselves at least 25 yards, and getting out of the water. Lessons should include realistic scenarios such as falling into water while wearing clothes.
8. Appropriate, US Coast Guard-approved flotation devices save lives. Numerous types are available. Check the web. Many are designed to keep young children’s heads above water. Devices should fit properly and comfortably; some are weight-specific. Toddlers should wear flotation devices when they play anywhere near the water. Most children who drown were not supposed to be in the water. Many air-filled swimming aids on the market are toys, not flotation devices. They may deflate suddenly, the child may slip off them, or they may blow away in a strong wind.
9. Swimming presents health issues. Ironically, a main risk factor for infants becoming ill while swimming is the number of other infants in the water. Skip swimming when your child is ill – and encourage other parents do the same. Even in optimally maintained pools, infants who place their heads in the water have stomach upsets more often than infants who do not. The cause is diarrhea-causing organisms – often shed by infants. Chlorine and other disinfectants kill most but not all of these organisms.
10. Children who are not toilet trained should wear swim diapers when in public swim facilities. So says the US Centers for Disease Control. Many public swim facilities insist on it. So should you. Swim diapers retain stool and urine. However, some leakage occurs, especially if diapers are not changed promptly. Check diapers frequently and change them a distance away for the swimming water.
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