Parents often ask what can they do to prevent young children from catching colds during air travel. While no one really knows if, indeed, flying increases the risk of catching colds, there is a safe technique that may decrease the risk (if it exists) and also make infants more comfortable: saline nose drops or sprays. Presumably, infants are more susceptible to colds than adults. (In studies of adults at home, the daily use of saline nose drops did result in a moderate decrease in cold-like illnesses.)
The structure of the nose is important in cold prevention. Colds are caught by breathing in cold-causing viruses. The nasal membranes and hairs in the nose trap most of these organisms. However, these membranes and hairs require moisture to function optimally. Aircraft air conditioning dries out cabin air – and the nose – by removing most of the moisture. Saline restores the moisture.
There is another possible advantage of saline nose drops/sprays in young children: helping to remove mucous. Mucous acts as a culture medium, enabling organisms to multiply rapidly and increasing the risk of ear and sinus infections. Very young children cannot blow their noses to remove mucous. Saline loosens mucous, allowing it to flow out.
Apply several drops or sprays into each nostril every few hours. There are no known side effects. Check that your drops/sprays contain only saline. Many products contain additional ingredients and should not be used indiscriminately.
“No need ever to wear shoes in our resort,” says the ad for an idyllic, upscale, family-friendly tropical beach resort.
Alas, if only true! Footwear – plus other precautions – is essential at all beaches, at home and in the tropics, with tropical beaches requiring some extra precautions.
Call it sand pollution. Researchers have known about it for years, but there have been few studies. While most health departments test swimming water for disease-causing microorganisms and ban access when pollution becomes excessive, sand is rarely monitored and access to sand is almost never restricted.
Beach sand can harbor as many types of disease-causing microorganisms and in similar concentrations as adjacent swimming water. So says the Environmental Protection Agency (EPA). There is a positive relationship between sand exposure and intestinal illnesses. Wet sand is more likely to cause illness than dry sand; it contains more water.
Fortunately, in temperate climates, most sand-related illnesses are more annoying than alarming. Families should watch their steps on beaches (literally and figuratively), but there is no need to discourage families from going, says the EPA.
Sand-related activities determine possible illnesses. Walking in sand can cause foot injuries. Intestinal illnesses are more commonly associated with (in order of increasing frequency) lying on the sand, digging in the sand, and being buried in the sand. Young children are particularly at risk. They place their hands in their mouths, eat food items that they drop in the sand, rarely wash their hands, and are particularly susceptible to intestinal illnesses. Skin, eye, ear, nose and respiratory infections also increase with sand contact. However, most of these illnesses, too, are not severe, and the mode of transmission is often not obvious.
Particular situations increase the risk of illness. Look for sand spots far from sewer outlets, especially in the days after major rainstorms. Heavy rainstorms can overwhelm the local sewage plant’s ability to treat wastewater, resulting in raw sewage flowing into the water and polluting the sand. Some microorganisms survive longer in sand than in water. Choose spots away from birds and animals; their feces contain many disease-causing organisms.
Take precautions to reduce the likelihood of illnesses. Read postings about local hazards. Dress children in appropriate footwear (see below). Wash their hands frequently. Have them lie on beach chairs or, at least, on blankets over the sand. Teach children not to touch strange objects on the beach or in the water, even if the objects appear harmless. Carry and use hand sanitizers.
Insist that children wear appropriate footwear. Walking barefoot in the sand or wading in the water can be the first leg of a trip to the first aid station or ER. Common injuries include bruises, stubbed toes, lacerations, puncture wounds, and burns from hot sand or pavement. Choose well-ventilated, hard-soled footwear that covers toes, is lightweight and easily slips on and off. Dozens of types are advertised on the web (search for “beach footwear”).
Tropical beaches are especially troublesome. Sandy sea bottoms conceal poisonous sea life that may have tentacles, fangs, barbs, spines, or stinging cells that can inject venom into human intruders. 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. Grains of coral may enter wounds, causing infection. Some coral produces venom, further aggravating the injury.
Treating tropical beach injuries requires expertise. Injuries caused by different forms of sea life call for different treatments, and the wrong treatment can worsen the problem. Moreover, many people, especially children, are unaware of what injured them. Waterfront personnel can be helpful in suggesting appropriate treatment. Seek expert medical care if the injured person shows shock-like symptoms (paleness and difficulty breathing, for example).
Playground sandboxes also can be sources of illness. Sandboxes attract small animals. They should be covered when not in use, checked for microorganisms periodically, and the sand should be changed from time to time. Very often, none of these are done. Many playgrounds have eliminated sandboxes as being too troublesome.
(After you read the article, test your knowledge. Look at each picture and ask yourself what the parent could have done better to protect the child from the sun. Answers are at the end of the article.)
Just when you thought that you knew all you have to know to protect your kids from the sun, the experts tweak their recommendations. Their latest advice:
a. Sunburns are an even worse risk factor in causing severe skin damage than excessive tanning.
b. Clothing, not sunscreens, should be your first line of defense against the sun.
1. Intense, intermittent sun exposure, especially during childhood, increases considerably the risk of melanomas in adulthood. Melanomas are the most serious type of skin cancer. The worse the burn, the earlier in adulthood melanomas may occur. Rarely, they occur in teenagers. In a lifetime, two percent of the population experiences a melanoma. Such tumors are generally curable if discovered very early.
2. Skin damage from sunburns is permanent. Most sunburns in children heal in a relatively short time, have symptoms that are rarely overwhelming, and leave little or no scarring. However, the sun’s intense ultraviolet radiation on vulnerable skin causes irreversible damage to the DNA in skin cells, setting off a cascade of negative effects. Badly sunburned skin cells viewed under a microscope resemble cancer cells.
3. Risk factors for melanomas include skin type, skin moles and family history. As with all skin cancers, people with fair skin and light hair and eye color are more at risk. The risk for “normal moles” – small brown blemishes, or “beauty marks” – is extremely small. But children with large, raised, black or irregularly shaped, enlarging moles should see a dermatologist twice a year after the age of ten years. The increased incidence of melanomas within a family may be genetic or due to similar lifestyles (beach-going, for example).
4. Sunburns are frequent occurrences in children. Though there are no statistics (since most such burns are treated at home), estimates suggest that most children have at least one sunburn during childhood. One blistering sunburn in childhood or adolescence almost doubles that person’s chances of developing a melanoma.
5. Tanning is unhealthy. Like sunburns, tanning also causes skin damage, including cancer, albeit the damage is generally less alarming than melanomas. Sun exposure is cumulative over a lifetime. A large percentage of lifetime sun exposure occurs during childhood, when skin is especially vulnerable to tanning (UV radiation.)
6. Skimpy attire has no place in the sun. Even present day “protective” beach apparel – white T-shirts, for example, especially when wet – provides almost no protection. Comfortable, lightweight, and stylish clothing is increasingly available. Such clothing is virtually 100% protective against UV radiation. The more skin covered by such clothing, the less need for sunscreens. Clothing at the beach may be a nuisance but so is winter clothing for the outdoors. Get used to it.
7. Sunscreens are still essential, but are no panacea. Sunscreens are rarely applied correctly. Generally, far too little is applied and is reapplied too infrequently. Applying the correct amount is expensive. Sunscreens’ effectiveness is reduced by water, perspiration, wind, humidity, and other factors. Occasionally, sunscreens cause rashes. Also, sunscreens merely slow down tanning, they do not eliminate it. But many parents believe sunscreens are totally protective, and therefore allow their children to stay in the sun for prolonged periods of time.
8. Most vacations increase sun exposure. A large percentage of vacations include time at the beach or pool. Intense, sudden exposure is especially common for children (and adults) who live in temperate climates and go on winter vacations in the tropics. The sun is more intense in the tropics. Winter vacations in snow country can cause sunburns of the face. Snow reflects almost all of the sun’s UV radiation.
9. Ibuprofen may reduce short and long term skin damage if taken immediately after excessive sun exposure. Continue weight-appropriate doses for about 48 hours. Routine sunburn treatment – ointments and compresses, for example – do not reduce long-term skin damage.
10. Miscellaneous. Get sunglasses that wrap around towards the ears to help protect the sensitive skin of the eyelids. Skin tumors occur rarely on skin not exposed to the sun. People of color are less likely than Caucasians to develop melanomas but when they do occur, the outcome is worse. The reasons: a widespread misconception that dark skinned people do not get skin cancer and melanomas are more difficult to detect in dark skin.
Answers to the Quiz:
A. In photo A, the child has no hat or sunglasses.
2. In photo B, the person is applying a sunscreen to skin that should be covered by clothing.
3. In photo C the child’s upper chest exposed to the sun.
4. In photo D, sand reflects the sun’s UV rays onto the child. A blanket over the sand would increase protection.
5. In photo E, the sunglasses should wrap around to the ears. The sunglasses look a lot like “fun glasses.”
So, how did you do on the quiz?
Hey Mom! Make room in your already bulging diaper bag for one additional item, sunglasses. For your infant. The earlier children begin to wear “shades” the less likely they are to have cataracts and other eye problems when they become grandparents.
1. Any old shades won’t do. Infants’ eyes are especially susceptible to the sun. Their eyes absorb greater amounts of harmful ultraviolet (UV) radiation than do adults’. Infants’ lenses are more transparent because the lenses do not yet contain pigment that helps reduce radiation. And infants’ pupils are relatively large, allowing more light into the eyes. Infants often look directly into the bright sun – though reflexes will quickly make them blink and look away.
2. Children spend more time outdoors than adults. People get a large percentage of their lifetime sun exposure by the time they are eighteen years of age, the period during which eyes are particularly sensitive to UV radiation. While about 80% of parents realize that it’s important for children to wear sunglasses, more than half of these children seldom or never wear sunglasses.
3. Children less than six month of age should be kept out of the sun. Protect their eyes from the sun when carrying them and when they are in the back seat of a car. Note that the sun comes from different directions as you drive. (Also, sunscreens are not recommended at this age. Sunscreens have not been tested on infants. And infants have thin and permeable skin, possibly leading to excessive amounts of sunscreen chemicals being absorbed into the body.)
4. Older infants and children should be protected from the sun. Broad-brimmed hats decrease UV exposure up to 30%. Have sunshades on strollers; some sunshades specifically block UV radiation. Minimize outdoor activities between 10 AM and 2 PM when radiation is most intense. Children with fair complexions are especially vulnerable to UV radiation because their eyes and skin contain less protective pigment.
5. All shade is not created equal. Clouds are only partially protective. Being in the shade of a building but having a blue sky directly above offers little protection from UV radiation. Being under a beach umbrella protects from direct radiation but allows considerable radiation reflected from water and sand. Dirt, grass and concrete reflect comparatively little radiation.
6. Beware of “fun” or “novelty” sunglasses. These are mainly marketed for young children for entertainment but offer no UV protection. Moreover, some have large brightly colored frames that may contain lead. Such glasses were sold in 2013 and 2014 and labeled Disney, Marvel and Sears/Kmart. Buy infants’ sunglasses at reputable stores that sell eyeglasses.
7. Read labels. All sunglasses should block 99 to 100 % of UVA and UVB. For infants and young children, choose sunglasses made of shatterproof polycarbonate, not glass, to reduce the risk of injuries. Also, choose ones that have flexible frames. Such frames also reduce injuries and are less likely to be damaged when children bend or twist them or leave them where they can be stepped or sat on. Polarized lenses reduce glare. 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.
8. Other considerations. Lenses should be large and wrap around towards the ears, and have an adjustable strap to go around the head. Straps help keep glasses in place and make it more difficult for children to remove them. Dark colored lenses are no more protective than light ones; protection results from chemicals applied to the lenses. Replace sunglasses when they become scratched. Good sunglasses need not be expensive. Cost reflects frames, not UV protection.
9. Good luck in having young children wear sunglasses. While most young children seem to enjoy wearing them – it makes everything look more colorful – some children will refuse. To encourage them, wear them yourself, and point out other children wearing them. For older toddlers, let them pick out a pair they like. Reward them with a toy but let them play with it only as long as they wear the glasses. Be persistent. Don’t let them go outside unless they wear sunglasses and bring them indoors when they take them off. Compliment them on how good they look. Take a picture and show it to them.
10. Days in snow country are as harmful for eyes as summer days at the beach. Snow is a far better reflector of UV radiation than water or sand, reflecting up to 85% of rays. Many winter activities take place in snow-covered hilly terrain, allowing evenmore reflected rays to hit children’s eyes, and from additional angles. Modern winter clothing permits children to spend more time outdoors. Altitude increases radiation; the higher the elevation, the less atmosphere to filter out harmful rays. And cold weather, light clouds, and a sun low on the horizon offer little protection.
In national parks, your family’s health and safety are your responsibility. The National Park Service (NPS) has two missions: minimizing mishaps for visitors and maintaining a pristine wilderness. All large parks have experts to monitor safety conditions. But the wilderness, by its very nature, has inherent dangers with wild animals roaming free and “land in the rough.” Planning ahead and common sense can virtually eliminate health and safety problems.
1. Go prepared. All parks have websites. Conditions in parks may be quite different from those where you live. And each park is different. Check climatic conditions, weather, altitude, pollen counts and whether pets are allowed, for example. Summertime temperatures at many parks in the Western US reach more than 100 degrees. The Grand Canyon (Arizona) is not only dry and hot but the rims are at elevations in excess of 6,000 feet (1,880m). Large parts of Yellowstone (Wyoming) are at 8,000 feet (2,440m). Altitude sickness is possible at higher elevations. See below. Insects are a big nuisance in the Everglades (Florida.). Covering up with clothing and insect repellents is essential.
2. Stop at Visitors’ Centers. Check the literature and bulletin boards for safety information and ask rangers about fun, age-appropriate, seasonal- and weather-permitting activities. Ask if cell phones are operative. The NPS has been slow in implementing service. There are ongoing, heated debates between powerful groups wanting to ban phones entirely, arguing that phones distract from the very concept of wilderness and that phone towers ruin the scenery. Others argue that phones are essential in case of emergencies and to stay in touch with relatives back home.
3. Know your family’s limitations. However far you walk, you must walk back. Leave more time for the return trip, due to heat, fatigue and other factors. Most four-year-olds can walk a mile or so, rest thirty minutes, and then walk back. Six-year-olds can walk two or three miles each way. In some places (at the Grand Canyon, for example), the outward hike is downhill into the Canyon, making the return uphill. How far can you carry your child?
4. Backpacks. Children’s backpacks should not exceed 10% of a child’s body weight for backpack beginners, going up and down hills, walking on tough terrain, and in hot weather. Backpacks that are too heavy or worn incorrectly can cause temporary aches and pains. Some backpacks, especially ones designed for small children, have long straps to fit children of various sizes. Long straps may cause tripping and become entangled in branches. Tuck them in.
5. Supervise children closely in sensitive areas. Obey signs. At higher altitudes, for example, snowfields persist all summer and are irresistible to children. However, the snow may conceal hidden cavities under the snow and collapse under the weight of a child. And falling off walkways over hot geothermal water may expose children to scalding water.
6. Keep your distance from large animals. Stay at least 100 yards (90 m) from bears and wolves and at least 25 yards (23 m) from all other large animals – bison, elk, bighorn sheep, deer, moose, and coyotes. Best to hold children’s hands. Discourage children from playfully flailing their arms at animals; animals may interpret flailing as aggressive moves.
7. But cars, not animals, are the chief cause of most serious mishaps. When driving, be prepared for a child in your car to shout, “I see a bear.” Roads are heavily traveled, hilly, often narrow and winding, and often there are families walking along the road. Expect cars in front of you to make sudden stops and children to dart into the road when they see a large animal.
8. Other mishaps involving children. Children fall (especially when walking on slippery rocks in streams), are bitten by small animals while feeding them, and drink water from lakes and streams. Feeding animals is prohibited. Report bites to park personnel. Persons bitten may require rabies vaccine. Untreated water from lakes and streams may contain organisms that cause diarrhea days or weeks later. In case of illness soon after all travel, tell health care personnel where you have been.
9. Take pictures from the distance. Many children have their own cameras and are overly zealous in taking pictures. Don’t open car windows to take pictures when animals are nearby. Leaning out is even worse. Camera-related accidents can also occur from going too close to thermal pools or cliffs to get better views.
10. Altitudes higher than 6,000 feet may cause altitude sickness. Symptoms include headaches, loss of appetite, nausea, inability to sleep, excessive shortness of breath with exercise, and, in young children, irritability. Generally, at the altitudes of National Parks, symptoms are mild and disappear after a day or two. Treatment is rarely necessary. However, young children with significant heart and lung problems should be medically cleared before traveling to higher elevations.
With your family’s health and safety in mind, find a park to visit at http://www.nps.gov.
You need not travel halfway around the world to acquire “travelers’” diarrhea. A short trip to your neighborhood recreational water facility may suffice. But if indeed someone does become ill, don’t panic. Hold off on treating. Most cases get better by themselves, while medication may cause harm – especially for children.
1. All recreational water facilities can be polluted. Such facilities include pools, hot tubs, water play areas, interactive fountains, lakes, rivers, and oceans. Most intestinal illnesses are due to swallowing water but can also be due to breathing in mist produced by water or by not washing hands after playing in sand.
2. The number of such illnesses is steadily increasing. And young children are especially susceptible, says the Centers for Disease Control (CDC). Children have little or no immunity against the causative microorganisms. Such organisms include cryptosporidium (crypto), giardia, shigella, and norovirus – some of the same organisms responsible for travelers’ diarrhea in poor countries. Crypto, for example, can survive in well-maintained chlorinated pools for several days.
3. “Don’t drink the water.” This old adage is probably more important for recreational water than for tap water. The probability of illness depends on how polluted the water is, how much is ingested, and which organism is involved. For some organisms, swallowing just a few, easily contained in a mouthful, suffices to cause illness. The younger the child, the more likely he/she will swallow water. Dunking infants’ heads to get them “used to water,” a common practice, can make them ill.
4. The chief source of intestinal-causing diseases is fecal matter. In recreational water, the fecal matter comes from people, especially infants in diapers. However, even adults’ routine toilet-related hygienic practices fail to remove all fecal matter from skin. Showering with plenty of soap and water before swimming reduces the incidence of illness. Avoid recreational water entirely while you are ill, and a few days after recovery.
5. Some recreational swimming facilities ban infants in diapers. Think twice before swimming where there are many such infants. While special swim diapers have become popular – they don’t disintegrate in water, fit snuggly around waist and thighs, and have a plastic outer lining – such diapers merely retard and decrease leakage, but do not prevent it.
6. Man-made public water facilities must be professionally maintained. Ask pool operators if free chlorine and pH levels are checked at least twice a day and more often when the pool is heavily used and the weather is hot. Some large pools now use ultraviolet ozone technology or hyperchlorination to treat recreational water. Check backyard pools yourself for adequate free chlorine (1-3 parts per million) and pH (7.2-7.8) levels. Test strips are available at local home improvement stores and pool supply stores.
7. Public beaches are generally checked for pollution. Reports are available from local health departments. Ask for the latest report. Never swim near storm drains or after heavy rain; the water draining into the beach often carries sewage from overflowing sewage treatment plants and may contain fecal material, fertilizer, pesticides, and other pollutants.
8. Most intestinal illnesses in young children need not be treated. The vast majority of cases of loose stools in this age group disappear spontaneously. If a child is happy, playful, and eating and drinking normally, medication and changes in diet are not necessary. Treatment, especially with antibiotics, alters the “good” bacteria lining the intestine and may make children more susceptible to intestinal illnesses in the future.
9. Children who have symptoms in addition to loose stools need prompt medical evaluation. Of concern are fever, blood in the stool, listlessness and not drinking, for example. Even in such cases, fluids may suffice and antibiotics may not be necessary. However, this is a decision to be made by a health professional.
10. Miscellaneous. Well-maintained facilities have no odor. A strong chemical smell of chlorine, for example, may indicate a maintenance problem, especially in hot tubs and spas. When hot tub equipment is working, pumps and filtration systems make noise and you should hear them running. Children less than five years of age should not use hot tubs. Poorly maintained recreational water can also be the source of skin rashes, eye and ear infections, and other illnesses. For additional information about recreational water, see http://www.cdc.gov/healthywater/swimming/protection/pool-user-tips-factsheet.html.