You’re considering taking your kids on a cruise but then you hear about yet another outbreak of intestinal disease aboard a large ship. Do you go? It’s your decision. Here are the facts. My recommendation is below.
1. About 14 million passengers, including 1.5 million children, sailed from American ports last year. And, as in previous years and in spite of the best efforts of the U.S. Centers for Disease Control (CDC) and the cruise industry, some passengers became ill with intestinal illnesses, mostly due to the norovirus. Young children appear more susceptible to this virus than adults.
2. On cruise ships, most cases of norovirus result from placing your fingers/hands in your mouth after touching virus-contaminated objects – other people’s hands and doorknobs, for example. A less likely source of norovirus on cruise ships is ingesting virus-contaminated food and water. The virus can survive for 12 hours on most surfaces and up to 12 days on contaminated fabrics. It takes relatively few viruses to make people ill, far fewer than for other intestinal illnesses.
3. Cruise ships are ideal places for outbreaks.Thousands of passengers and crew are confined in relatively close quarters for many days. They touch the same objects and eat food and drink water from the same sources. One infected individual can spread the virus widely. The virus is often brought aboard unwittingly by passengers or crew, often at ports where sanitation is poor and the virus more common. Once aboard ship, it is difficult to eradicate.
4. Outbreaks on cruise ships are widely reported. The medical staff must document passengers and crew who visit the ship’s infirmary with intestinal symptoms or who ask for medication for such illnesses. Since the symptoms of norovirus generally occur within two to three days of infection, most victims are still aboard ship when symptoms appear. If the number of ill individuals surpasses 3%, the outbreak is reported to the CDC immediately, special sanitizing programs are instituted on the ship, and the ship is inspected when it reaches port. Ships are also inspected twice yearly (often unannounced) and are barred from sailing if they receive a failing sanitary score. Outbreaks and scores are posted on the CDC’s website (see below) and often widely publicized by the media.
5. Cases of norovirus are far more common on land. Last year, in the U.S., there were 21 million reported cases of food-related intestinal illnesses. Of these, norovirus accounted for more than half. However, far more cases go unreported. Physicians need not report cases to health authorities, and almost never do. Moreover, when outbreaks occur at restaurants, diners scatter after meals, and the outbreak goes unreported.
6. The majority of norovirus cases are merely annoying. Symptoms generally include mild diarrhea and stomach discomfort for a day or two. Vomiting occurs occasionally, especially in children. Children who drink and eat normally and are happy and playful need not be treated, even when symptoms last a few days. But these children should be isolated to avoid spread. No swimming. No playgroups. Seek medical care if children have frequent vomiting and diarrhea, are cranky and listless, and refuse liquids.
7. Proper and frequent hand washing greatly reduces the chances of illness. The CDC recommends the following:
Wet hands with clean, running water (warm or cold). Turn off tap. Apply soap. Lather by rubbing hands together. Lather back of hands, between fingers, and under nails. Scrub for at least 20 seconds. (Hum “Happy Birthday” twice.) Rinse under clean, running water. Dry with clean towel or air dry.
8. Use soap and water if possible, not hand sanitizer, to clean hands. When soap and water are not available, use alcohol-based hand sanitizers that contain at least 60% alcohol. Compared to soap, sanitizers remove fewer types of disease-causing organisms, are less effective when hands are visibly dirty, and can cause alcohol poisoning when swallowed. Read instructions.
9. Choosing cruise ships by their sanitary score is not helpful in avoiding illness. Ships’ current and past sanitation scores are available at http://www.cdc.gov/nceh/vsp/surv/gilist.htm. However, there is little correlation between scores and risk of illness; outbreaks occur on ships with perfect scores. The same is true for avoiding leafy salads and shellfish, for example, foods associated with norovirus outbreaks on land.
10. My opinion: Most types of travel and many outdoor recreational activities – camping and swimming, for example – increase the incidence of intestinal diseases. Chances of illness aboard cruise ships are small and in most cases of illness, symptoms are mild. And there is “in-house” medical care available on ships. Even staying home has its pitfalls. Young children average two episodes of intestinal diseases yearly, more if they attend daycare or nursery school. So taking children on cruises is a reasonable travel decision. Bon voyage.
If a decade ago you’d asked your doctor if young children should fly with ear infections, nasal allergies or bad colds the likely answer was an emphatic no, that flying with these conditions could damage the ears. Today, if you asked, the likely answer is a conditional yes.
1. No studies exist to help make the decision. While saying “no” is prudent, doing so ruins long planned family trips, often unnecessarily. Worse, sometimes it strands families on vacation. The scenario: An infant is cranky and is feverish, or an older child has an earache. They are seen at a medical facility, a diagnosis of ear infection is made, medication is prescribed, and delay in flying is recommended. That delay may be until the pain/fever subside, or until a course of antibiotics is completed, which may be five to ten days.
2. Ear infections are greatly over diagnosed. Especially in emergency care clinics, the kind often found in resorts. Children are often seen by personnel with limited experience in examining screaming, struggling young children, in removing wax from the ear canals to visualize the ear, and in deciding if an infection is present. Not to miss an infection, treatment is prescribed, “to be on the safe side.”
3. Air travel does cause earaches. And possibly more so in young children than in adults. However, millions of children fly each year, many with the conditions described above. Yet my asking hundreds of pediatricians, pediatric ear specialists and physicians in aviation medicine I have yet to find one who has seen a case of permanent damage to a child’s ear from air travel. And no case of such damage is described in the medical literature. If it does occur, it is an extremely rare event.
4. Earaches associated with flying are caused by changes in atmospheric pressure plus the presence of mucus in the nose. As airplanes ascend and descend the changes in altitude also change the air pressure in the ears. Normally, there is no pain; a tube, the Eustachian tube, which connects the middle ear to the upper nose allows air to flow freely back and forth, equalizing pressure. However, if the tube(s) are clogged, with mucus from colds or allergies, the changing pressure may cause pain.
5. Young children who already have ear infections can fly. In fact, they are generally less likely to have pain than children with no infection. The reason: infection generally produces fluid in the middle ear. The fluid replaces the air. No air, no change in air pressure. No pain. Children who have aerating tubes in their ears (to prevent infections) can also fly safely. These tubes connect the middle ear with the outside through the ear canal, equalizing pressure.
6. When infants cry during flight, is it because their ears hurt? Older children complain of earaches during air travel, so presumably infants also experience pain. Their Eustachian tubes are narrow making blockage by mucus more likely. But, in fact, surprisingly few infants cry, considering that air travel disrupts their sleep and feeding schedules, they rest in unfamiliar and often uncomfortable positions and, if they are on a parent’s lap, are disturbed every time the parent moves. They do seem to cry more frequently during descent when ears are more likely to hurt, but that is also the time they are likely to be disturbed.
7. Conventional “wisdom” says to feed infants during ascent and descent, and often during flight. Allegedly, this prevents both dehydration and earaches. However, dehydration is a myth. And, at cruising altitudes, due to the changes in air pressure, the air in the stomach and intestine is already expanded by 20% (giving adults a bloated feeling.) For infants, sucking adds air and food to the stomach, which may cause fussiness and crying. On the other hand, the sucking motion may help keep the Eustachian tubes open. Feed infants no more often in flight than at home.
8. Commonly used remedies given children are of questionable usefulness. Oral antihistamines to reduce nasal secretions/congestion are no longer recommended under any circumstances. Saline nose drops/sprays and drinking lots of fluids to unplug the tubes are ineffective.
9. Preventing ear pain. Pain most commonly occurs during descent. Descent may commence before the captain announces it. Ask flight attendants to inform you when descent begins. Keep infants awake during landings. Sleep reduces the frequency of swallowing. Acetaminophen (Tylenol) or ibuprofen (Motrin, Advil) reduces pain. Give about 30 minutes before descent, if indicated.
10. Treating ear pain. Administer acetaminophen or ibuprofen. Teach older children the Valsalva maneuver: blow firmly, as if blowing your nose, while pinching your nostrils and keeping your mouth closed. Repeat several times. Encourage children to swallow. Older children can try chewing gum, sucking on hard candies, yawning, and moving their jaws from side to side, maneuvers that may open the tubes.
You may reproduce this article for your organization. (Many pediatric groups do so.) Two issues per month. We are non-commercial. Our goal: to help parents keep kids healthy/safe for travel/outdoor recreation. Recently quoted in NY Times, USA Today, Travel & Leisure. Author: retired pediatrician, travel medicine expert, journalist.
Karl Neumann MD FAAP CTH
If you need to visit a ship’s infirmary while cruising with your family, chances are it will be (1) to obtain medications your child needs but you forgot at home or (2) to have your child seen for a minor illness, one you’d handle yourself when at home. Cruises are healthy and safe for children. Significant illnesses and mishaps are rare at sea. And if a problem does arise, “in-house” medical care is available. Children on cruises are now so common that some childless adults clamor for adults-only voyages.
Tips for smooth sailing:
1. Call your child’s health care providers when non-emergency problems occur. Often they can advise on how you can handle the problem or whether you need to visit the infirmary. Health issues tend to be more upsetting away from home. Bring your child’s medical record if he or she has an ongoing health issue.
2. Carry a small personalized medical kit. It reduces the chances of leaving items you’ll need at home. Check which medications your child has taken in recent years; those are the ones you are most likely to need. Many common over-the-counter medications and some Rx items are available on large ships but may be expensive, not covered by insurance and not identical to ones you are accustomed to.
3. Does your health insurance cover shipboard medical expenses? If not, buy travelers’ assistance insurance. Such insurance includes evacuation to a medical facility on land – a rare occurrence, but one that can cost tens of thousands of dollars. Policies are available through major credit card companies. Policies have exclusions: pre-travel conditions and hazardous activities (parasailing and diving, for example, sports popular at some ports).
4. Update your children’s immunizations. Aboard ship are passengers and crew from many countries, the crew often from poor countries with lax immunization programs. Influenza vaccination is recommended for children six months and older (and adults). Shore excursions in foreign countries, even short ones, may require vaccines and preventative medications.
5. Shipboard medical care is expensive. The medical staff is trained in emergency medicine. Consultations generally cost over $100. Injections, x-rays, lab work, after-hour visits and “house” calls to cabins are extra. Fees may be waived for minor ship-related injuries. Most ships are equipped to electronically transmit x-rays, ECGs, digital pictures and other data to specialists on shore for immediate interpretation. If a family member has an ongoing medical problem or mobility issue, consult the cruise line’s medical department several weeks before sailing. In most cases, they will be able to accommodate you.
6. Sunburns are common. Children burn easily. In the tropics, the sun is directly above, daylight is long, there is almost no haze to filter out rays, and rays reflect off water, increasing exposure. In temperate climates, don’t let cool weather and breezes lull you into complacency; neither reduces radiation. Taking ibuprofen immediately after excessive exposure and before burn symptoms occur may alleviate discomfort, but doesn’t reduce long-term skin damage. Use sunscreen of SPF 15 or above. Reapply frequently.
7. Seasickness is uncommon. Weather data enables captains to change course to avoid most storms. Ships are equipped with stabilizers. If children feel “queasy,” stay on deck and tell them to keep their eyes on the horizon. Or keep them in air-conditioned areas, reclining and with their eyes closed and heads still. Avoid large meals and food odors. Sip fruit juices. Transderm-Scop, a patch placed behind the ear, is effective, but not approved for children. It requires a prescription and has side effects. Oral medications and injections are available aboard. See http://kidstraveldoc.com/?s=motion+sickness.
8. Most shipboard accidents are preventable. Leading causes are embarking and disembarking and the rolling of the ship. Inform children about risks related to steep stairs, wet decks, doorsills, and tripping over items in the cabin. Leave a small light on to reduce the possibility of falls. Baby-proof cabins for toddlers. In many ports, launches are necessary to reach shore. Getting on and off launches, particularly in heavy seas or while holding young children, is dangerous. Allow crew to assist you.
9. Many cruise-associated mishaps and illnesses occur on shore. Riding motorbikes and parasailing are hazardous activities; in many ports there are no age restrictions. Tropical beaches have undertows and hazardous sea life. Lifeguards are rare. Apply insect repellents for shore excursions in tropical ports. In developing countries, watch for broken sidewalks, exposed roots and unexpected steps. Eat food that is cooked and served hot, drink beverages from sealed containers, avoid ice, and eat fresh fruit only if you have washed it with clean water and peeled it yourself.
10. Familiarize yourself with child safety procedures. Most ten-year-olds can be left alone to find their way around the ship (usually better than their parents). They can sign themselves in and out of professionally supervised programs. Parents can track their children via electronic devices. Confined activities are available for younger children. Cameras manned by security personnel cover most public areas. On many ships children under 12 must wear wristbands when alone that list muster stations in case of emergencies. Crew can read the bands and guide children accordingly.
Miscellaneous: Generally, infants must be six months old. Gluten free, dairy free and other special diets are available on most large ships. Inquire beforehand.
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The next posting: preventing gastrointestinal disease on cruises at sea, a subject that is frequently in the news.
The ideal vacation spots for children (and adults) with asthma and other respiratory allergies are the North and South Poles, ships anchored in mid-ocean, and atop the higher peaks of the Himalayas – destinations hardly realistic for families. These are the only places where air is still relatively free of industrial pollutants, mites, molds, trees, grasses and other substances that make kids cough, sneeze and wheeze.
But no need to stay home, either. Tons of information is readily available to help your family travel comfortably virtually everywhere, even if the allergies accompany you.
1. Plan trips to minimize exposure to allergens. Consider climate, weather, altitude, air pollution, animal exposure and vegetation, for example. Lots of maps and charts containing relevant information are available (see below). If vegetation is a concern, seashores, cruises and desert areas are generally better destinations than rural national parks or lush tropical islands. Air-conditioned accommodations are preferable to camping. Damp climates often increase exposure to mites and airborne molds. Most cities in developing countries have poor air quality. Asthmatics generally do well at higher altitudes even though the air contains less oxygen. For asthmatics, medication may need adjusting for strenuous activities and scuba diving is often contraindicated.
2. See an allergist if your child has troublesome symptoms. Allergists can usually identify the allergen(s) triggering the symptoms, suggest preventive measures, outline treatment, and possibly provide names of colleagues at your destination.
3. Review your child’s medications. Are any outdated? Do you have sufficient amounts? Will they be at hand at all times? Are you familiar with rules about carrying liquids, medications, nebulizers, and syringes/needles through airport security? Do you know how and where to store items? (Some substances lose potency when left in parked cars in extreme temperatures.) Is your nebulizer operative in cars, in flight, with overseas electricity? Do you know the names of your medications and related paraphernalia in other languages?
4. Are there medical facilities at your destination? Facilities tend to be reasonably good on cruise ships, problematic in developing countries, nonexistent on some smaller Caribbean islands, and hours away in some of the larger National Parks. Make sure to carry the telephone numbers of your children’s health care providers back home. Call them first should a problem arise. Check that your phone is operable where you are going.
5. Rid cars of allergens. Before entering the car, let the air conditioner or heater run for at least ten minutes with the windows open. This helps remove mites, molds, and other allergens found in carpeting, upholstery and ventilation systems. Pollution and pollen can also be minimized by driving early in the day or in late evening, and keeping windows closed and air conditioning on. New car odors can worsen symptoms for some allergy sufferers.
6. Have medications available during air travel. Chances are you won’t need them. Pollen, mites and mold counts are usually lower in aircraft cabins than in most homes and schools. However, increasingly, passengers have service dogs aboard. Also, some passengers bring pet dander on their clothing or wear strong perfumes, for example. Planes are generally cleaned at night; the air may be cleaner on early morning flights. Asthmatics are no more likely to have problems in flight than at other times. (Occasionally, older children hyperventilate, i.e., have rapid and deep breathing, usually due to anxiety. This is often misdiagnosed as asthma.)
7. At hotels, ask for “allergy-free” rooms. Such rooms prohibit pets and guests who smoke. The rooms are cleaned with substances that leave no irritating fumes and minimize allergens in carpets, drapes and beds. (Upscale hotels are most likely to do sophisticated cleaning.) There tend to be fewer molds in sunny, dry accommodations away from swimming pools (indoor and outdoor), beaches and wooded areas. Don’t place clothes of children allergic to molds in closets and drawers. Run air conditioners and keep windows closed. Consider bringing your own bed linens to reduce exposure to mites.
8. Visiting family and friends. Pet-related allergens remain in rooms for weeks after the pet is removed. Routine cleaning is insufficient for removing allergens. Visits during the holiday season can be problematic. Sources of allergens include mites and molds on holiday decorations and from wood-burning fireplaces and wet leaves. Ask hosts if they have an air purifier or bring one with you.
9. Choose summer camps equipped to treat allergies. Does the camp have a nurse or doctor on the premises? Are backup medical facilities easily reachable? For sleep-away camps, are cabins located amidst vegetation? Are the cabins cleaned thoroughly and aired-out before children arrive?
10. Additional resources:
Asthma and Allergy Foundation of America: http://www.aafa.org/page/traveling-with-asthma-allergies.aspx
National Allergy Map: https://www.pollen.com/
Weather.com Allergy Tracker: (Enter the zip code for the desired destination.)
American Academy of Allergy, Asthma and Immunology: https://www.aaaai.org/conditions-and-treatments/library/asthma-library/allergies,-asthma-and-winter-holidays
Allergy and Asthma Network: http://health.usnews.com/health-news/patient-advice/articles/2016-06-27/how-to-travel-with-asthma-and-allergies
You are not the only one who has asked yourself this question. Type it into Google and you’ll get a mind-boggling 39,900,000 responses — with the vast majority of the respondents giving the same answer.
[Confession: I did not read all 39.9 million responses before writing this article. (I am a slow reader.) I randomly scanned well over a hundred and read about half of these, especially ones from psychologists, educators, and others likely to be knowledgeable about this topic.]
The consensus: parents taking well-planned vacations without their children do their children no harm and may even benefit them. But there are pitfalls.
1. Consider “togetherness” when planning the length of vacations. Vacations provide far more togetherness than being at home, more togetherness than some families are comfortable with. At home, there are acceptable “escape valves” such as separate leisure activities, school, multiple TVs and friends to visit, for example. Not so in hotel rooms and trailers. On long vacations, some adults become anxious about missing work. Children miss friends. Homesickness causes moodiness.
2. Family vacations need not involve all family members. A growing trend is for one parent to go with one child. It may be because one parent is tied up by work or family obligations. Or sometimes vacations are planned for one parent, one child to tailor to specific interests or reward for outstanding achievements. Such vacations, likely produce quality togetherness for those going, but they also require strategic planning to prevent those remaining at home from feeling left out. The stay-at-home child (or parent) must understand that his or her turn is coming.
3. School-age children successfully vacation without their parents. Experience shows no on-going ill effects on the millions of children who go to sleep-away camps, many for eight weeks. Most parents and children find such children’s attendance at camps to be positive experiences, occasional homesickness notwithstanding. Yet most camps severely restrict contact between parents and children, acting almost prison-like. Usually, children can make or receive few, if any, telephone calls and no texts. They generally get one Parent Visiting Day when staying many weeks and none when staying a week or two.
4. Some parents foster separation anxiety in their children.These parents (more often mothers) in subtle ways encourage their children to remain dependent on them. Such children are rarely left with sitters (even when capable grandparents are available) and are breastfeed and co-sleep well into the second year. They are more likely to experience their own separation issues, school phobia later on, for example.
5. There are reasons parents need to spend time away from the kids. Raising children is difficult and most parents who differ are not being honest with themselves. Parenting is emotionally and intellectually draining, often requiring professional sacrifice and financial hardship. Kids are demanding. Yet societal pressures force parents to convince themselves that their children are an essential and continuous source of contentment.
6. Couples who have been together for many years and have young children often forget the importance of being alone. They need time to rekindle their relationship somewhere other than home. Adult-only vacations are healthy and low stress. Rediscovering each other in a romantic environment is ideal. Consider a resort that restricts young children.
7. Vacationing without children will not necessarily restore marital bliss if there are problems in a relationship. Too much togetherness can widen rifts. At home, interactions with children, outside work, separate hobbies and different bedtimes provide buffers that permit acceptable social separation.
8. Leave infants between six and thirteen months of age only with adults with whom the infants are thoroughly comfortable, adults they see almost every day. This is the period for separation anxiety, a normal developmental stage. Before six months of age, infants appear unaware of their surroundings and probably do not recognize their parents (though many parents disagree). After about 13 months of age, infants seem to grasp that a parent cannot be present continuously and that they do return after being out of sight.
9. Modern technology makes possible being “virtually there.”Studies on children between seventeen months and five years of age show that readily available video communications (Skype, for example) provide many of the same effects as does a physical presence in giving children a sense of proximity and security — far better than traditional telephone contact does.
10. Return home with substantial presents for the kids. Call it bribery. Bringing them something that they have wanted for a long time lets them know you were thinking about them while you were apart. It helps kids forget any lingering resentment they may have regarding your absence.
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Hey parents, although it’s midwinter, pry your kids away from their TVs, electronic games and computers. Even the very young ones. Dress them for the cold and push them out the door. Literally, if need be. Ignore their yelling and sarcasm. If they threaten to report you to child welfare, tell them that being active in the cold is just what the doctor ordered to keep them healthy and happy. Kids need at least one hour of exercise daily (just “running around” counts) as soon as they’re old enough to do so. Kids get too little exercise in cold months, partly because indoor exercise is less strenuous.
Here what you should know:
1. Indoor air can make kids sick. In winter, kids stay indoors a lot, often with friends over. Or they’re crowded into daycare centers and such, windows shut, heat turned up. Kids cough up and sneeze out disease-causing germs. Dry air indoors lowers humidity, allowing airborne germs to stay viable longer and travel further. Also, low humidity dries out nasal membranes; membranes need moisture to ward off germs. Meanwhile, air outdoors is relatively germ-free.
2. Indoor air is often polluted. Energy-efficient homes keep cold air out and let no fresh air in, allowing unhealthy buildups of vapors from heating units, household cleaning materials and other sources. Concurrently, outdoor air quality is improving, due to the use of better fuels for heating houses and for running cars and trucks.
3. Overdressing kids for the cold is counterproductive. Modern fabrics are so efficient in retaining heat and repelling rain/snow that perspiration can be a problem. Modern clothing allows kids to stay out longer. Wearing wet clothing, whether wet from perspiration or the elements, is like standing naked in the cold. As kids perspire, remove layers of clothing, open zippers, take off hats, and unbutton jackets.
4. Exposure to cold does not increase susceptibility to illnesses. Only extreme and prolonged exposure to both cold and wetness causes body temperature to tumble and leads to serious cold-related health issues. This does not happen to toddlers frolicking in the snow or older kids skiing, sledding or ice skating.
5. The colder the weather, the more active kids are and the more calories they need. Calories provide energy to maintain body temperature, warm cold air being inhaled, and fuel muscles. Even moderate activities require about twice the calories needed for sitting and watching TV. Frequent eating helps maintain steady heat production. “Trail food” (mixtures of raisins, dried fruits, chocolate and nuts) supplies the necessary calories. And kids like it. Bribery can help get them outside.
6. Cold weather increases the need for fluids.The body loses fluids through deeper breathing, perspiring under clothing, and exertion. Remind kids to drink even when they are not thirsty. Water and juices suffice. These are quickly absorbed. The benefits of hot drinks, if any, in keeping kids (and adults) warm are mostly psychological. “Sports drinks” are helpful only for older children participating in competitive sports.
7. The sun helps boost vitamin D levels.Vitamin D is especially important for building and maintaining strong bones. An important source is the action of the sun on the skin. However, many children living in cold climates spend limited time outdoors in winter, and when they do go outdoors, they’re covered with clothing, with little skin exposed. This results in less than optimal levels of vitamin D in their blood. Check with your pediatrician to determine if your children require oral supplements.
8. Winter sunlight helps minimize being sad and having SAD. Sad (small letters) is having the “winter blues” or “cabin fever.” SAD (capital letters) stands for Seasonal Affective Disorder, a more serious form of the winter blues. This condition is brought on by too little exposure to light. In children, SAD causes listlessness, concentration issues, irritability, crying and increased difficulty getting up in the morning. In the Northern hemisphere, the farther north you live, the higher the incidence of SAD. Exposure to sunlight or specific artificial light is the antidote.
9. Sick children can play outdoors. Exposure to cold does not cause, worsen or prolong illnesses (see #4 above). However, if ill children prefer to rest indoors, obviously, let them. Note that children’s noses often start running when they are outdoors in cold weather. This is due to the cold air, and is not necessarily a sign of illness. Ignore old wives’ tales that illness is caused by wet hair, drafts, and overheating.
10. Wearing sunglasses when snow covers the ground is as important as wearing them on a sunny day at the beach. Snow reflects almost 80% of the sun’s rays, far more than water or sand. Reflected rays are additive to direct rays in causing damage. Many winter activities take place in snow-covered hilly terrain, allowing reflected rays to penetrate eyes from different angles. (See http://kidstraveldoc.com/kids-winter-sunglasses/