Kids Travel Doc
A Pediatrician's Guide to Travel and Outdoor Recreational Activities
Adults Getting Vaccinated Protects Children
Parents! Having your children optimally immunized against every vaccine-preventable disease may still not suffice to fully protect them from these diseases. Such protection may require that you, too, are immunized.
1. Experience has shown that there are optimum ages to administer vaccines to children and adults. It is the age before (1) the person is likely to become infected with that disease, (2) the vaccine provides maximum protection, and (3) the protection is long-lasting. These features vary greatly for different vaccines; some give lifetime protection while others do not.
2. Well-functioning programs exist for vaccinating children, but not for adults. Pediatric immunization schedules are prepared by a national board of respected experts and the vast majority of parents comply with their recommendations. They take their infant/young children to the same pediatric facility every month or two to receive a slew of shots to prevent fourteen diseases. These facilities maintain records and the records are freely available to parents.
3. Programs to vaccinate adults function poorly. The importance of vaccinating adults is a fairly new development. Many adults’ physicians are not well informed on vaccinations and most adults are unaware that they too need routine vaccines. Moreover, many adults see physicians only when they are ill and, increasingly, they see specialists who treat one body part and do not offer vaccines. When adults do receive vaccines, it may be from different facilities, sometimes pharmacies, with no central location keeping records.
4. Vaccinating adults protects children. For example,during the first year of life infants are only partially protected against many vaccine-preventable diseases. One reason: it requires several months and multiple doses for some vaccines to establish optimal immunity. One way to protect the infants is to eliminate the most important source likely to make infants ill – unvaccinated adults.
5. Having yourself vaccinated to protect your children protects yourself. Vaccines provide excellent protection. However, some vaccines are not providing protection for as long a time period as previously anticipated. Maintaining protection requires booster doses. Some childhood vaccines require boosting already in teenage years. Maintaining protection for adults is especially important because many vaccine-preventable diseases are far more serious for adults than children. For example, some infections during pregnancy may cause catastrophic damage to the unborn child.
6. Vaccines are especially important for the elderly. Being up-to-date with vaccines throughout adulthood negates the need to give certain vaccines. Advanced age weakens the immune system. This tends to worsens the severity of some vaccine-preventable diseases while lessening the protection afforded from the vaccines. Moreover, many elderly have chronic illnesses, some immune system-related, or are taking medications or treatments that affects the immune system, further complicating the situation.
7. Travel increases your chances of being exposed to an infected individual. Overseas, even in developed countries, vaccination programs are less comprehensive than in the US. This increases the risk of exposure to an infected individual. And traveling with children makes it more likely to have contact with local children, the major source of such diseases. And you need not travel overseas to be exposed. Millions of tourists enter the US. You encounter tourists on local fights, at amusement parks and in national parks. Diseases may also be imported by college students (1.2 million entered the US in 2017), hundreds of thousands of immigrants, and adoptees from overseas.
8. Fewer American children are being vaccinated. The percentage of children under two years of age who are incompletely or not at all vaccinated has quadrupled since 2000. While that percentage remains relatively small, the trend is troublesome. About 100,000 children in this age group aren’t fully vaccinated against the fourteen vaccine-preventable diseases. Some health care providers acquiesce to parents’ requests to start vaccination for infants at a later date, give fewer vaccines at a time, or increase the intervals between doses. Such actions postpone optimum protection.
9. Start keeping records of the vaccines you receive. This is an obvious recommendation but one that few adults follow. Many medical facilities now print summaries of the reason for your visit, diagnosis, and treatment and immunization, if any, given. Store the reports with your other important papers. (Confession: I am a retired (elderly) pediatrician. I have received immunizations in recent years but have no written proof of when, where and what I received, and if and when booster doses are due. I am changing my ways as of now.)
10. Retrieve your immunization records from the past. Ask your parents or relatives if they recall the medical facilities you were taken to as a child. Records may still exist. Large clinics, colleges and the military tend to keep records longer than private medical offices. If you traveled internationally you may have a booklet listing the vaccines you previously received plus the vaccines you needed for the trip. Your age can be a clue; you may need vaccines that were not yet available when you were a child. In some situations a blood test determines susceptibility or immunity. If immunity cannot be established, giving you an additional dose of the vaccine is not known to be harmful.
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Playground safety – a kid’s point of view
Hey Kids! Grownups need our help in keeping us kids happy, healthy and, especially, safe. True, nothing makes us happier (or safer) than staying home, lying on the floor and watching cartoons on TV. However, we kids are told that we need fresh air and exercise, like going to playgrounds to run around aimlessly and climb on strange-looking contraptions that send 200,000 of us to ERs every year. Where’s the logic?
Here’s some advice we kids need to give grownups about playgrounds.
1. Bear in mind why you take us to playgrounds. You’re there to keep an eye on us, not to schmooze with your friends on getting us into a popular kindergarten while we’re getting hit by someone on a swing trying to reach the sky. Better supervision of us could prevent about 40% of playground accidents.
2. Many home playgrounds are unsafe. The equipment is placed into any available space, with little thought to the surroundings — next to the driveway for the family car, for example. We kids love exploring, like running around to where we can’t be seen, like a neighbor’ back yard or into an unlocked car. Often the play equipment in home playgrounds is old and was assembled from a do-it-yourself kit by someone who had never done it before and then the equipment is never checked again.
3. Take us to recently-built, public playgrounds. These are generally planned and equipped by experts who know about proper spacing between rungs on ladders, where to place hand rails and the size of openings we kids should and shouldn’t fit through. Modern playgrounds are fenced in with single exits, all areas in sight, and equipment spaced far apart. They have segregated area with different equipment for our various age groups: infants and toddlers (under 2), preschoolers (2- to 5-year-olds), and school-age kids (5 to 12-year-olds). Sure, we know that we are put into a corral but it lets us make believe that we are free-range kids for a while.
4. Falls are the most common cause of us getting hurt. We kids love to climb high. But sometimes, when we look down, we panic and let go. Never coax us into activities that scare us. Stay within arm’s reach when we climb – and be ready to catch us if we do fall.
5. Preventing falls on our heads is especially important. Most such falls occur from monkey bars, playground gyms and swings. Kids between 5 and 9 years of age are most frequently involved, boys more frequently than girls. If after such falls we act weird or can’t recall exactly what happened, it’s time for a ride to an ER.
6. Grownups, make sure that the playground has special groundcover around equipment to cushion our falls. Us kids learn the day we take our first step that falling is scary and hurts, especially falling on hard stuff like concrete. “Good” stuff to fall on includes wood chips, mulch and various rubber-like substances. Dirt and grass can feel like concrete in cold weather. Good ground cover is rarely found in home playgrounds.
7. And let us kids play only on equipment meant for our age. Seesaws, for example, are no-no’s for us toddlers and preschoolers. Such equipment requires coordination between two kids, something we can’t manage yet. And school-agers can get entangled in equipment meant for younger kids. Also, older kids, who think they’re smart alecks because they already go to school, can roughhouse or bully us younger kids, hurting us in the process. (Safety information for each type of equipment is available on the web.)
8. Dress us for safety, not to impress other grownups. Do we really care if we look like ragamuffins? Safety means no hooded jackets, scarves or clothing with ties and loose cords; these can get caught in playground equipment. No sandals or flip-flops; they may cause tripping. Long hair should be tied back. Shoes should be on securely.
9. Trampolines and sandboxes are not well-suited for us kids. On trampolines, too often we land on our heads, collide with other kids or fall off. Sandboxes are rarely covered when not in use and attract animals. And we know what animals do in sandboxes. Also, many of us real young kids are curious about what sand tastes like.
10. On family vacations, grownups, check the safety of playgrounds, pools, beaches, water slides, and such. (And, kids, no temper tantrums, if such checking delays us from having fun.) Non-professionally installed equipment is frequently found at small resorts and traveling carnivals. Be especially careful overseas. In many countries medical facilities to take care of us kids aren’t as good as they are back home.
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Teaching Young Children to Cross Streets
Crossing streets is not child’s play. In simulated studies done at the University of Iowa, when compared to adults, 8% of 6-year-olds might be hit by cars when crossing streets. The percentage drops to 6% for 8-year-olds, and 2% for 12-year-olds. Adult street crossing skills are not reached until the age of fourteen. (To read the study, see link below.) Obviously, this is a skill kids must master. Yet the subject has virtually no formal oversight. It’s entirely up to parents to do the teaching.
Here’s your first lesson:
1. Start teaching at about four years of age. It takes no extra time on your part. Talking to children is important for all kinds of reasons. This gives you a subject. Describe them everyday street scenes, everyday. At first kids may have no idea what you are talking about and show little interest. This gradually changes. Casually point out whether all the cars are going in one or both directions and that sometimes two cars go in the same direction next to each other, for example. Discuss where and when you cross and whether cars are going fast or slow.
2. Teaching basic pedestrian safety can start at about seven. Ask children to identify traffic signs and traffic lights and to explain what they mean. Discuss how small children can be difficult to see by drivers, especially in parking lots. Use toy cars at home to demonstrate various scenarios. Explain gaps in traffic. Let them “cross” you or a younger child.
3. Some children are ready to cross streets alone at about ten years. However, and very important, the precise age depends on maturity, judgment and traffic patterns in your neighborhood. Point out hazards on routes they are familiar with and later on routes they are not. Ask them what they would do if they were driving a car and saw children preparing to cross.
4. Looking left and right before crossing is not sufficient. Before crossing children should come to a full stop and judge the speed and distance away of oncoming traffic. Then they should look left, look right and, at intersections, look over their shoulders to see if cars are coming from a side street, and then look left again. (Note: This is only correct in countries where traffic moves on the right side.) When walking on the sidewalk stop at driveways. Make them aware that lit tail lights may mean that a car is backing out.
5. Some school age children have difficulty differentiating left from right and distinguishing colors. They can tell left from right by making an “L” with their thumbs and first fingers. The correct “L” is for “Left”. See diagram. And ask them if they can identify green traffic lights from red ones and green traffic lights from street lights.
6. To children it is intuitive to run across the street as fast as possible to avoid problems. However, running increases the chances of stumbling, or dropping objects and stopping to pick them up. And when more than one child is involved, running becomes a fun activity which is a distraction from correct decision-making.
7. Emphasize that drivers are not always predictable. (Children tend to think that adults are infallible.) Tell children to wait until cars make complete stops before starting to cross, not when cars are slowing down. Alert children to signs that drivers in parked cars are ready to move – motors running or lit headlights or taillights, for example.
8. Make eye contact with motorists. However, tinted windows, and cabs of trucks far off the ground, for example, make this difficult. Also, new model cars make far less noise than older ones, making listening for traffic a less effective safety precautions.
9. School bus safety requires special attention. Some school districts train children well; other do it perfunctorily. Children should be taught to avoid rough housing while waiting for the bus, not to approach buses until they stop and the doors open, inform drivers that they dropped objects close to the bus and and want to retrieve it; walk about ten feet in front of the bus, stop, and make eye contact with the driver before crossing; and to stay away from the rear wheels at all times.
10. Miscellaneous. Consider dressing children in reflective vests, even during daytime. Reinforce the dangers of listening to music or using cell phones while crossing streets, crossing between parked cars and exiting cars before an adult gives the OK to do so.
For details of the University of Iowa study, go https://now.uiowa.edu/2017/04/why-children-struggle-cross-busy-streets-safely
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Measles alert: Newark, NJ airport on Christmas Eve
Here is the latest health bulletin about a case of a vaccine preventable disease introduced into this country from overseas a few days ago. Below is an article about how you can prevent your children from being exposed. It appeared on this website two months ago.
If your family visited Newark Liberty International Airport on December 24, 2018, Christmas Eve, between noon and 4 PM you may have been exposed to measles by an infected traveler from Belgium, says the New Jersey Department of Health. It could take until January 14 for a susceptible (non-optimally vaccinated) person to develop symptoms: rash, high fever, cough, runny nose and red, water eyes. Rarely, the disease is life-threatening.
Measles spreads through the air when an infected individual coughs or sneezes. If you think that your family was exposed, please call your doctor or ER before visiting them. They will make special arrangement for you to be seen while avoiding exposing others.
When planning family vacations, check that everyone, adults included, are up-to-date on their vaccinations, lest one of you returns home with a souvenir you didn’t bargain for – a vaccine-preventable disease. Such souvenirs do not require visiting Equatorial Africa. A trip to Disneyworld or a Caribbean cruise could suffice.
1. Fewer American children are being vaccinated. The percentage of children under two years of age who are incompletely or not at all vaccinated has quadrupled since 2000, says the Centers for Disease Control (CDC). While that percentage remains small, the trend is troublesome. About 100,000 children in this age group aren’t fully vaccinated against the 14 vaccine-preventable diseases. (See list of diseases below.)2. There are several reasons parents choose not to vaccinate. Ironically, the success of vaccination programs is partly to blame. Most parents have never seen a case of these diseases and thus conclude that vaccinations are passé. Some parents believe vaccines cause the diseases that the vaccines are designed to prevent. Not so. In fact, the achiness following some vaccines is due to the immune system “revving up” to boost protection. Other parents believe that vaccines cause autism; there is no evidence for this. Still others refuse vaccines for ethical or religious reasons.
3. “Compromising” the accepted vaccination schedule to please parents is counterproductive. By 18 months of age, children who are vaccinated on schedule receive about two dozen separate injections. Such scheduling at young ages provides maximum protection while causing no serious side effects. Delaying vaccinating, increasing the interval between doses, or giving one vaccine at a time delays achieving immunity.
(Some vaccine-skeptical parents use “natural” ways to protect children. When a child has chickenpox, for example, like-thinking parents may organize a party at the child’s home and invite non-chickenpox-vaccinated children. The party takes place in an indoor tent. This assures that guests inhale the chickenpox viruses in the air that the sick child exhales, virtually guaranteeing contagion.)
4. Most countries outside the US have less comprehensive vaccination programs. In some countries, governments cannot afford the cost so programs are haphazard and rarely compulsory, and children are immunized against fewer diseases. The result: vaccine-preventable diseases remain common outside the US, including in European countries.
5. Non-vaccinated travelers (adults and children) have returned home with vaccine-preventable diseases. In the US, most children are vaccinated so chances of catching such diseases are remote. Not so abroad, especially in developing countries. Moreover, traveling with children increases your family’s odds of interacting with local children. Many of these diseases are extremely contagious, can be devastating to adults, and spread before symptoms occur. For example, measles viruses remain viable in the air for several hours. Brief exposure suffices to infect susceptible individuals. And rubella, which is currently active in Japan, is devastating for fetuses of non-vaccinated pregnant women.
6. The US “imports” infectious diseases. Millions of tourists enter the US yearly to visit theme parks and national parks and to take cruises. Some ships carry thousands of passengers and crew from many different countries. They live in close quarters, breathing the same air, for extended periods. The crew members are usually from developing countries and are immunized by the cruise operator, but only with some vaccines. Diseases may also be imported by college students (1.2 million entered the US in 2017), hundreds of thousands of immigrants, overseas adoptees – and returning travelers.
7. Diseases can be contracted in flight. However, such spread is uncommon. Cabin air is replaced every few minutes with mostly sterile air. Air circulates from ceiling to floor, not through the entire aircraft, making passengers susceptible only to those sitting in close proximity. Moist membranes and nasal hairs may help resist disease-causing viruses. Saline (salt water) nose drops restore moisture to nasal membranes that have been dried out by air conditioning. Washing hands frequently and wiping tray tables and lavatory surfaces with disinfectants may help prevent intestinal illnesses. Children should be fully immunized before traveling by air.
8. Inform healthcare providers of foreign travel as soon as you finalize your plans. Family members may require additional vaccines and preventive medications, especially when visiting developing countries, and even more so if you are planning to attend large gatherings or stay at the homes of friends and relatives. Some destinations require vaccines that require multiple doses over a period of a several months.
9. Vaccinating children for travel requires expertise. Sometimes children may require vaccines for travel at ages earlier than routine schedules call for. Such accelerated schedules are available from the CDC and the American Academy of Pediatrics. However, not all travel-related vaccines are appropriate in infants, and some are specifically contraindicated. Non-vaccinated adults also may require vaccination against childhood diseases.
10. Don’t wait until you are overseas to get necessary vaccines. Some travelers do. Travel-related vaccines usually cost far less overseas. However, most vaccines require a week or two to reach optimum effectiveness, leaving you unprotected for that period of time. In some poor countries vaccine quality, storage, syringes, and needles may be problematic.
List of vaccine-preventable diseases:
♦ Diphtheria ♦ Hemophilus ♦ Hepatitis A ♦Hepatitis B ♦ Human papilloma
♦ Influenza ♦ Measles ♦ Meningococcal ♦ Pertussis ♦ Pneumococcal ♦ Polio
♦ Rotavirus ♦ Rubella ♦ Tetanus
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Myths regarding Children/Cold weather/Health
The “official” 2019 debunking issue
Hey parents, don’t fret every time your kids catch colds. Yes, you can try preventing colds by having kids wear facemasks, not sending them to daycare or school, banning birthday parties and never having visitors. It may even help. But don’t be surprised if child welfare people come calling. Alas, myths are still the source of much (dis)information. And “new” myths keep popping up.Here’s some sense to replace “non-sense.”
1. Yes, cold weather is responsible for most colds. But indirectly. Cold weather keeps kids indoors, often crowded together with other kids, with windows shut and the heat on. This dries the air and lowers humidity, conditions that allow airborne cold-causing viruses to travel farther and stay viable longer. Low humidity also dries out nasal membranes. These membranes need moisture to effectively prevent the viruses from taking root on the membranes, multiplying and causing infection. You may be able to reduce the incidence of colds by improving ventilation, increasing room humidity, and applying saline nose drops several times a day.
2. Expect children to have numerous colds in cold weather. There are more than 100 known cold viruses. Immunity is acquired by infection, one virus at a time. Kids practice poor hygiene, sneeze and cough into the air, for example. And they shed viruses for more days before and after symptoms are present than do adults. Symptoms may last a week or two. Cold viruses do not “ping-pong” back and forth within a family. A second round of colds is due to a new virus entering the household.
3. Neither rain nor snow nor the gloom of night increase the risk of catching colds. Nor does wet hair, drafts, wearing winter clothing indoors, being “run down” (whatever that is) or lack of sleep. And kids can play outdoors with colds. Cold weather does not prolong, worsen or bring on new colds.
4. Wearing hats is not especially important to preserve body heat. Some myths claim that in cold weather the body loses much heat through the head. In fact, body heat loss is related to the area of skin exposed to the air regardless where on the body – and is actually less from the head if the child (or adult) has a thick crop of hair. However, in really cold weather, going hatless is as silly as wearing shorts rather than long pants.
5. No need to dress kids in one layer more than adults wear. To do so can be counterproductive. Modern winter clothing effectively protects the body from cold, wind, and wetness while retaining body heat. However, with activity, children perspire. Perspiration can soak inner layers of clothing. Wearing wet clothing, whether from perspiration or the elements, is like standing naked in the cold. When kids perspire, remove a layer of clothing, open ventilation zippers, unbutton jackets and take sleeves out of gloves. If kids are happy, active and dry, no need to worry about the cold.
6. While cold weather increases the need for calories, cold increases appetite accordingly. Even poor/picky eaters get the calories they need. The benefits, if any, of extra vitamins, zinc, Echinacea, and foods rich in antioxidants, for example, are largely unproven. Feeding fevers and starving colds (or is it vice versa?) is nonsense.
7. Warm drinks have negligible effects on increasing body heat. Do encourage kids to drink. If kids like hot cocoa, fine. If they don’t, let them drink whatever else is appropriate, hot or cold. Milk does not increase mucus production. Positive effects, if any, from warm beverages are psychological.8. No cures for colds. Most children’s cold remedies are ineffective – and the rest are potentially harmful due to side effects. Fever is a sign of illness but for children otherwise active and happy no treatment is indicated. Acetaminophen (Tylenol) and ibuprophen (Motrin and Advil) reduce fever and relieve aches, but do not shorten the duration of colds. Get prompt medical evaluation when children run fevers and, in addition, are less active than usual and not eating and drinking.
9. Kids who come indoors with runny noses are not necessarily ill. The nose warms and humidifies inhaled dry air by secreting moisture. Some of this moisture reaches the cold tip of the nose and condenses into a watery discharge.10. Influenza (flu) is a distinct and serious illness. It is not just a bad cold. Some children with flu require hospitalization. Flu vaccines prevent or ameliorate a large percentage of flu cases, but not all. There are no known serious reactions to the vaccine. Because the vaccine is given during the cold season, by chance, colds may follow soon after the vaccine. All children six months of age and older should be vaccinated.
Caution: New car odors may be hazardous for infants. An update.
A newborn in your home and a new car in your garage are events worth celebrating. But celebrate them separately. Resist the urge to take your baby for a spin in your new car to show baby and car off to your neighbors. New car odors may be hazardous for an infant’s wellbeing – and not particularly healthy for the rest of us.1. New car odors consist of gasses emanating from the 100 or so plastic products found inside cars. Products include most everything: seat covers, steering wheels, armrests, carpets, drink holders, sun visors, and dashboards, to mention just a few. All are made of volatile organic compounds (VOCs) and, when new, emit vapors that are toxic to humans, especially to newborns and young children.
2. Not known is how hazardous the odors are. In animal studies, very high levels of VOCs inhaled over prolonged periods of time are linked to cancer and other serious illnesses, says the US Environmental Protection Agency. However, these facts cannot be accurately extrapolated to infants. Infants spend limited time in new cars and aren’t exposed to the high levels of vapors used in the studies. Nevertheless, researchers suggest that parents (1) minimize the time infants inhale the vapors and (2) rid cars of the vapors.3. Toxic levels of vapors decrease gradually. In one study, the day cars left a dealership the toxic vapor levels were about thirty times what is considered safe. Safe levels were reached in about four months. To be cautious, consider cars safe after being in use for six months and when no odor is detectable. Insignificant amounts of VOCs may remain for three years and can become troublesome if the interior of the car becomes extremely hot.
4. Methods to lower odor levels. Whenever possible, park outside, even overnight, with windows open. Avoid parking in small indoor garages. Every week or so, wipe the car’s interior with a damp microfiber cloth and vacuum upholstery and flooring with a machine that has a HEPA (high-efficiency particulate air) filter, available at car washes and auto supply stores. When driving, run the vents on high, using the “fresh air” setting to bring outside air in.5. Allow new cars that have gotten hot to cool down before infants and children enter. When possible, park cars in the shade. Temperature inside cars parked in the sun on hot days can reach 190 degrees Fahrenheit (88 degrees Centigrade). Heat leaches VOCs out of plastics; the higher the temperature, the more leaching. After cars are parked in the sun, move them into the shade, turn on the AC, open all doors and wait until the cars are cool and odor-free before allowing infants and children in. Consider purchasing solar window shades.
6. Use heat to leach out toxic odors. Intentionally park your car in the hot sun. Let it stand for a couple of hours with the windows closed. Then move it into a shady place and let it stand for additional hours with the doors open. If the sun is uncooperative, substitute the car’s heater for the sun. Do this outdoors to avoid carbon monoxide poisoning.7. Don’t make your old car smell like a new one. Car air fresheners are available that duplicate the odor of new cars – and may contain some of the same toxins as new cars. Manufacturers of car air fresheners don’t have to list the ingredients of their products. (Ditto for room air refreshers.) Many air fresheners merely disguise odors without neutralizing them. This includes substances often used for this purpose such as baking soda, vinegar and charcoal. You need industrial-strength odor eliminators do this. These are available at auto supply stores.
8. Do new car smells affect older children and adults? The common custom of slowly, deeply and repeatedly inhaling the vapors to better enjoy the aroma of new cars is akin to glue-sniffing, with similar unhealthy affects, as the two have similar ingredients, says the Daily Telegraph, a British newspaper. Immediate symptoms include sore throats, headaches, dizziness, and nausea, depending on the sensitivity of the individual. Little is known about long-term effects, if any.9. New cars are becoming “healthier.” At the urging of government regulators, mostly those in Europe, automakers are putting more effort into using materials with fewer and less toxic VOCs. Automakers are also increasing the use of entirely natural soy-based materials, while installing better ventilation and filtration systems to get rid of the vapors. Many new car dealers can supply information about this.
10. Miscellaneous. No information is available on the effects, if any, of VOCs on the fetuses of pregnant women or infants of breastfeeding mothers. However, researchers suggest pregnant and breastfeeding women should limit their exposure. Various VOCs and VOCs-neutralizers may cause respiratory-type allergic symptoms, especially in allergy susceptible children. Many websites discuss the VOCs levels in specific car models. VOCs may be toxic for pets. For additional information, see https://www.wikihow.com/Get-Rid-of-New-Car-Smell
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