Dr. Karl Neumann's KidsTravelDoc
A pediatrician's guide to travel and outdoor recreational activities
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.
Was this article informative? Sign up to receive similar articles twice a month. Each article covers a single subject to keep kid(s) healthy and safe for travel and outdoor activities. Widely read by healthcare professionals and sophisticated parents around the world.
Safe and Healthy Travel
Prevention
Outdoor Recreation
Travel
Destinations
Food & Water Precautions
Sun
Air Travel
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.
Was this article informative? Sign up to receive similar articles twice a month. Each article covers a single subject to keep kid(s) healthy and safe for travel and outdoor activities. Widely read by healthcare professionals and sophisticated parents around the world.
Safe and Healthy Travel
Prevention
Outdoor Recreation
Travel
Destinations
Food & Water Precautions
Sun
Air Travel
KidsTravelDoc Newsletter
Dr. Neumann, August 2019 photo by Michael Perlman 
Dr. Neumann examines medical facilities for travelers in Uganda circa 2014. 
Dr. Neumann greets Taiwan President Lee Teng-hui, president from 1988 to 2000 while giving a lecture on travel medicine. 
Dr. Neumann is the recipient of an honorary doctorate degree in travel medicine in Glasgow in 2010. 
Banner photo: Dr. Neumann observed the vaccination program to eradicate polio in Cameroon in 1998 at the Ministry of Health. Sunglasses for young children: there is a lot for you to know
Consider making your next baby gift a pair of sunglasses – a gift that is thoughtful, unique, practical, a gentle reminder for new parents to start sun protection early, and, hopefully, a trendsetter that others will follow.
1. Infants’ eyes absorb more harmful ultraviolet (UV) rays than adults. Infants have relatively large pupils, allowing more light to enter. And their lenses contain less pigment to absorb radiation. Moreover, infants tend to look directly into the sun – though reflexes quickly make them blink and look away. Children with fair complexions are especially vulnerable.
2. Children spend more time outdoors than adults. We get a large percentage of our lifetime sun exposure by the time we are eighteen years old. While about 80% of parents acknowledge the importance of wearing sunglasses, more than half of children seldom or never wear them. Damage is cumulative over a lifetime, causing cataracts and other eye problems later in life.
3. Sunglasses and certain hats protect eyelids and skin around the eyes. These areas have delicate skin and burn easily. Using sunscreens is impractical: children won’t hold still for you to apply it, and spray products are not recommended for the face due to risk of inhalation. Sweat, tears, and water can cause sunscreens to seep into eyes, causing burning. Use sunglasses with large lenses and that wrap around toward the ears. This prevents rays from coming in around the glasses. Dress children in sun-protective hats with brims at least three inches (7.5 centimeters) wide and that extend around the head.
4. Sunglasses also protect eyes from injury. Choose ones that are impact-resistant, made of shatterproof polycarbonate, not glass, and have flexible frames. Such frames are less likely to be damaged when children play with them or leave them where they can be stepped or sat on. Impact-resistant glasses are recommended for sports.
5. Be aware of unusual sun exposure. This can occur in cars, for example. Side and back windows may not protect against all radiation. Ask your car dealership about the option of installing transparent UV-blocking window film. Note that the sun may come from different directions as you drive. Check where the sun is when you carry an infant on your shoulder or back. Sunshields are available for strollers and carriages. (Skin- and eye-damaging UV rays may also penetrate window glass in homes, trains, buses and planes.) Infants less than six months should have no sun exposure.
6. Buy sunglasses from reputable stores that sell eyeglasses. Beware of “fun” or “novelty” sunglasses. These are mainly marketed for children’s entertainment or “self-esteem,” or so they can make a “fashion statement.” Such sunglasses are widely available on the web and at variety stores at beaches; they offer little or no UV protection. Rarely such glasses, especially ones with wide frames, may contain lead.
7. Special features to look for. All sunglasses should block 99 to 100 % of UV rays. 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. Straps help keep glasses in place – and help prevent loss. Dark lenses are no more protective than light ones; protection results from treatment of lenses. Replace glasses when they become scratched. Good sunglasses need not be expensive. Cost mostly reflects frames, not protection. Polarized lenses reduce glare making wearing them more comfortable. Avoid heavy frames to minimize possible discomfort.
8. Being in the shade of a building while having blue sky directly overhead offers little protection. This is also true of fluffy clouds. Being under a beach umbrella protects from direct sunlight but allows considerable radiation reflected from water and sand. Dirt, grass and concrete reflect comparatively little radiation. Minimize outdoor activities between 10 AM and 2 PM when radiation is most intense.
9. Winter days in snow country are as harmful for eyes as summer days at the beach. Snow reflects up to 85% of direct sunlight; this is additive to the direct sunlight. Many winter activities take place in snow-covered hilly terrain, adding radiation from different angles. Modern winter clothing allows more time spent outdoors. Altitude increases radiation; the higher the elevation, the less atmosphere to filter out harmful rays. Cold weather and the sun low on the horizon offer little protection. Many experts recommend wearing sunglasses year-round when spending extended periods outdoors.
10. Getting young children to wear sunglasses can be a hassle. Most young children seem to enjoy them; they make everything appear more colorful. Other children are hesitant. Try various doses of age-appropriate patience, coaxing, compliments, flattery, rewards/bribery and firmness (e.g., a “no going out without them” rule). Have periods daily when all family members wear sunglasses. Point out other children wearing them. Let older children pick out their own pair. Some children, especially children with special needs (ADHD or autism, for example) may be fearful of sunglasses. Check the websites of organizations devoted to such conditions for tips to help you manage.
Was this article informative? Sign up to receive similar articles twice a month. Each article covers a single subject to keep kid(s) healthy and safe for travel and outdoor activities. Widely read by healthcare professionals and sophisticated parents around the world.
Safe and Healthy Travel
Prevention
Outdoor Recreation
Travel
Destinations
Food & Water Precautions
Sun
Air Travel
Facts you may not know about protecting your children from the sun
Little darlings, it’s been a long coronavirus winter
Little darlings, it feels like years since the sun ‘s been hereLittle darlings, I feel that the ice is finally melting
Little darlings, it seems like years since the sun ‘s been hereLittle darlings, the smiles are returning to children’s faces
Here comes the sun, here comes the sun, and I say, it’s all right…The Beatles (with editing)
Yes, here comes the sun, and, yes, it is all right – children need to go outdoors to end our winter of discontent – as long as you protect your little darlings from that fireball up in the sky.
1. June is the month when sun protection is often overlooked. The weather tends to be cool, but the sun is directly overhead and shines the most hours. Don’t let cool weather lull you into complacency. Temperature has nothing to do with the sun’s intensity. Also, in June, protective tans from the previous summer have vanished, possibly leaving children more vulnerable to burning. Not that tanning is a panacea. Every tan is skin damage and it is cumulative over a lifetime.
2. The basic concept for using sunscreens is often misunderstood. Sunscreens are not intended to prolong the amount of time that children (and adults) can safely remain in the sun – though in practice this is what often occurs. Sunscreens are meant to protect skin when sun exposure is important, for playground activities, for example, with the place and time of day chosen to minimize exposure.
3. Most experts recommend physical sunscreens for children. These contain zinc or titanium as the active ingredient. They coat the skin, prevent tanning and can be applied just prior to sun exposure. Chemical sunscreens are recommended less often. They contain various chemicals as active ingredients, may permit some tanning, are effective by being absorbed into the skin, and must be applied 20 minutes before exposure. Some of the chemicals may enter the blood stream. This is presently under study as being a possible health issue.
Most parents apply far too little sunscreen and apply it too infrequently. Check labels for how much (often in tablespoons) is needed to cover children of different sizes. Generally, sunscreens with SPFs of 30 are adequate. Using white colored sunscreens helps prevent skipping areas that need covering. The degree and duration of protection is reduced by wind, water, towel drying, and excessive perspiration, for example. Sunscreens should protect against both UVA and UVB radiation.
4. Consider using sun-protective clothing. Such garments cover most of the body, including much of the head, the ears and the back of the neck. This greatly reduces the need for sunscreens. The clothing is lightweight and allows air to circulate, keeping the wearer relatively cool. A rating system, ultraviolet protection factor (UPF), describes the clothing’s effectiveness. The higher the UPF, the greater the protection. Fabrics rated below UPF 15 are not considered protective. UPFs of more than 50 add little additional protection.
5. Infants less than one year of age should be kept out of the sun – with one exception. Infants’ skin is thin and contains little melanin, the substance in the skin that protects from the sun. However, if sun exposure is unavoidable, using sunscreens is safer than risking sunburns. Use the same protective measures as used for older children.
6. No need to purposefully expose children to the sun to maintain healthy bones. True, the sun activates Vitamin D, which is necessary for the body to absorb calcium from food. Calcium is essential to grow healthy bones. However, the time in the sun necessary to absorb Vitamin D is minimal – even when sun-protective clothing is worn. Many foods are fortified with vitamin D.
7. Waterproof sunscreens have yet to be invented. All eventually wash off, usually sooner than later. In the US, products can no longer be labeled “waterproof” or “sweatproof;” they can be called “water-resistant.” Labels are required to state whether the sunscreen remains effective for 40 minutes or 80 minutes when swimming or sweating profusely.
8. Familiarize yourself with the UV Index. In the US, daily readings of sun intensity are available for virtually every zip code. Forecasts include predictions for the next few days and the degree of protection required to minimize skin damage. See https://www.epa.gov/sunsafety/calculating-uv-index-0
9. African-American children need protection too. Children with much melanin in their skin are not immune from sun damage though the incidence is very low. Nevertheless, parents must be vigilant. The darker the skin, the more difficult it is to spot skin abnormalities.
10. Miscellaneous. Don’t confuse SPFs with UPFs… Never leave sunscreens in a parked car in hot weather. Excessive heat rapidly reduces potency… Most sunscreens have expiration dates of three years… The brims of sun-protective hats should be at least three inches (7.5 centimeters) wide and extend around the head… Many medications, including some over-the-counter ones, increase the effects of sun damage. Check with your healthcare providers or on the web.
Was this article informative? Sign up to receive similar articles twice a month. Each article covers a single subject to keep kid(s) healthy and safe for travel and outdoor activities. Widely read by healthcare professionals and sophisticated parents around the world.
Safe and Healthy Travel
Prevention
Outdoor Recreation
Travel
Destinations
Food & Water Precautions
Sun
Air Travel
The ABCs of children covering their faces in a pandemic
Children two years of age and older should wear cloth face coverings outdoors if other people are nearby, says the US Centers for Disease Control (CDC).
1. Protection may be especially important at the present time. For better or worse, many jurisdictions are loosening restrictions on isolation in order to reopen the economy. That means more children (and adults) will be venturing outdoors – while the virus is still circulating. In some jurisdictions wearing masks outdoors is mandatory, with fines for the “unmasked.”
2. Having your children wear a face covering protects your entire family. Especially during a pandemic, your child may encounter people infected with the virus but showing no symptoms. Yet such people shed the virus into the air when they talk, sneeze and cough. And they may not be wearing face coverings and your child may not observe social distancing. Moreover, very rarely, the opposite occurs. Your asymptomatic child may be the one shedding viruses. Then your child’s face covering protects others.
(Many experts suggest replacing the phrase “social distancing” with “physical distancing.” Distancing is the key word here. Socializing should be encouraged – but at a distance.)
3. Optimal protection calls for wearing the right face covering, wearing it correctly, and wearing it when and where necessary. Traditional masks are not essential. Scarves or other cloth face coverings that fit comfortably and securely over the nose and mouth offer protection. Such face coverings should consist of tightly woven material that allows little light to pass through when held up to a light.
4. All you need to know about facial coverings is on a CDC website. It’s illustrated and a must read. Learn how to make face coverings (surprisingly simple), how to fit them on children, when and how to launder them, and much, much more. See https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/diy-cloth-face-coverings.html
5. Children under the age of two years need not wear masks. Placing masks on this age group can be near impossible. Moreover, wearing face coverings presents a remote risk of choking or suffocating. Generally, infants and toddlers can be adequately supervised outdoors by keeping them in carriages and strollers.
6. Young children react to face coverings in various ways. Some take to them as they take to lollipops – with enthusiasm. Others are reluctant to wear them, probably because they find them uncomfortable and make breathing a bit difficult. And some children become apprehensive when seeing face coverings on their parents. Likely, in those children’s thinking, face coverings make parents “disappear” along with the parent’s facial expressions which convey acceptance and security.
7. Getting young children to wear face coverings is not child’s play. It takes various doses of patience, coaxing, flattery, rewards/bribery and firmness, as appropriate to the child’s age. Have periods daily when all family members wear them. Make sure face coverings fit well but not too tightly. Use material with the child’s favorite cartoon character but be aware that many cartoon character face coverings available online are fun masks intended for children’s parties, not for preventing infections…. Let children see themselves in a mirror wearing one. Place a face covering on the child’s favorite stuffed animal.
8. Make face-covering time less onerous. No need to wear them for routine car drives, for example. Provide children with treats and toys to keep their hands and minds occupied. This also deters them from touching, pulling on, or placing their fingers under their face coverings.
9. During a pandemic, initiate COVID-19 precautions every time children have fever, cough, nasal congestion, vomiting or diarrhea. While every healthy child has these symptoms many times each year, ruling out COVID-19 is difficult. Start strict isolation procedures, including face coverings, immediately. Take temperatures several times a day. Continue precautions until you have spoken to your pediatric health care providers. Let them tell you what to do next. This is the age of telemedicine.
10. Miscellaneous. Many children with special needs (ADHD or autism, for example) are fearful of face coverings. Check the websites of organizations devoted to such conditions for tips to help you manage… Face coverings supplement – not replace – other practices for preventing COVID-19 spread. Continue distancing, frequent hand washing, and leaving home only when essential… Children who are considered high-risk or severely immunocompromised are encouraged to wear professional N95 masks… If you must take your child to a medical appointment, call ahead to see if medical facilities are running on time, and again before entering the door. No need to sit in a small exam room for extended periods.
Was this article informative? Sign up to receive similar articles twice a month. Each article covers a single subject to keep kid(s) healthy and safe for travel and outdoor activities. Widely read by healthcare professionals and sophisticated parents around the world.
Safe and Healthy Travel
Prevention
Outdoor Recreation
Travel
Destinations
Food & Water Precautions
Sun
Air Travel
Follow Us on Social Media
