Quiz: Look at the pictures. How could the adults and children improve their sun protection? Answers at the end of the article.
If you live in snow country or are planning to take your kids on a visit there, outfit them with a pair of snow-appropriate sunglasses (“shades,” in teen talk). While the sun’s warming rays are off frolicking in the tropics, the troublemaking ultraviolet (UV) ones bombard us the year ‘round. Snow worsens the rays’ effects, with young children particularly at risk. Yet a mere third of parents correctly protect their children’s eyes from the winter sun.
Here is what you should know:
1. The sun burns the outer layers of the eyes just as the sun burns skin. And, as with skin, damage occurs each time of exposure, with the effects cumulative for life. The younger the child, the more years of damage ahead. Children’s skin and eyes contain less melanin than adults’. Melanin is the substance that helps block out the damaging UV rays.
2. A winter day in snow country can be more damaging to eyes than a summer 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. Modern winter clothing allows kids to spend more time outdoors. Many winter activities take place in snow-covered hilly terrain, allowing reflected rays to penetrate eyes from different angles. Most winter resorts are located at higher elevations; the higher the elevation, the less atmosphere to filter out harmful rays.
3. Recognize early signs of too much sun. Symptoms include sensations of discomfort, perception of brightness, difficulty blinking, and dryness and redness of the eyes. Such discomfort, often called snow blindness, is often erroneously attributed to wind or cold. Unfortunately, the onset of such symptoms generally occurs many hours after exposure, making prevention particularly important. While the immediate effects of snow blindness are generally reversible, the cumulative long-term effects are a major cause of impaired vision in the elderly.
4. Consider sun exposure when infants cry excessively. Minimize exposure; thirty minutes suffice to cause discomfort. Check if the sun is in an infant’s eyes when you push them in a stroller or carry them in a backpack. Sun shields are available for strollers and carriers. (Other causes of infants crying in cold weather are frostbite and tight clothing.)
5. Seek shelter from the sun. Ideally, go indoors or into a car. The shade from buildings or mountains offers virtually no protection from UV rays if the sky is visible directly above. When shelter is unavailable, place a loosely woven scarf or ski hat over the eyes, allowing some vision. Relieve discomfort with cold compresses, ibuprofen (Motrin, Advil) or acetaminophen (Tylenol), a dark environment, and saline eye drops. Seek medical help, if necessary. Virtually all cases heal spontaneously over a few days. But damage is cumulative.
6. Buy children’s sunglasses from eye care professionals. Sunglasses are available in supermarkets and variety stores and may be less expensive there. But there is no one to help you select correct ones. Some sunglasses for children are “fun glasses” − meant for children’s parties and offer no protection.
7. Most summer sunglasses allow too much light into the eyes for snow country. Choose ones that give 100% protection against both UV-A and UV-B radiation, fit snugly, cover the entire area between the eyebrows and middle of the cheeks, and wrap around toward the ears. Wrap-arounds prevent rays from entering from the side and help prevent irritation from wind. Large lenses protect from flying ice particles and dirt and from branches when skiing and snowmobiling. Glasses need not be expensive. Cost is mostly related to frames. Polarized lenses add cost and reduce glare, increasing comfort but adding no protection.
8. Hats with brims three or more inches wide help protect the eyes as well as the eyelids. The skin of the eyelids is thin, fragile and susceptible to damage that may cause cancer decades later. Ski caps and helmets offer no protection; baseball caps offer limited protection. Some winter sports call for protective goggles.
9. Insist that children wear sunglasses. No exceptions. In fact, most infants and toddlers enjoy wearing them. Allow them to see their surroundings in different colors. Let them choose color and style. Wear sunglasses yourself. Adjustable straps help keep glasses in place.
10. Miscellaneous. Teach children never to look directly at the sun. Check if medications your children take increase sensitivity to the sun. UV damage to the eyes occurs all day, even when the sun is low on the horizon.
Answer to the quiz: (a) None of the sunglasses wrap around to the ears; (b) No one is wearing a hat with a wide brim.
If a car seat containing an infant is placed “just for a moment” on a non-moving conveyor belt at an airport security machine the infant may pass through the machine.
It has happened. How? Parent places car seat on the belt. Parent turns around to take off his/her shoes or to tend to another child. Belt starts. Infant enters machine. Parent hysterical. Infant unharmed. Radiation negligible. (One grandmother intentionally placed her infant granddaughter in a baggage bin and sent her through the machine, thinking it was mandatory to do so.)
In fact, family trips involving air travel are quite safe for infants and young children. Mishaps are rare, mostly preventable, and more likely to occur at airports than in flight.
Here’s how to make your family’s airport experience safer and less stressful:
1. Security screening machines are safe for infants (And for pregnant women.) No X-rays are involved. Presently, passengers are screened by advanced imaging technology (AIT) or by metal detectors. AIT uses non-ionizing radio-frequency energy. Both techniques have been extensively studied and have no known harmful effects. Parents do have the option to decline such screening in favor of pat-downs. Low dose X-rays are used to scan items on conveyer belts but cause no harm to milk, other foods, medications (or infants). For details on screening children, see https://www.tsa.gov/travel/special-procedures/traveling-children.
2. Sign up with . The Transportation Security Administration (TSA) has programs especially helpful for parents. It allows adults and their children under the age of twelve to go to the head of the security line on domestic flights. Registering for the program requires filling out a form online, a onetime visit to a TSA office (usually at an airport) and a onetime fee. A similar program, TSA Goes is available for overseas travel. See http://kidsareatrip.com/tsa-precheck-what-you-need-to-know-and-how-to-apply/.
3. Prepare for screening process. Carry tickets and ID items in an easily accessible place. Empty your pockets – and those of your children – of items that set off alarms to avoid passing through the detector again or a hand search. Wear shoes that are easy to remove. Place strollers on the belt first so that they will be available first on the other side, enabling you to place your infant in the stroller while you retrieve other belongings. Consider wearing a sling carrier to hold infants, freeing your hands for other chores.
4. Instruct older children not to make jokes about terrorism, weapons or explosives. Security personnel take mention of such subjects very seriously, even from children, possibly resulting in delays, missed flights and (extremely rarely) fines. Authentic-looking toys and knives may cause similar problems.
5. TSA also has a website and a telephone helpline for screening children with disabilities. “TSA works closely with disability advocacy groups to help understand their needs and adapt screening procedures accordingly.” See https://www.tsa.gov/travel/special-procedures/traveling-children. Call the helpline (1-855-787-2227) about 72 hours ahead if you’ll need specific assistance for your child. If necessary, they will arrange for personnel to assist you on your arrival at the airport
6. Prevent accidents. Injuries to pedestrians occur daily at large airports. For example, many drivers of carts transporting people around airport terminals are poorly trained, and drive too fast, and many carts emit no noise. Children make sudden moves, sometimes darting into the path of carts. Lately, more carts are equipped with flashing lights and beeping sounds when in motion. (Some airports have speed traps to check on how fast cart drivers go.)
7. Avoid escalators. Injuries result from carts, luggage and strollers falling down escalators and when people fail to quickly step away from the escalator when getting off. Leave a few stairs or a short distance empty before entering an escalator or moving sidewalk. Be careful with strollers. On down escalators, the first few steps are level at the onset, forming a platform, giving you a sense of false security. Wherever there are escalators there are elevators, often out of sight. Ask.
8. Parking lots are hazardous. They intermingle people and cars and require drivers to back in and out of spaces. And children can be near impossible for drivers to see. Airport lots may be especially hazardous. Much time is spent milling about to load/unload children, toting luggage may leave no hands to hold children, and the shortest walk to the terminal may entail walking between cars.
9. Many airports provide children-friendly facilities. Ask. They generally have playrooms, restrooms, diaper changing facilities, and breastfeeding rooms. Some airports have special attractions. Chicago O’Hare has an interactive exhibit featuring a cargo plane that needs fueling, a cockpit in a fantasy helicopter, and an air traffic control tower. San Francisco International has an aquarium. Boston Logan has a baggage-claim slide. Many airlines provide free transportation within terminals for families with children.
10. Miscellaneous. The most common accident at airports is falling over luggage, often your own. Consider leashing rambunctious children and placing toddlers in strollers, even if they usually walk. This reduces accidents and prevents children from becoming lost. Milk and other liquids necessary for young children may be carried in larger amounts than otherwise allowed. US authorities are easing rules governing the carrying of breast pumps and related paraphernalia though security screening.
For in-flight health/safety issues for infants, see tinyurl.com/p2lse2d
Season greetings! Tis the season to be jolly. However, the very events that make holiday seasons so special for kids – festive atmospheres, gifts, and visiting friends and family – also cause holiday-related illnesses and mishaps.
Here are some tips to help you make the holidays healthier and safer.
1. Give your friends and relatives the gift of declining their invitations when your children are ill. And hopefully, they will disinvite you if someone at their end is ill. Family gatherings bring together people of all ages, from different communities, crowd them into close contact, with much hugging and kissing, ideal for exchanging disease-causing viruses. Kids with fevers accompanied by coughs and runny noses, for example, are likely contagious. Also, are your family’s flu shots up-to date?
2. Mentally baby-proof homes you visit. This is especially important in homes without children. Each year, American ERs see about 15,000 injuries resulting from holiday festivities. Serious hazards include lamps that can be pulled down, curtain cords that reach the floor, and tree ornaments. Place fragile ornaments sufficiently high that young children can’t reach them. Check that doors and windows are locked; they are often left open during parties. Very rarely, children have been shot by children finding poorly stored guns.
3. Consider poisoning when children become ill. Stomach upsets and peculiar behavior at parties or soon thereafter can be due to ingesting mistletoe, holly berries and other plants, or alcoholic drinks (left on coffee tables), or medications (carelessly left on nightstands), for example. The telephone number of the National Poison Control Center is 800 222 1222.
4. Ask about smoke and carbon monoxide monitors – especially for overnight visits. Each year, more than a thousand home fires are related to holiday decorations. Malfunctioning heaters to warm spare rooms and extension cords also start fires. Keep candles at least 12 inches from flammable objects.
5. Appoint a designated “toddler watcher.” Everyone wants to play with infants and toddlers. But when “everyone” watches them, no one is in charge, and toddlers wander off. When not overseeing your child yourself, make sure that someone responsible is, and that they personally return the child to you.
6. Be wary of pets. No dog is totally predictable, especially ones not accustomed to children. Two-thirds of dogs that bite have no history of aggressive behavior. Toddlers may innocently incite dogs by suddenly running towards them, arms flailing and making happy noises – behavior dogs often interpret as threatening. Pets become edgy with numerous and unfamiliar people, much activity and noise and owners ignoring them.
7. Check toys. Well-meaning guests may bring presents that are age-inappropriate, with sharp edges or small pieces, or not include safety items to go with the presents, helmets for skates and bikes, for example. Toys may have been brought from overseas and bypassed safety inspections. Toys requiring plugging into electric circuits are inappropriate for children younger than 10 years of age. Avoid toys which require small batteries – these can become detached and swallowed.
8. Be wary of food left standing at room temperature for long periods. Hosts may be inexperienced catering for large groups. Guests also bring food. Buffets are popular. With people coming and going, food is left standing unrefrigerated. Creamy items are especially likely to spoil. If your child has serious food allergies assume that hosts may be unaware of all the ingredients in the food that they serve.
9. Have infants and toddlers sleep in their own crib. For overnight stays, portable travel cribs are handy. Avoid “heirloom” cribs. These may date back to before stringent regulations regarding paint and spacing between slats. Also, avoid “co-sleeping. Infants have been injured falling off beds, or by adults rolling onto them, (especially obese and sound sleeping adults). Infants may experience breathing difficulties by burying their heads into pillows, blankets and loose bed linen.
10. Children who take baths and showers alone at home may need assistance elsewhere. Many bathroom fixtures are difficult to decipher, even for adults. Children receive burns in showers by turning on the hot water and then falling, trying to escape the water. Most tub injuries occur exiting the tub. Grab bars in tubs and showers may not be reachable by children. Instead, they reach for non-weight bearing towel racks, which pull off the wall. Floors wet from splashing increase the accident risk.
Don’t be surprised when planning your baby’s first trip – whether across town or across the ocean – becomes a monumental undertaking, not unlike outfitting a cruise ship for a long voyage. For one, how do you carry your baby plus all the paraphernalia he or she requires?
1. “Wearing infants” is the most practical way to transport them. While wheeling or carrying them in a car seat may be somewhat safer, these conveyances have shortcomings. Wheels can’t go everywhere and seats are heavy, clumsy, and fatiguing for the adult carrier. The least safe way of transporting infants is in your arms. A squirming infant or toddler is a distraction and may block your view when you walk, which can affect your balance, causing you to stumble.
2. But infant carriers can be problematic. Issues arise when you wear carriers incorrectly, are unaware some types may be hazardous for certain infants, or have not been notified that your carrier has been recalled for a newly found defect.
3. Familiarize yourself with various models before buying one. There are chest, front and hip carriers, each with numerous variations. At purchase time, “test walk” a few. Find an object that weighs approximately the same as your infant. Practice assembling the carrier and walk it with the weight. Have someone with experience accompany you. Infants have been injured when they were improperly placed into a carrier or when an incorrectly assembled carrier came apart. Carriers come with written directions and, sometimes, videos. Read/watch carefully.
4. Prior to purchasing one, make sure that you are comfortable wearing it. Some salespeople tell you that aches experienced when first wearing one are temporary. Not always so. Select one that is comfortable immediately and doesn’t tilt or pull you to one side, affecting your balance.
5. Match infant to carrier. Most carriers have minimum/maximum weight limits and need replacing as infants grow. Sling-types keep infants’ heads upright. Backpack carriers are the most comfortable for adults, especially when carrying older infants, and for long walks/hikes, but should not be used until infants can sit unassisted. Many carriers come with headrests. Front strap-on carriers tend to cause back and neck strain for the adult. Generally, the most practical ones for younger infants are front-carriers; they allow you a full view of the baby.
6. Take special care when using carriers with very young infants. Infants cannot support their heads until four or five months of age. They bend their chins onto their chests, possibly compromising their airways and reducing the amount of oxygen that gets into their lungs. This also impairs their ability to cry for help, increasing the risk of suffocation.
7. Check frequently that an infant’s nose and mouth are free. Many carriers consist of soft fabric, which can contour over the infant’s face, impairing breathing. Even if the fabric only partially covers the nose/mouth, the infant’s ability to inhale oxygen-rich air is impaired and forces him/her to re-breathe air with less oxygen. A similar situation can arise if the infant’s head is covered with a blanket (for breastfeeding, for example).
8. Certain infants are at risk for additional breathing issues. This includes infants born prematurely or with an unexplained low birth weight, or who were one of multiple births or experienced significant heart/lung problems at or soon after birth. Such infants, for the first year of life, even if they appear healthy, have less heart/lung reserve when their breathing is compromised. (They are also more likely to have breathing issues with upper respiratory infections and during air travel as lower cabin oxygen levels require more forceful breathing.)
9. Be leery of hand-me-down carriers. Products for young children are frequently modified for safety reasons. Previously used carriers may lack the latest safety features and may have been recalled by the manufacturer. Register warranties with the manufacturer at time of purchase so you can be notified if recalls occur. The US Consumer Product Safety Commission maintains a website, https://www.cpsc.gov/recall-products/baby-carriers/ where recalls and other problems are posted. You can also sign up to get recall notices by email. Go to www.cpsc.gov/cpsclist.aspx.
10. Unusually cranky infants in carriers may be asking for help. “The sun is shining in my eyes.” Sunshade attachments are available for some carriers. “I’m hot.” Most sling carriers consist of thick fabric that acts like a blanket, increasing an infant’s temperature in hot weather. Some slings have mesh sidings or flaps to allow air in. “I just touched a rose bush. My finger is bleeding.” Be aware of your surroundings. And “my foot is caught under my backside.” Ensure infants are placed properly.
Miscellaneous facts about infant carrying. Carriers are not substitutes for car seats. Don’t use carriers while cooking or in other potentially hazardous places. When picking up an object from the floor while wearing a carrier, bend at the knees rather than at the waist. Keep an eye out for carrier wear and tear. Small infants can fall through leg openings of carriers designed for an older child. Baby carrying is not safe while you are riding in a car.
When planning family vacations, check that everyone is up-to-date on their vaccinations. Adults included. Travel increases the risk of catching a host of preventable diseases: measles, mumps, rubella, meningitis and whooping cough (pertussis), to name just a few. And you need not visit Equatorial Africa to become infected. Anyone not fully vaccinated can become infected without leaving this country, especially if you frequent places where travelers congregate such as theme parks, on flights and on cruise ships. Rarely, you can catch one of these diseases in your own eighborhood.
1. Travelers spread diseases. Already in the 14th century, passengers arriving in Venice by ship from plague-infested countries were forced to stay aboard ship for about forty days, until it was clear that the disease was absent. (“Quarantine” comes from the Italian word for forty days.) When Europeans first came to America they brought with them diseases previously unknown in the New World, decimating local populations.
2. More people are traveling than ever before. Every year, millions enter the US, lots of them from poor countries with less than optimal immunization programs. Many are children, the main culprits when it comes to spreading these diseases. They visit amusement parks, fly on domestic airlines, and visit friends and families — sometimes in your neighborhood.
3. There is no practical way to check travelers for contagious diseases. (Except the way the Venetians did.) Infected people start spreading their diseases before they show any signs of being ill. Moreover, because canceling trips at the last minute can be cumbersome and expensive, some parents travel knowing that their children are ill.
4. Air travel helps spread contagious diseases. Fortunately, that spread is limited. Most of the microorganisms that cause these diseases are airborne, that is, the organisms are exhaled, sneezed out or coughed up by infected individuals and then inhaled by susceptible (non-vaccinated) ones. Close, continuous exposure over many hours, as exists on airplanes, increases the risk of becoming infected. However, modern aircrafts have efficient air filtration systems that change cabin air every few minutes. And airflow is from ceiling to floor, not through the entire cabin, limiting the air you breathe to that from passengers in nearby seats.
5. An increasing number of children in this country are not fully vaccinated. Ironically, one reason is the success of vaccination programs. Because most parents have never seen cases of the illnesses that these vaccines prevent, some parents erroneously conclude that vaccination is no longer necessary and that, possibly, the vaccines are more risky than the disease. Not so. Other parents refuse vaccinations on ethical or religious grounds.
6. Many parents ask to have vaccinations “spread out”. They believe it is “too much” to give more than a dozen different vaccines — with some requiring multiple doses — in the first eighteen months of life. However, experience from giving billions of doses and seeing the diseases virtually disappear shows that vaccine scheduling is safe and effective. Moreover, the younger that children are vaccinated, the earlier in life they are protected, often from diseases that are especially troublesome early in life.
7. If routine vaccination programs were discontinued these diseases would quickly return. The causative organisms continue to circulate in many parts of the world, including some in this country. Until all children worldwide are properly immunized, vaccination programs must continue. The more people not vaccinated in this country, the greater the risk that diseases from abroad will establish beachheads here, and then continue to spread.
8. Is your child fully vaccinated? The length of time vaccines are effective varies by vaccine and in some cases the time of effectiveness is proving to be shorter than anticipated. This requires giving multiple booster doses. Moreover, new and improved vaccines appear every few years, many for teenagers. Check with your health care providers. Keep your own records.
9. Travelers going overseas may require additional vaccines. Inform your healthcare providers of your travel plans and do so as soon as your plans are finalized. Most overseas destinations require no additional vaccines for fully vaccinated people.
10. Review periodically the vaccination status of every household member. (Do so even if you don’t travel.) This is especially important if there are infants in your home. Check with your health care providers and have nannies, housekeepers and frequent visitors (grandparents, for example) check with their providers. Flu vaccine must be given yearly. (Safety officials suggest that you check fire alarms and smoke detectors when you adjust your clocks in the spring and fall. Add “check vaccination status” to that list.)
“I carry a light-weight blanket when I travel with my breast-fed infant. If someone seems bothered by my nursing – even though I do it discreetly – I offer them the blanket so they can cover their eyes.” (From a website on breast-feeding.)
1. No reason to curtail your travel plans because you breast-feed. Stories that travel-related stress significantly interferes with milk flow are hearsay. In fact, the alternative, bottle-feeding, is a bigger hassle, requiring you to carry formula, bottles and paraphernalia for sterilization, for example. (However, most experts say that sterilizing bottles and nipples is necessary only where sanitation is very poor.) Until infants are six months of age, exclusive breast-feeding is recommended, negating the use of solid food – which also can be problematic where sanitation is poor.
2. Restriction on breast-feeding in public, once common in the US, is now legal in 47 states and the District of Columbia. Two of the three remaining states, South Dakota and Virginia, exempt breast-feeding women from indecency and nudity laws, making breast-feeding legal. Idaho is the only state that has no laws regarding breast-feeding in public. Outside the U.S., attitudes for breast-feeding in public are far more relaxed with few, if any, restrictions. No airline restricts breast-feeding.
3. Many mothers are wrongly advised to discontinue breast-feeding for travel-related issues. Limitations on breast-feeding generally come from people, including health care professionals, who are overly cautious and not familiar with the latest findings, says the American Academy of Pediatrics. Check with lactation and travel medicine practitioners. For information on medications and breast-feeding, go to LactMed.
4. Check with your health care providers back home if you become ill while traveling. Routine illnesses virtually never require discontinuing nursing. However, being away from home, especially being overseas, tends to make illnesses seem worse than they are. Your own health care providers usually can advise you if you need to take medication or to seek medical care – or do nothing, which increasingly is the suggested cure for most minor illnesses. Carry your providers’ telephone numbers. Virtually all over-the-counter medications are safe while nursing.
5. Be fully vaccinated. Both mother and infant. Most vaccines given to mothers do not protect their infants; infants need their own age-appropriate vaccines. Only one vaccine, for preventing yellow fever, is contraindicated while nursing. This disease is limited to mostly rural areas of tropical Africa and South America. The vaccine can cause serious problems for young infants. Neither mother nor infant should receive this vaccine if the infant is less than nine months of age. Consult a travel medicine professional.
6. Overseas travel may also require changes is preventative medications. Malaria, for example, exists in large areas of tropical Central and South America, Africa, and Southeast Asia. Malaria can affect infants beginning at birth. Anti-malarial medications given to mothers do not pass through breast milk. Infants need their own medication, which may be different from that given to adults. Consult a professional.
7. Air travel. At US airports, inform security agents if you are carrying expressed breast milk in excess of the allowable 3.4 ounces (100 millimeters) for liquids. If yes, the milk will be X-rayed – which does not harm the milk. If you prefer that the expressed milk not be X-rayed, agents will pour a small amount into a container to be examined for prohibited substances. Ice packs and breast pumps are allowed in carry-on luggage. Rules governing security issues may change and vary overseas. The latest US information is available at www.tsa.gov/traveling-formula-breast-milk-and-juice.
8. Never breast-feed infants in moving cars. Infants should be securely restrained at all times – as should adults, making safe nursing virtually impossible. For example: An unrestrained mother is nursing her infant in a car going about 40 miles (63 kilometers) per an hour. The car hits another car. In a millisecond, the infant becomes the equivalent of a missile weighing hundreds of pounds and flies forward at about 40 miles per hour.
9. Travel with an infant-carrying sling. Slings help maintain breast-feeding by allowing opportunities for unrestricted nursing, help protect infants from surrounding hazards, ease the burden of carrying the infant and, because slings free the hands, simplify many travel-related tasks (boarding an airplane, for example).
10. Miscellaneous. The use of sunscreens and insect repellents by mothers has no adverse effects on the infant. However check the web regarding the use of these substances on the infant. No need for mothers to drink extra fluid during air travel. Dehydration during air travel is a myth. And no need for nursing mothers to offer infants extra fluids in hot weather. Breast-feeding suffices.