Dr. Karl Neumann's KidsTravelDoc
A pediatrician's guide to travel and outdoor recreational activities
Do Your Children Drink Enough Water?
You don’t have to be lost in the Sahara Desert without water to become dehydrated.
Mild dehydration occurs commonly in young children (and, sometimes, in adults) at home, in your back yard, and at school. In most cases a few simple steps suffice to prevent virtually all cases – and prevent the resulting health issues.
1. At any one time, more than half of all children and adolescents in the US are minimally dehydrated, says the Harvard School of Public Health. The simple reason: not drinking enough water. Boys are 76% more likely than girls to be involved. Nearly a quarter of the participants drank no plain water at all.
2. Mild dehydration occurs before thirst sets in. At its onset, the sensation of thirst is not a sensation that requires an immediate response to drink; thirst is easily ignored by young children engrossed in play or digital media. By the time children complain about being thirsty, most are already mildly dehydrated. The age-old parental response to cranky infants is to offer them bottles of water, milk or juice to pacify them. In fact, unwittingly, parents are treating some cases of mild dehydration.
3. Minimal dehydration causes subtle bodily changes. It interferes with physical, mental and emotional functions. “While such dehydration is rarely an immediate, dramatic health threat, it is an issue that can reduce quality of life and well-being”, says the Study. “These findings are significant because they highlight a potential health issue that has not been given a whole lot of attention in the past.”
4. The signs of mild dehydration are mostly indistinguishable from other common conditions. The signs include fatigue, moodiness, irritability, headaches, nausea, and cloudy thinking. In infants, increased crankiness. These changes cause or worsen school performance and make children more prone to accidents, for example. Regardless of the cause of these symptoms, drinking water is helpful.
5. Knowing how much water children should drink is important only when you think that their intake may be insufficient.
Needs for water may be greater for children who are involved in competitive sports or vigorous “just running around.” Also, children who are large in size for their age, and are very active in very hot or cold environments. These recommendations are for total water intake, including water from all sources: other beverages, and fruits and vegetables.
6. Plain water is the drink of choice for prevention. Sports drinks may be indicated for older children involved in competitive sports. Most licensed coaches are well versed in amounts and types of water athletes should consume. Sugary and caffeinated drinks are generally not recommended. Sugar adds unnecessary calories. Caffeine can result in jitteriness and difficulty concentrating and sleeping.
7. Encourage children to drink. Make access to water simple, make drinking fun, and drink water yourself in children’s presence. Leave cups of water where children can easily see and reach them. Provide a straw. Bring bottles wherever you go. Pack water in lunch boxes and, with teacher’s permission, for sipping during the day. For the rare children reluctant to drink, try cups with their favorite cartoon characters. Add flavors and colors to water.
8. Mild dehydration can be treated with oral rehydration solutions (ORSs). ORSs are available without a prescription at pharmacies and supermarkets. Follow instructions. ORSs contain the optimum combination of sugar and salts that mildly dehydrated children need and, importantly, are safe if mild dehydration is not the cause of their symptoms. Call your pediatric health providers with questions. Many such facilities now use telemedicine, i.e., have a designated pediatric specialist to offer appropriate advice via telephone or electronically.
9. Be alert for unusual drinking patters. The onset of frequent requests for water and drinking ever larger amounts, including waking up at night to drink, can be signs of diabetes and other conditions requiring prompt medical evaluation. Check out infants whose demand for water suddenly spikes. Never force children to drink. Extremely rarely, children can be coerced into drinking too much, resulting in water intoxication. The symptoms vaguely resemble those of severe dehydration.
10. Severe dehydration requires prompt medical care. The condition is generally associated with easily recognizable conditions: vomiting, diarrhea, refusal to drink, or the unavailability of water. Children appear very ill. Intravenous fluids may be required. Other signs include marked decreases in urine output, dry mouths, few or no tears when crying, sunken eyes and listlessness. A very sick child.
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Sweaters: armor for kids against COVID-19?
Having your children wear sweaters this winter may help prevent them from catching the coronavirus. True, sweaters are hardly as important as the usual recommendations for avoiding infection (see below), but neither is it an old wives’ tale. Sweaters help offset some of the discomforts resulting from using scientifically-proven methods of preventing the virus.
1. Wearing sweaters indoors has gone out of style. Once upon a time, putting on a sweater (or two, if necessary) was the first step in keeping warm. Most sweaters were bulky and uncomfortable. However, wearing them did minimize the need for continually feeding coal or wood into the furnace, obviously, messy and labor-intensive.
2. Sweater wearing increases the number of days that windows can be kept open in cold weather. Open windows increase ventilation – the amount of outdoor air coming indoors. Airflow helps rid indoor air of viruses and other pollutants. Nowadays, however, homes are designed with airtightness in mind. No air getting in is good for energy efficiency and for the family budget but bad for air quality.
3. Turning up the heat is the modern way to stay warm. Press a button or turn a switch and presto, you select the temperature you desire. This makes wearing sweaters no longer necessary – even though sweaters are now lightweight and comfortable, a simple and healthy way to stay warm.
4. Airtight homes, closed windows, and overheating are problematic. They dry out indoor air and lower humidity, creating conditions that allow airborne cold-causing viruses to travel farther and stay viable longer. Warm environments dry out nasal membranes. These membranes need moisture to effectively block viruses from taking root on the membranes, multiplying and causing infection.
5. Improving ventilation in your home in cold weather is relatively simple. Try micro-ventilation, opening windows three or four inches (seven or ten centimeters) in each room. This allows small amounts of fresh air into the room without excessively cooling the room. Weather permitting, open windows wider, especially when the room is not in use. If possible, set up cross ventilation (opening widows facing in opposite directions) and let a breeze circulate through the home. For windows that open from top and from bottom, open both. How do you compensate children (and adults) for feeling a bit chilly? With sweaters, of course.
6. Increasing indoor ventilation is only one part of reducing the COVID-19 risk, says the US Environmental Protection Agency (EPA). For optimum protection, ventilation must be combined with mask wearing, social distancing, hand washing, and surface disinfecting. Before visiting friends/family, or sending children on playdates, ask (politely) whether the home is hot, stuffy and crowded, or if is it cool and your child will need a sweater. Also, check daycare, schools, houses of worship or other places your children may go. Another way to improve air quality in a confined area is by reducing capacity – for example, by your family members not going there.
7. Use fans. Placing fans in front of windows helps increase indoor ventilation and clear the air of COVID-19 viruses. However, do not rely on fans as the sole method of protection, says EPA. Fans ventilate by either blowing fresh air into rooms or sending stale air out. Consider placing fans in each of two windows, even if the windows are in different rooms, with the door(s) open. One fan blows inward, the other outward, creating a form of cross ventilation. In crowded rooms, on the possibility that someone is infected with the virus, avoid placing fans so that air blows from some individuals onto others. When using fans, remember child-appropriate safety considerations.
8. Keep indoor humidity between 40 and 60%. This provides personal comfort, helps minimize the spread of airborne viruses, and helps keep allergy-causing molds in check. Hygrometers, which measure humidity, are readily available on the web. Humidity can be lowered by opening windows and allowing more dry winter air in. Humidity can be increased by placing pans of water on or near sources of heat. Humidity can also be controlled with room humidifiers and dehumidifiers.
9. Don’t treat drafts as nuisances. While annoying for most people, drafts can be a blessing in disguise because they allow some fresh air in. (Sweaters, anyone?) No need to cover room air conditioners because some air is leaking through. Ditto for repairing poorly fitting windows or doors, or fixing chimneys. Running bathroom and kitchen exhausts are also somewhat helpful by expelling room air.
10. The best “ventilation” available is at your doorstep, free. It’s called “the outdoors,” with fresh air aplenty making it an unlikely place to catch airborne diseases. Don’t let cold weather keep kids indoors, often crowded together with other kids. Winter weather permitting, use the outdoors for playdates or for kids to run around, snow notwithstanding. Dress kids accordingly. (Again, sweaters.) Blame the English language for suggesting that “cold” as in “weather” is why one “catches colds.” Weather does not increase susceptibility, or prolong or worsen colds. A runny nose after playing outside in cold weather is not necessarily a sign of a cold. Exposure to cold air in itself can cause nasal congestion.
For your information. A study at Brown University shows that the likeliest way to avoid spreading the COVID-19 virus in a moving car is by keeping all the windows open. The worst situation? Driving with all car windows shut and the heat or air conditioning on. The best situation? Open windows and wearing sweaters.
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Questions and answers regarding your children and COVID-19
December 24, 2020 (Hi reader. Once again, an issue of KidsTravelDoc is devoted to COVID-19’s effect on children, rather than our usual subject, keeping kids healthy and safe for travel and related outdoor activities. Family travel has been pummeled by concerns over the pandemic. Hopefully, soon we will return to discussing, “Is air travel safe for infants?” “Is outdoor cold ever too cold for young children?” and “How to protect your kids from the sun – and from certain sunscreens?”)
1. Does vaccinating parents against COVID-19 protect their children? Most children who do acquire COVID-19 do so from adults. And children are generally not the individuals who bring the virus into households; adults do. Moreover, to date, few outbreaks have been reported in schools, suggesting that spread within school settings to adults from children may be limited.
2. Should reports of reactions to COVID-19 vaccinations cause adults to hesitate being immunized? To date, the vast majority of recipients reported either no reactions or mild ones such as fatigue, headaches and muscle pain. Reactions occur after most vaccinations, likely indicating that the immune system is being activated. There has been a scattering of allergic reactions after the vaccine. In most cases, such reactions occurred in individuals with known allergic histories. The recipients were carrying appropriate medications for such events, used their medications and did well. In a handful of more serious reactions, recipients were kept under medical surveillance for a few hours, or in several cases, overnight, and recovered completely. Probably, by now more than a million doses of the vaccine has been administered.
3. Is the large increase in the number of children infected with COVID-19 worrisome? This number – now well over a million children in the US – merely reflects that the virus continues to spread and that the number of children being tested is increasing. There has been no increase in the percentage of infected children requiring hospitalization or dying. Children overwhelmingly have mild cases. The rate of hospitalization among children is 8 per 100,000 population, as compared with that in adults: 164 per 100,000 population. Deaths or serious complications are extremely rare, occurring almost exclusively in children with preexisting, serious health issues.
4. Should you allow your children to be tested for the virus? Testing helps answer questions such as should children have playdates (see below) and how common are asymptomatic cases. However, testing is not beneficial in all situations. Testing children in school settings failed to identify nearly half (45%) of all children infected with the virus.
5. Are playdates safe for children? The fewer individuals children come in contact with and the shorter those interactions are, the lower their risk of contracting COVID-19. However, completely isolating toddlers and kindergartners for long periods may also cause issues and is not generally recommended. While eliminating all risk is not achievable, risks can be greatly reduced by the following: well-ventilated indoor areas, windows open, air conditioning and fans going, children with no visible signs of illness, the same children for each playdate, responsible parents, mask wearing, no hugging, and no immunosuppressed people in children’s households. Daycare and nursery school attendance is more problematic. For more information, see https://www.cdc.gov/coronavirus/2019-ncov/community/schools-childcare/guidance-for-childcare.html#General
6. When will there be a vaccine for children? Hopefully, vaccinating large numbers of children will occur by late summer/fall 2021. However, delays are possible. Large-scale trials of vaccines in children are still in the early stages and will take many months, and possibly longer. Several additional COVID-19 vaccines still being studied, but being counted on to fulfill expected needs, are experiencing delays in development. And children, because of their relatively mild COVID-19 illnesses, have low priority to be vaccinated.
7. Is it necessary for children to be vaccinated in order to eliminate COVID-19? A large percentage of the population, perhaps 75%, must be vaccinated to interrupt a pandemic. Many families are expected to refuse vaccination, especially at first. Moreover, even in the midst of the COVID-19 pandemic, only half of adults say they will “probably” or “definitely’’ get the vaccine. Less than half of adults have gotten previous recommended vaccines. The number of adult cases of vaccine-preventable diseases drops significantly only when the vaccine is included in pediatric vaccination programs. Children are a “captive audience.” Vaccination is generally required for school attendance.
8. Should children wear masks even though they are not considered important spreaders? Children two years of age and older should wear masks as do adults – and wear them correctly, covering both mouth and nose. However, the use of masks may be challenging for some children, especially children with cognitive, intellectual, developmental, sensory and behavioral disorders. Most organizations that deal with such disorders have suggestions for mask wearing on their websites. These suggestions may also be helpful for children without these issues.
9. Is it true that the virus rarely spreads by touching virus-contaminated objects? Articles to that effect are appearing in the media. Likely they are true, but research is lacking. Distances that COVID-19 travels through the air depends on the force with which an infected individual coughs (young children cough less forcefully than adults), air currents, humidity and temperature, and other factors. Survival of the virus depends on the surface on which the virus lands (metal or cloth, for example). Children should continue to wash their hands often and thoroughly. They constantly touch objects and then place their fingers in their mouth, nose, and eyes.
10. Why is it especially important this year to vaccinate children against the flu? The incidence of flu is surprisingly low, likely because protective measures against COVID-19 also protect against the flu. However, surveillance for flu shows that the flu virus is present in most communities. Many children remain unvaccinated and are vulnerable. (Some parents avoid pediatric offices fearing their children will become infected with the COVID-19). In fact, for children, the flu may be the more serious of the two diseases and children are better “spreaders” of the flu virus than they are of COVID-19.
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When will your child be vaccinated against coronavirus?
December 3, 2020. Vaccinating your children against the COVID-19 virus will not take place “anytime soon,” says Dr. Anthony S. Fauci, director of the National Institute of Allergy and Infectious Diseases.
1. The COVID-19 vaccine has yet to undergo trials in children. “Only after there is sufficient safety and efficacy information regarding COVID-19 vaccines in adults will trials begin in children.” Barring unforeseen events, such trials will commence in a few weeks. Hopefully, having a vaccine for children “anytime soon” means that it will be readily available by the onset of the 2021 fall schoolyear. Generally, trials in children start with children ages twelve and older. Experiences with previous vaccines show that children react well to vaccines that have been proven successful in adults, sometimes with lifelong immunity.
2. The vaccine trials in adults show “almost ideal” results. Because of new technology and know-how, trials in adults have been successful in a matter of months instead of years. Some COVID-19 vaccines produce protection in about 95% of recipients, have few and only mild side effects, and appear to be effective in older adults, a group in whom many vaccines produce poor immunity. Additional COVID-19 vaccines are in the pipeline. One vaccine may not only protect but also prevent asymptomatic carriers from spreading the infection. Asymptomatic carriers, some of them children, appear to be a significant conduit for spread.
3. If children are not added to research trials very soon, there will be a significant delay in when they are able to access a potentially life-saving vaccine. A million-plus American children have been infected since the onset of the pandemic. Moreover, children have suffered in numerous ways: disruptions to their education, harms to their mental and emotional health, and diminished access to critical medical services, for example. Still unknown are possible long-range effects. Already there have been a small number of cases of catastrophic multi-organ failures in children. Such cases may occur months after the COVID-19 infection.
4. Generally, vaccine trials with children take longer than with adults. Issues needing answers include the lower age limit where vaccines become safe and effective. That age can vary from infancy to teenagers. Adult doses may require adjustments for children’s age and weight. And numbers of doses and intervals between doses may affect optimal immunity more in children than adults. Trials typically start with older children and work their way down to infants.
5. The positive experience with adult COVID-19 vaccines trials bodes well for trials with children. Technology and know-how are similar. Vaccines safe in one age group are generally safe in others. Also, the excellent safety record in adult trials plus the terrible toll of illness and deaths from the virus will encourage parents to volunteer their children. The larger the number of volunteers, the sooner necessary data are assembled.
6. COVID-19 cannot be defeated without vaccinating children, says the US Centers for Disease Control (CDC). Even in the midst of the COVID-19 pandemic, only half of adults say they will “probably” or “definitely’’ take the vaccine. Less than half of adults take other CDC-recommended vaccines. Experience has shown that the number of adult cases of a vaccine-preventable disease drops significantly only when the vaccine is included in pediatric vaccination programs. Children are a “captive audience.” Generally, they need vaccines for school entry.
7. Hopefully, most parents will accept yet another childhood vaccine. Present vaccine schedules require children to have dozens of doses of various vaccines by school entry. A small but growing number of parents are “anti-vaxxers.” They believe that vaccines are unnecessary or harmful, that diseases disappear spontaneously or are only minor inconveniences, that too many vaccines overpower children’s immune systems making children vulnerable to other illnesses, or that vaccines are plots from rogue government agencies to control children’s minds.
8. In fact, worldwide, vaccines save millions of lives annually with virtually no known downside. The World Health Organization (WHO) has named “vaccine hesitancy” as a top threat to global health. (Some years ago, health experts named “vaccines” as a top advancement in modern medicine.) There is no evidence to substantiate anti-vaxxers theories. Moreover, parents who don’t vaccinate their children benefit from those that do; the fewer unvaccinated children there are, the lower the risk that anti-vaxxer’s children will become infected.
9. Anti-vaxxer’s computers are revved up to sow doubt about COVID-19 vaccines. On social media, the number of pages opposing vaccines far outnumbers pages promoting them. The message: COVID-19 vaccines are based on science never used before and need further study, but is being “green-lighted” for political reasons. Not so, says Dr Fauci. Fast-tracking is not skimming. The technology that made the COVID-19 vaccines available in record time also enables government oversight agencies and peer review committees to better oversee vaccine development.
10. For your information. Vaccinating children against COVID -19 may be further delayed if children receive low priority for vaccination. Other groups, health care workers and the elderly, for example, are more vulnerable to serious consequences from the virus. Early shortages of the vaccine may cause additional delays. Also, children may require more than one dose given a month or more apart to acquire optimum immunity. And immunity may not occur until several weeks after the final dose.
Note: You may find a related artcle of interest; schooling during the COVID-19 pandemic
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Schooling during the COVID-19 pandemic: The facts
(November 18, 2020. Hi Reader: We’re devoting this edition of KidsTravelDoc to help you cope with an important aspect of the COVID-19 pandemic: elementary schooling. Hopefully, we’ll soon return to our main – and more pleasurable – topic: helping you to keep families healthy, safe, and comfortable for travel and fresh air activities. )
1. When reading about COVID-19, note the date and source of the material. Also note the frequent use of words such as “likely” and “probably.” We don’t know as much as we would like to know about this pandemic. And what we do “know” can be outdated overnight. Moreover, some “experts” lack “expertise,” with opinions based on emotions and politics, rather than on science. (All our information comes from the US Centers for Disease Control, the World Health Organization, the American Academy of Pediatrics – accepted “best sources available.”)
2. Transmission of COVID-19 in schools may be less common than initially feared. That thinking was largely based on data concerning the influenza virus. Experience is showing that school-based transmission of COVID-19 is far less common than with influenza. Each virus has its own “personality.”
3. School closures may not have to be a foregone conclusion. This is particularly true for elementary school-aged children who appear to be at low risk of infection. Closures alone may be insufficient to halt epidemic spread and have only a modest overall impact on infection rates compared with broader, community-wide physical distancing measures. However, traditional schooling may not be an appropriate option in communities where the virus is spreading rapidly. Local public health professionals must make decisions.
4. As of November 12, 2020, in the US, just over one million children tested positive for COVID-19 since the onset of the pandemic. In the one-week period ending Nov. 12th, there were 111,946 new cases in children, which is substantially larger than in any previous week. However, these numbers are not necessarily alarming. They are mainly due to an increase in the number of children being tested. (In the US, the definition of a “child” in regard to COVID-19 varies state by state, from 0-14 years to 0-20 years.)
5. Children are infected far less often than adults. More important comparisons are the percentage of infected children that require hospitalization (only about 2% of adult admissions), rate of admissions to intensive care units (one in three hospitalized children), and deaths (extremely rare in children and usually only in children with serious underlying conditions). Overall, the risk is low, but not negligible.
6. Children most frequently acquire COVID-19 from adults, rather than transmitting it to them. And children are generally not the individuals who bring the virus into households; adults generally do. Limited information indicates that teachers are unlikely to become infected by young children. However, this may not be the case for teachers with predisposing health issues.
7. The consensus among educators and parents is that remote learning is a poor substitute for in-person schooling. This is especially true for children in the early elementary school grades. Remote learning seems to slow the development of social and emotional skills, eliminates schools as safe places while parents are working, and keeps many children from having healthy meals and access to the internet, to mention just a few.
8. A COVID-19 vaccine for children is NOT “just around the corner.” The vaccine most advanced in development is being studied only in adults, not in children. Likely, this vaccine, in adults, will require two doses given several weeks apart, and then require more weeks until it provides optimal immunity. Only then will it be considered for children and probably only after more testing, to establish lower age limits of effectiveness, for example. Furthermore, the most promising drug to treat COVID-19 infections has a tentative lower age limit of 12 years.
9. The risk of infection for children in school settings can be reduced with simple measures. Improving air circulation, for example, by keeping windows and doors open. And placing desks all facing in the same direction rather than sitting children around tables. Three feet (one meter) of separation of desks may be sufficient to minimize spread. Other measures include having teachers, not children, move from classroom to classroom to avoid crowding halls and stairways, and having children eat lunch at their desks.
10. For your information: Becoming infected with COVID-19 by touching virus-contaminated objects and then placing ones’ fingers in ones’ mouth/nose – common habits among children – are uncommon means of spreading the virus… The necessity of storing and transporting the vaccine currently furthest in development at extremely low temperatures will likely delay the widespread availability of that vaccine… Children, like adults, should be isolated for two weeks after being in close contact with individuals testing COVID–19 positive – regardless whether that contact individual has symptoms… Close contact is generally defined as being within six feet (two meters) of such a person for at least 15 minutes, whether or not that person was wearing a mask.
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