Kids Travel Doc
A Pediatrician's Guide to Travel and Outdoor Recreational Activities
Kids and the Great Outdoors
Kids Playing Video Game Hey, parents! It is time to pry your kids away from their TVs, video games, computers and smart phones – forcefully, if necessary. Ignore their yelling and sarcasm. Then kick them out the front door – literally, if need be. If older kids threaten to report you to child welfare, call their bluff: according to experts, the current cure-all for practically everything that ails kids is merely spending more time in the great outdoors.
1. While wondrous cure-alls come and go, this one is backed by impressive credentials. They include the Harvard Health Letter, The Centers for Disease Control and the American Academy of Pediatrics (AAP), to name just a few. A few of quotes from such organizations: “Letting your children ‘go alfresco’ helps them grow up healthy.” “Children have become ‘dis-connected’ with the outdoors, resulting in physical and mental issues – call it ‘the nature-deficit’ syndrome.’”
2. Do organizations with impressive credentials always get it right? Not necessarily. In fact, some of the support for equating the outdoors with heaven is not based on traditional, evidence-based research. However, the philosophy is worth listening to – while remembering that we tend to exuberantly embrace simple, safe and free cure–alls that promise better health for our children, especially cure-alls that have virtually no known downside. Only time and research may uncover challenges to the current adulation of alfresco.
3. Today’s children are “screen bound.” “The nature of childhood has changed and there isn’t much nature in it.” “Screen time” rates are higher than ever. Children between the ages of 8 and 18 spend half as much time outdoors as they did 20 years ago. On average, preschool children spend 32 hours a week with screen media. The AAP recommends that kids under the age of two years have no screen time, and those older than two watch 1 to 2 hours a day, preferably quality programming.
4. The worst sedentary activity is TV-watching. Children who spend their indoor time watching TV have higher blood pressures than those playing electronic games, involved with computers or texting. TV-watching involves no movement on the part of the child and is often associated with eating, generally foods high in salt and calories.
5. Children are more active outdoors. While kids need not be outside to be active and being outside is no guarantee of activity, indoor living is associated with being sedentary. The younger children start active outdoor recreational play, the more likely they will find ones they enjoy and will continue them as adults.
6. “Green” outdoors may be the best outdoors. Spending time surrounded by trees, grass and plants is superior to being amid buildings, concrete and artificial turf, with the wilderness being the ultimate outdoors. Five minutes of green exercise a day results in improvements in self-esteem and mood. A window view of trees helps hospital patients recover faster than a view of brick walls.
7. Activity should be sufficiently intense to increase heart rates. Brisk walking, biking, or “running around,” for example, have beneficial effects on muscle strength and endurance, bone and cardiovascular health, concentration, memory, and classroom behavior. Children with attention deficit disorders scored higher on tests of concentration after walking through natural surroundings than those walking through residential neighborhoods or downtown areas. Children living in greener neighborhoods maintain lower average body weight.
8. Some children need coaxing to enjoy the outdoors. Others take to it “naturally.” Parents should expose children to various activities, ones appropriate for their ages. Look for activities provided by after-school programs, park departments and neighborhood organizations. Structured play times and activity-friendly environments are conducive to enjoyment. Ideally, children should spend at least one hour a day outdoors.
9. “Nature time” may help family bonding. The natural world seems to invite and facilitate parent-child connection and sensitive interactions. What better way to escape the constant, interrupting beeping of modern life, than spending concentrated time with your child during a walk in the woods?
10. Nature time may be especially important when colder weather tends to keep kids indoors. Less sunshine may cause both “sad” and “SAD”. Sad (small letters) is having the “winter blues.” SAD (capital letters) stands for Seasonal Affective Disorder, a more serious form of the winter blues. Sufferers, including young children, have less energy, difficulty concentrating, become irritable more easily, need more sleep, and take longer to get up in the morning. In younger children, crankiness and crying spells may occur more often. Our next posting, in about two weeks, will be an in depth review of SAD in young children.
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
Is global warming harming our children?
Children are in the crosshairs for climate change, says the American Academy of Pediatrics. They are especially susceptible to toxins in the environment and to many of the infectious diseases that spread more readily as the weather becomes warmer.
1. Rising global temperatures decrease air quality. Children spend more time outdoors than adults, breathe in more air per weight, and, due to their age, have more years to breathe in toxins. The toxins, mostly carbon dioxide, emanate from fuels used in cars and power plants. They cause wheezing, coughing and can damage lungs. The younger the child, the more hazardous the toxin.
2. Higher environmental temperatures increase the length of summers. This prolongs the growing season and broadens the geographic area for allergy-causing plants, ragweed, for example, increasing the incidence and severity of allergies and some forms of asthma.
3. Forest fires are especially harmful. They emit fine particulate matter over a much larger geographic area than covered by visible smoke. Global warming increases the number and severity of fires by decreasing rainfall and drying out the underbrush which helps spread fires. The tiny particles reach deep into the lungs. Childhood exposure is associated with decreased lung function, more severe asthma, and chronic bronchitis.
4. The incidence of waterborne infectious diseases will rise. Infectious diarrhea, for example, spreads largely via bacteria, viruses and other microorganisms, found mainly in sewage. The incidence of such illnesses increases following severe storms and floods. (Both drought and floods are associated with climate change.) Increased sewage from runoffs can overwhelm sewage disposal plants, allowing sewage to leak into fresh water reservoirs and into land where vegetables grow.
5. The incidence of insect-transmitted diseases also increases. Warm, standing water from excessive rainfall and flooding creates additional breeding grounds for insects. Milder winters kill fewer insect eggs, allowing the numbers to increase cumulatively every summer. While most insects are merely annoying, some carry potentially deadly organisms which cause malaria, Zika, West Nile, Lyme and dengue, for example.
6. Long-term effects. As atmospheric carbon levels increase, common crops contain less protein and vital nutrients, iron and zinc, for example. Lack of such nutrients impair immune systems, cause cognitive issues, anemia and diarrhea, to mention just a few. Children from poor socioeconomic communities are especially at risk; more likely to suffer from these deficiencies and less likely to have access to dietary supplements to correct them.
7. Complex interactions of climate-warming factors affect young children. Studies suggest that children who spend less time outdoors (to avoid toxic air, for example) exercise less, eat more and are more likely to become overweight and obese. Also, worrisome are the possible effects on developing brains from chemicals necessary to eradicate insects. Likely, both the microorganisms that cause the disease and the insects that transmit them will become more resistant to chemicals used in insecticides. This will require ever more potent chemicals to be used. Some of these chemicals may harm fetuses’ brains when inhaled by pregnant women.
8. Additional factors to consider. “Fracking,” for example, pumps large amounts of chemicals into the ground to extract relatively cheap gas and gasoline. Great for our economy, but possibly harmful for our children. These fuels result in more toxins in the air. Moreover, fracking delays the development of other sources of energy, clean wind and solar power, for example. And some of the chemicals used in fracking may be toxic for the development of children’ central nervous systems.
9. Casualties from global warming-related disasters are usually much greater than stated. Most reports include only immediate deaths and injuries, stemming from drowning, mudslides, falling trees, and the collapse of houses. Not included is the toll from the subsequent lack of electricity, for example. Power outages make healthcare facilities (if, indeed, they survive the disaster), sewage disposal plants and refrigeration virtually useless. People, especially children, become ill and some die from diarrheal diseases from drinking polluted water and eating spoiled food, or from asthma since their ventilators no longer function. Death rates calculated months after disasters are generally much greater than those calculated in the first week.
10. Many young children experience emotional problems from the social turmoil surrounding natural disasters. Children are confused by such events, experience feelings of stress, fear and anxiety, akin to depression and post-traumatic stress syndrome. Especially at risk are children with previous exposure to trauma or pre-existing emotional, developmental, or behavioral disorders.
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
Hand washing for children is no longer child’s play
Hey kids, are your parents bugging you about hand washing? Join the club. Some hotshot experts say that many illnesses kids get come from germs on their hands. And they are right. Proper hand washing is important. That means following a long list of do’s and don’ts about soaping, rinsing and drying. What a nuisance! But a lot better than having colds, diarrhea and other icky illnesses.
Here’s what you should do:
1. Ask your parents to set up a child-friendly hand washing station. You may need a slip-resistant stepstool, easily accessible and easy-to-use faucets, soap (preferably liquid), and your own towel. You pick the color of the towel. (In the old days, no one took hand washing so seriously. Some kids just turned on the faucet and fooled around for a minute while the water ran. Often, hands never got wet and soap remained untouched. It wasn’t smart. Lots of kids got sick.)
2. Wash your hands under running water. Teach your parents that washing in sinks or basins of standing water may re-contaminate your hands. Turning faucets on and off between different phases of washing saves water and does not significantly contaminate faucets. Warm water is no more effective than cold water. Water sufficiently hot to kill germs can irritate your hands.
3. Soaping and vigorously rubbing your hands together separates dirt and germs from your skin. Rinsing washes the mess away. So, completely cover your hands with soap lather. Include between your fingers. Then firmly rub your hands together for at least 20 seconds. If you can’t tell time yet, sing “Happy Birthday” twice. (Sing slowly, not as fast as you can.) Then rinse well with running water until all lather is removed.
4. Sometimes nasty germs hide under your nails. Remind parents to keep your nails short, making it easier to clean them. Ask your parents to get you a colorful, easy-to-grip, animal-shaped nail brush. They’re easy and fun to use. Brush nails daily.
5. Ideally, use liquid soap. Child-friendly dispensers are available. Many toddlers are not good at using bars of soap. However, for everyday purposes, soap bars are just about as effective. While soap bars may retain some germs from previous users, this is not a problem if you rinse well. Soaps marketed as “antibacterial” and “antimicrobial” are unnecessary for routine hand washing.
6. For situations when soap and water are unavailable, your parents should carry hand sanitizers containing at least 60% alcohol. Use it at the beach, between you digging in the sand and eating your hotdog, for example. Such sanitizers are almost as good as soap and water when you cover all parts of the hands. Rub hands and fingers together until hands are dry. (Remember “Happy Birthday.”) Re-wash your hands with soap and water when those become available.
7. Approved sanitizers are safe for kids. But avoid getting them into your mouth. Accidentally licking your fingers after a sanitizer is applied is OK; ingesting more is unhealthy. If that happens, tell your parents to call your Poison Control Center. In the US, the number is 1-800-222-1222. (Rarely, teenagers drink sanitizers for their alcohol content. Not a good idea.)
8. Moistened, packaged wipes are not substitutes for sanitizers. Ads claim that such wipes are great for kids’ skin: non-alcoholic, hypoallergenic, and able to kill 99%-plus of germs. However, all that wipes reliably do is get rid of visible dirt, not disease-causing germs, if they happen to be present (like after digging in sand). If alcohol-containing sanitizers make you hands feel dry and itchy, ask your parents to apply aloe-containing cream.
9. And kids, your hand drying techniques really need improvement! Shaking your hands in the air or wiping them against your clothing may leave moisture on your hands. Germs love that. They eat moisture up and thrive. Dry hands until they are really dry. Use single-use, disposable paper towels, when available. Reusable cloth towels, especially when slightly moist from a previous user, also may spread germs.
10. Miscellaneous. Kids: if you are three years old, chances are that you can wash your hands on your own… Remember to use good handwashing techniques everywhere, not just at home… In public restrooms, use a disposable towel to turn faucets on and off and to open doors as you leave… Tell your parents that fun picture books are available online to help make you an expert handwasher… And check out CDC’s Hand Hygiene Guideline for Children
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
Helping young children adjust to the heat of summer
Outdoor temperatures are soaring this summer. Children less than four years of age adjust poorly to heat. So how do you keep the little ones hale and hearty?
1. Young children produce more heat per body mass, perspire less, and dehydrate more rapidly and more severely than older children and adults. Perspiring helps the body shed excessive heat. Moreover, hot environments tend to make children cranky, listless and reluctant to drink.
2. Start offering children extra drinks hours before exposure to heat occurs. Encourage them to drink but never force them; that may cause vomiting. If children are happy and active let them decide how much they want to drink. Offer fluids often; every fifteen minutes if necessary. No need to give them sports drinks or electrolyte solutions at this point; plain water is fine. Cold drinks do not appreciably cool children’s bodies.
3. Air conditioning (AC) to the rescue! Not only does AC lower indoor temperatures but, equally important, it decreases humidity. High humidity impedes perspiration. And forget the “new” old wives’ tales about AC: no one becomes sick from going in and out of AC or having cold air blow on them.
4. When AC is not available, cool kids using old-fashioned ways. Fans help cool bodies by reducing skin temperatures, which helps promote perspiration. Fans do not cool rooms and the higher the temperature the less effective fans become. Pools, sprinklers and lukewarm baths help lower body temperatures. Wrap children in lukewarm towels or sheets, if necessary. In some neighborhoods cooling centers open in hot weather.
5. Check the heat index (HI) before going outdoors. The HI calculates how the combination of air temperature and humidity on a given day affect our bodies. The data is placed into one of four categories: Caution, Extreme Caution, Danger and Extreme Danger. (See the table at the end of this article.) Readings are available daily for every zip code. See US National Weather Service at https://www.weather.gov/safety/heat-index A very high HI may be reason to stay indoors or shorten the time spent outside.
6. Young children tend to eat less in hot weather. But so do adults. This is not a problem. Neither is what type of food you give to children. Diet plays little role in staying cool. While fruits and vegetables contain more liquid than foods high in fats and protein, the difference is negligible, especially with the small portions young children eat.
7. Dress children in lightweight, light-colored, loose-fitting cotton garments. Loose-fitting shirts allow wind currents to remove heat from the skin and absorb perspiration. This helps cool the body and helps prevent heat-related rashes. Avoid sunburns. (See my article on sun-protective clothing at http://kidstraveldoc.com/sun-protective-clothing-has-gone-high-tech/)
8. In hot weather, assume that all signs of illness are heat-related. Regardless of the cause of the illness, the early treatment is the same: offer additional drinks and find air conditioning. If symptoms worsen, call your pediatrician or pediatric nurse practitioner. Ask whether it’s time to give electrolyte solutions or seek further medical assistance.
9. Choose tropical vacations with young children in mind. Consider avoiding extremely hot and humid destinations. Children may take a day or two to acclimatize. Increase fluids on arrival and limit time spent outdoors during this period. While serious problems are quite rare, check that your cellphone is operable and that there is a local, readily accessible medical facility, just in case.
10. Other considerations. Some baby carriers and car seats are made of heavy fabrics that increase the heat surrounding infants… Chronic illnesses and certain medications may make young children more susceptible to heat-related illnesses… Little is known about the benefits, if any, of “natural” cures (coconut water, for example).
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 Do Parents Forget Their Infants in Cars?
New York. July 31, 2019. It happened again. A father, a social worker, was charged with manslaughter and criminally negligent homicide for leaving his one-year old twins strapped into the backseat of his car on a hot July day while he worked his eight-hour shift at a VA hospital. He forgot to drop them off at daycare. The twins are the 22nd and 23rd children to die such deaths in the US this year. And August, the commonest month for heat-related deaths, is yet to come.
Neighbors of the father are rallying to his support. They describe the circumstances surrounding the deaths as incomprehensible. They say he is a caring, loving, child-oriented person.
1. Surveys show that the vast majority of adults involved in these tragedies are responsible individuals. Like you. They simply forget that a child is in the car, or there is a mix-up between parents regarding who is to drive the child that day, or they leave the car “for a second” to mail a letter and become distracted by a friend or an event, for example.While it is a hassle to remove children from car seats for two-minute errands, leaving them can land you in jail – even if nothing happens. In some states it is a felony to leave children unattended in a car.
2. Be aware of your state of mind when driving with a child. Stress, emotional issues, lack of sleep, medications, and concerns over the weather, for example, can affect your judgment. Other contributing factors include mechanical problems with your car, or an impulse to stop for coffee. Combinations of factors further increase risk.
3. Parked cars can be killers. Last year, 51 American children died of heatstroke and dozens more suffered permanent brain damage due to heat. Fifty-two percent (52%) of these children were accidentally left in a car; 30% climbed into a car on their own, and 17% were left in a car on purpose and then forgotten. Many other children experienced “close calls.” Only 7% of the adults are believed to have been under the influence of alcohol or drugs at the time of the incident.
4. Temperatures inside cars rise fast. The temperature inside a car parked in the sun on a hot day can reach 160 degrees F (71 C). Windows rolled down a few inches (or centimeters) helps little. Even when outside temperatures are only 80 degrees F (27 C), the temperature inside the car can reach deadly levels in 20 minutes. In fact, children have suffered heat stroke in parked cars with outdoor temperatures in the fifties.
5. The younger the child, the greater the risk. In a hot vehicle, with no access to liquids, a young child’s body temperature increases rapidly, far faster than an adult’s in similar circumstances. Children are less able to sweat; sweating rids the body of heat. At 105 degrees F (40 C), the body’s temperature control systems become sluggish. At 107 degrees F (42 C), vital organs begin to shut down. Much of the damage is irreversible.
6. Look Before You Lock, says the National Highway Traffic Safety Commission. Train yourself to check the backseat before leaving cars. Place your briefcase, wallet, or work badge on the seat next to the child. One mother puts her shoes there. (She drives barefoot but wears shoes for walking.) Also, place one of the child’s toys or the diaper bag on the front seat.
7. Check your car immediately if your child is out of sight. Teach children that cars are not play areas. Lock cars when not in use. Young children find it easier to enter unlocked cars than exit them. And keep an eye on children when the trunk is open.
8. When you see a young child alone in a car, call 911. Don’t assume that an adult will be right back. Minutes count. If the door is unlocked, remove the child from the car if the child does not look right. In an emergency pour cold water over the child. If the child is responsive, also offer liquids.
9. The incidence of children left in cars rose sharply in the 1980s – the result of campaigns to improve safety. Until then most infants rode car seats placed in the front seat. But studies showed that infants are safest when their car seats are on the backseat and facing backwards, making sleeping infants practically invisible to the driver. But overall, placing infants on the backseat facing backward is safest.
10. Some new car models are equipped with various devices to alert drivers of an infant in the backseat. One system under study consists of sensors that are activated when the driver closes the driver’s car door. The sensors send off an audible alarm if it detects movement in the back seat. The problem: some healthy infants when sleeping move insufficiently and their breathing is too shallow to activate the alarm. In another system, an alarm sounds when the motor is turned off if the rear door was opened before or during the trip. This alerts the driver to check the back seat. This system is plagued with false alarms. No system is yet entirely reliable.
Bills are in front of both houses of Congress to mandate the use of such devices.
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
Treating diarrhea in young children away from home: A primer
When packing for family trips, for overnight or overseas, include a pen, a paper pad and a cellphone. These come in handy if your child experiences diarrhea, a common health issue for young children away from home. The pad and pencil is to record symptoms. The cell phone is to call your pediatrician if symptoms worsen.
1. The vast majority of cases of diarrhea in young children need no treatment. Watchful waiting, doing nothing, is what you do when kids are happy and playful and eating and drinking normally – even when the number of daily stools double or triple and become loose. Rare vomiting and slight stomach aches can also be ignored under these conditions.
2. Watchful waiting stops when children’s dispositions and stool consistencies take a turn for the worse. Write down changes in activity, decreases in food and fluid intake, the presence of vomiting, the frequencies and description of stools and the frequency of urination. These findings become significant if symptoms continue to worsen.
3. Encourage children to drink. Never force them. If necessary, offer them fluids every 15 minutes and in small amounts. If they vomit, try a tablespoon or a teaspoon at a time. Record intake. Continue feeding breast milk, infant formula or cow’s milk. Restricting or diluting milk serves no purpose. Avoid giving copious amounts of plain water or sugary drinks; these can worsen diarrhea by pulling more fluids into the intestines. If your child does not get better promptly, it’s time to use your cellphone.
4. Continue offering food. Don’t force. Food is essential to supply calories and may actually help restore a damaged intestinal lining. The type of food is less important than previously believed. The BRAT diet (bananas, rice, applesauce, toast) is only marginally better than the child’s favorite food, whatever it is; children are more likely to eat and drink what they like.
5. Add electrolyte solution to the child’s diet if symptoms persist. These solutions reflect the makeup of fluids lost via vomiting and diarrhea and help avoid dehydration. Electrolytes are also available in pharmacies and most supermarkets as lollipops and small packets of powder. Mix powder with safe water in amounts directed on the product. Sports drinks (Gatorade) are less appropriate. They are designed to replace electrolytes lost by perspiration, not via vomiting and diarrhea.
6. Many customary treatments are outdated or controversial. Withholding food to “rest the intestine” is counterproductive. Probiotics are “good bacteria” to replace the “bad” microorganisms that cause most cases of diarrhea. Though probiotics are not harmful, there is no convincing evidence that they are effective. The same is true for substances that contain cow colostrum. Most natural, “chemical-free” and homeopathic remedies have not been studied scientifically.
7. Medicinal treatments can cause serious side effects in children. Use the following products only after speaking to your pediatrician: Kaopectate (kaolin-pectate), Pepto-Bismol (bismuth), Imodium (loperamide), and Lomotil (diphenoxylate and atropine). The same is true for anti-vomiting substances.
8. Recognize symptoms that require immediate medical care. Such symptoms include continuous vomiting or diarrhea; the refusal of fluids or the inability to retain them; reduced activity; presence of fever; complaints of or showing signs of severe abdominal pain; or blood/mucus in the stool. In such cases intravenous fluids may be necessary.
9. Improved sanitation reduces the incidence of diarrhea. The vast majority of cases are due to bacteria, viruses or other microorganisms. The organisms are ingested in contaminated food and water, by swallowing recreational water, and by children placing previously contaminated hands in their mouths. Frequent hand washing helps reduce the incidence. Remember to wash your hands after handling dirty diapers.
10. Miscellaneous. All children with diarrhea, even mild cases, should be isolated to prevent spread to others… Young children should be routinely vaccinated against rotavirus, the most common cause of diarrhea in this age group… Treat traveler’s diarrhea the same as other cases. However, some cases may be more severe and require professional intervention earlier… Check that your phone is operable wherever you travel.
Follow Us on Social Media
