Brittany Arnold: Summer health & safety: Part II

Last week, I shared some great information from Wendy Zyziewski, a local family nurse practitioner at Evergreen Family Medicine and mother of two, and I am here with some more in an effort to hopefully save you from the aisles of sunscreen choices, lines at urgent care and the countless number of things the Internet will tell you regarding your child and their summer safety.

Water Safety

What are some ways to teach our children about water safety and preventative measures that parents can take regarding children who are attracted to water?

WZ: Swim Lessons are huge! The YMCA offers swim lessons for infants up to adults and is a great way to introduce children to the water, plus they teach a lot about water safety. The AAP does not recommend mandatory swim lessons for all children ages 1-4, but the decision should be made by the parent based on their developmental readiness. Even if they have had lessons, children should never be left alone in or near a pool, spa river, or other body of water, not even for a moment. Drowning can happen in a matter of seconds in a few inches of water. Avoid inflatable swimming aids like “floaties.” These are not a substitute for approved life vests and provide a false sense of security. They can deflate quickly and the child can then be in trouble. Whenever children are in the water they should be with an adult who is within arm’s length. Always enforce strict safety rules – no running, no pushing someone underwater. Your child should always wear a life jacket when he swims or rides in a boat. A life jacket fits properly if you can’t lift it off over your child’s head after he’s been fastened into it. For the child under age 5, particularly the non-swimmer, it also should have a flotation collar to keep the head upright and the face out of the water.

If you missed it earlier this week, check out fellow blogger Jayne Gautreau's post about water safety here.

Heat Exhaustion/Dehydration

How should parents check for heat exhaustion?

WZ: Heat exhaustion is the body’s response to an excessive loss of water and salt. Signs of this include: profuse sweating, cold pale clammy skin, muscle cramps, fatigue, weakness, headache, nausea or vomiting, dizziness, fainting, rapid shallow breathing or a rapid, weak pulse. Most of these symptoms are caused by dehydration from sweating.

What are some preventative measures for this?

WZ: Avoid activity in the heat of the day. Children should be well hydrated before even starting to play and should not be thirsty. Have your child take water breaks every 15 minutes in the shade. Encourage him to drink some water even if he's not thirsty. Thirst can be delayed until a person is almost dehydrated. Have your child wear a single layer of lightweight clothing. Change it if it becomes wet with perspiration. Protect infants from heatstroke by not bundling them in blankets or excessive clothing. Children usually need the same number of layers of clothing as adults. During heat waves, spend as much time as possible in cool environments with air-conditioning.

What are signs and symptoms of dehydration?

WZ: Signs of mild to moderate dehydration are: plays less than usual; urinates less frequently (for infants, fewer than six wet diapers per day); parched, dry mouth; fewer tears when crying; sunken soft spot of the head in an infant or toddler.

Signs of severe dehydration include: Increasingly fussy; excessively sleepy; sunken eyes; cool, discolored hands and feet; wrinkled skin; urinates only one to two times per day.


For physical injuries, when should parents call the doctor verses bringing them into the emergency room?

WZ: Concussions should be evaluated at the Emergency Room if there has been a loss of consciousness. Any fracture or possible fracture should be seen at the ER or urgent care.

Here is a list of times when to take a child to ER rather than wait for the PCP: If you have a baby under a month of age who is vomiting, not eating well or excessively sleeping; child is severely lethargic – staring off into space, too weak to cry, floppy, hard to awaken; sudden onset of confusion; child complains of severe pain and/or has inconsolable crying; sudden inability to walk; child has an extremely tender abdomen with minimal pressure; extremely tender testicle; breathing difficulty – grunting or wheezing with each breath, retractions (where skin pulls in around the ribs); infant with bulging soft spot; any neck injury or stiff neck; purple or red spots that appear unexpectedly; fever over 100.4 in a child 3 months or younger.

How should minor injuries be cared for?

WZ: Wash immediately with soap and warm water to get the dirt out. Apply polysporin or triple antibiotic ointment and cover with a Band-Aid.

What should parents look for in a possible concussion?

WZ: Monitor the child closely over the next 24 hours. Watch for the child to be overly sleepy, vomiting, change in behavior, inconsolable crying and/or a headache that will not resolve or gets worse. You should try to arouse the child every few hours during the night.

Bites & Stings

What are common bug bites to look out for in Douglas County?

WZ: Mosquitos, ticks, fleas, and spiders.

What should parents look at in a bite before taking the child in to the doctor?

WZ: It is normal to see a small, itchy red bump or even localized hives or welts. If a child develops shortness of breath, difficulty swallowing or confusion, they should be seen immediately by calling 911. If there is severe pain that does not resolve within a few hours of the bite or redness that is getting worse after 48 hours, the child should be seen by their PCP. If you notice redness that is streaking away from the bite more than an inch or the child develops hives or a rash elsewhere on their body, they should also be evaluated.

What is a good bug repellent for the whole family?

WZ: You can use DEET products. The American Academy of Pediatrics has approved the use of DEET in a concentration of 30 percent or less for all children 2 months of age and older. Don’t apply to children’s hands if they suck on their thumbs or fingers to prevent ingestion. Permetherin products can also be used, but should only be applied to clothing.

What should parents look for in their child’s first bee sting, especially if allergies run in the family?

WZ: An anaphylactic reaction will usually start within 20 minutes of the sting and always by two hours following a sting, so watch the child carefully. If the child becomes hoarse, develops a cough, wheezing, difficulty swallowing, confused or slurred speech, they should be seen immediately by calling 911.

When should the child be taken to the doctor?

WZ: Children should be seen if they are stung in the mouth or the eye, if they have had more than five stings for every 10 pounds of body weight (example: 20 lb baby who was stung 10 times), abdominal pain or vomiting, if swelling spreads beyond a joint such as the wrist or the ankle, if it has been 48 hours since the sting and the redness is continuing to spread or there is streaking away from the sting.

What are basic recommendations on treating a bee sting for all ages?

WZ: Remove the stinger if it is present (normally these are not left by yellow jackets, usually only by honey bees). Then use a meat tenderizer spice/water solution to make a paste. Apply it on a cotton ball for 20 minutes to the sting. This is supposed to help neutralize the sting and decrease the pain. Massage with ice in a compress for pain. You can use Tylenol or Ibuprofen for pain, as well as over-the-counter one-percent hydrocortisone cream or calamine lotion to the area up to three times a day for itching. It is normal for the redness to last for about three days and the swelling for about a week, but it is abnormal for it to spread or get worse.

Traveling Tips

As for traveling, what would you suggest are essential medical items to bring for the whole family (children and parents)?

WZ: Always have a copy of your medical insurance and your PCP’s phone number and address with you when traveling as well as a list of medical conditions, medications and allergies for each person. Also, if parents are traveling without their children, make sure that you leave a note for whoever the care provider might be (grandparents, aunts, uncles, etc…) that you authorize them to seek health care for your child in your absence and sign it. Provide the care giver a copy of your insurance and PCP information as well. I found a great recommendation for a first aid kid when traveling with small children on the AAP website. It includes the following: * Tylenol (acetaminophen) or a nonsteroidal anti-inflammatory medication (such as ibuprofen)* Antibiotic ointment (polysporin) * Prescription medications (a month’s supply) * Bandaids (in various sizes) * Gauze pads and tape (hypoallergenic) * Scissors * Tweezers * Soap or saline wash * Vaseline * Moistened towelettes * Thermometer.

Brittany Arnold is married with a daughter and another child on the way (in June!). Read her Wednesdays on Douglas County Moms. Also check out her personal blog here.

Signs of severe dehydration include: Increasingly fussy; excessively sleepy; sunken eyes; cool, discolored hands and feet; wrinkled skin; urinates only one to two times per day.

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The News-Review Updated Nov 18, 2013 07:28PM Published Jun 7, 2013 08:55AM Copyright 2013 The News-Review. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.