Summer Fun and Safety

After 20 years as an emergency room physician, Dr. Gary Kavit has divided the summertime injuries he expects each year into two basic categories: common, and devastating.

The first group includes the sunburns, insect bites and poison ivy that bring many people into Riverside Regional Medical Center in Newport News, where Kavit works as Medical Director of Emergency Services. The second covers the cases that make all doctors cringe, namely drowning, spinal cord injuries and heat stroke.

"No matter how many times I see these cases, my throat just tightens," he said. "Often, you know a family's life is going to change forever."

Fortunately, parents can do a lot to help their kids have fun in the sun and water without ever seeing the inside of a hospital, doctors say. "The majority of it is supervision and more supervision," said Dr. James Schmidt, an emergency physician at Children's Hospital of The King's Daughters in Norfolk. "Parents just really need to pay attention."

Drowning and Spinal Injuries

Children can drown not only in large bodies of water but in water as shallow as three to four inches, Kavit said. That more than covers the plastic pools in many backyards and the large buckets that people might use to wash a car. Once a child's head is fully or partially submerged, water can hit the larynx and close off the airway in a matter of seconds.

"What will happen is the parent will go inside just for few moments - say, to answer the phone - and the next thing they know their 2-year-old is upside down in a bucket," said Kavit, who reports that Riverside sees an average of two to three drowning or near-drowning cases each summer. "It's when parents let their guard down, even briefly, that trouble comes."

Improper supervision can be as simple as a parent turning to talk to a friend at the neighborhood pool and getting distracted, Schmidt said. That's why in addition to learning basic CPR, he suggests parents trade duties as "water watchers" at pools and beaches - even if a lifeguard is on duty.

"The rule is the person has to turn her back to any group that's chattering," Schmidt said, "and she can't take her eyes off the water during her entire shift." (To order waterproof plastic tags that designated watchers can hang around their necks, go to www.waterwatcher.org).

Without paying close attention, parents might not realize a child is in trouble until it's too late, agreed Kim Wood, Associate Branch Director at the Victory Family YMCA in York County, which offers a summer day camp that includes time in an indoor pool.

"You're often not able to hear them yelling for help," Wood said. "So you have to constantly watch them, and if they're in a group, constantly count them. Look for signs of real trouble like flapping their arms wildly or going under water and not recovering quickly."

Other YMCA water safety tips include following pool rules, always swimming with a buddy and banning all physical horseplay. "One minute kids are climbing on somebody and it's all a game, and the next minute they're under water for too long or they bump their head," Wood said. "It can change so fast."

At the beach, parents should be aware of the general landscape where a child is swimming, looking for strong currents and rip tides - ask a lifeguard for help spotting them - while keeping kids away from rocks, inlets or jetties. And anyone with a backyard pool should install a 4-foot-tall, non-climbable fence (usually made of a mesh material) with a self-latching gate.

Finally, parents should teach kids never to dive into water if they can't see the bottom. To Kavit, that includes waves at the ocean. "I know a lot of kids hate to hear that, but it's not worth the chance of hitting your head, breaking your neck and being paralyzed," he said.

Sunburn

A few summer sunburns are no big deal, right? Wrong, Schmidt said. In fact, every burn raises a child's lifetime risk of potentially deadly skin cancers. "You may think they just burn and peel and are all better," he said, "but even a small number of burns could be something they pay for as adults."

About 80 percent of a person's lifetime sun exposure happens in the first 18 years of life, studies have shown, and children's more sensitive skin can burn easily. Yet one University of South Florida found just 43 percent of parents apply sunscreen regularly, while a Boston University report discovered only a third of teenagers ages 12 to 18 had used sunscreen routinely the previous summer (not surprisingly, 83 percent of them got at least one burn).

The American Academy of Dermatology recommends applying sunscreen with an SPF of at least 15, and doing so about 30 minutes before going outside. Children need a new coat of sunscreen after they've been in the water, toweled off or gotten very sweaty.

But even using sunscreen isn't enough. Many parents wrongly believe that once kids have it on, they're fine to stay outside for long periods, said Amanda Evans, a Newport News resident who has lifeguarded at several area pools and beaches. "They'll slather on sunscreen when they first get to the pool but then don't do anything else for the hours they stay," she said. "It doesn't work."

The hourly breaks for swimmers at many pools are a great time to reapply sunscreen and have kids rest in a shady spot for at least 10 or 15 minutes, Evans said. She suggests creating a similar schedule at private pools and beaches: "I remember there once was this one mom who set a stopwatch for 60 minutes at a time," Evans said. "When that time was up, the kids had to come and chill under the umbrella and put more sun stuff on. I was like, 'That's really smart.'"

Dehydration and Heat Injury

In addition to sunburns, young children are more at risk for dehydration and heat-related illnesses than adults. However, they're often too distracted or busy to admit - or even notice - that they're thirsty or becoming exhausted.

One strategy is to have kids carry their own water bottles to camps and anywhere outdoors, giving them free access to fluids without having to take a complete break from an activity. Balancing indoor and outdoor activities also is important, especially in the middle of hot days; the YMCA, for example, shifts into "rainy day mode" whenever the heat index climbs above 105 degrees and keeps kids mostly inside.

There are three levels of heat illness: heat cramps, heat exhaustion and heat stroke. While muscle cramps and very heavy sweating can be a sign of trouble, the real danger is when a child suddenly stops sweating, meaning his body can no longer cool itself. Some people get to emergency rooms with a body temperature higher than 107 degrees.

Heading off that life-threatening scenario is crucial. Said Wood, "If we see that a child is excessively sweaty, complaining of headaches or being lethargic, we will immediately have them sit down and cool off, put a cool cloth on the back of their neck and give them water. You can't mess around with it."

Insect Bites and Poison Ivy

Even with insect repellant, instructions not to mess with stinging insects and tutorials on what plants to avoid, itchiness is a somewhat inevitable part of summer. In most cases, antihistamines and hydrocortisone creams can relieve discomfort.

But a severe allergic reaction - symptoms include a tightening throat, facial swelling, weakness or dizziness or a widespread rash - requires immediate emergency treatment, Kavit said. Parents also should watch for skin infections. While itching is normal, pain, tenderness, spreading redness or bulging that occurs two or three days later could need medical attention.

"At the first sign, you might try minor first aid such as putting on Neosporin," he said. "If it gets worse or you're worried, it's a good idea to see a doctor."

Jellyfish Stings

A parent's common first instinct when a child runs in from the ocean yelping is to pour or rub fresh water on a sting. But that change in salt levels only releases more tiny little barbed darts into their skin, Schmidt said.

Instead, the best approach is to rinse the area with salt water and use a razor or the edge of a shell or credit card to gently scrape away those barbs. Applying a baking soda paste for 30 minutes can speed healing, while at-home comfort measures include antihistamines, hydrocortisone cream or ice packs.

And beware: jellyfish can still sting even after they've died. So tell curious kids not to poke at or step on the jiggling bodies they see washed up on the sand.

Lightning Strikes

Storm-related injuries aren't common, but they tend to be severe. Getting inside when lightning and thunder are nearby is a non-brainer, but to determine if a storm is definitely unsafe, Schmidt recommends the "30-30 rule."

Basically, if thunder comes within 30 seconds of lightning - start counting as soon as lightning appears - it's time to seek shelter. "At that point you know you're in a danger zone," Schmidt said. Rain, he added, is not a good indicator of risk; the ground may still be dry when the 30-30 rule applies.

Once people have retreated inside, they should wait 30 minutes after the storm has passed to venture back out. If it's impossible to get indoors, find the lowest spot possible - preferably in an open space - and crouch on the ground.

Playground Burns... and Cuts and Bruises

Playground equipment and surfaces can heat up so much that they can cause first- or even second-degree burns in young children, doctors say. Kids also should wear shoes at all times on playgrounds, because surfaces such as black rubber mats also can reach broiling temperatures.

Jennifer Dixon, a Hampton mother, remembers watching her then-3-year-old daughter Jamie run screaming from a metal slide two summers ago. "She wasn't badly hurt or anything, but she did have a big red mark on one of her thighs," Dixon said. "And she wanted to go home."

Since then, Dixon has always touched every playground surface herself before letting Jamie and her younger brother Ryan, 2, start climbing. "I just do a quick sweep while the kids wait," she said, adding that she also looks for broken glass or other sharp objects on the ground.

Of course, children are vulnerable to broken bones, pulled muscles, cuts and bruises as they are all year round. And given how much energy many kids have to burn, that's not likely to change.

"Go out and have fun," Schmidt said. "Just do your best to be careful and know that sometimes, it's smart to take it easy."

Read Alison Johnson's blog at www.mytidewatermoms.com

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Source: Tidewater Parent Magazine