Tips To Keep Your Kids Safe This Summer with Dr. Paula Sabella

Podcast Transcript

Molly Shroades:

Hi, and thank you for joining us for this episode of the Health Essentials Podcast. My name is Molly Shroades and I'll be your host. Today we're talking about summer safety. It's a lot of fun once the sun comes out, but you have to remember a few basic safety tips, particularly with kids. We're here today to talk about this topic with pediatrician Dr. Paula Sabella. Thank you for joining us.

Dr. Paula Sabella:

Thank you for having me. It's a pleasure to be here.

Molly Shroades:

So starting off can you just tell us a little bit about the types of patients you normally see?

Dr. Paula Sabella:

Of course. So I'm a general pediatrician and that means I see and take care of children from birth up to 21 years of age, we find most of our children we'll see through 18 years of age. And then when they go off to college some of them decide to stay with us and some of them decide to move on into the adult world as we say. We take care of healthy children, we take care of children with chronic problems, acute injuries, and chronic illness. So you name it we have the gamut as long as they're pediatrics. A big part of what we do in our practice is preventative medicine, including vaccines, including counseling and working with families regarding growth and development. And of course, safety is a huge part of what we do. So the invitation to be a part of this is very timely so thank you.

Molly Shroades:

Wonderful to have you here. So starting into this topic a lot of kids are very excited for the summer months. They can't wait to get outside and play and take part in fun activities. I want to start off talking about temperature and talking a little bit about what's too hot, when should kids not be outside and does this change by age?

Dr. Paula Sabella:

So good question. So what's too hot? There are some recommendations that a heat index of 90, children should not be outside playing. However, in my opinion, that's certainly an important recommendation, but that's one recommendation. I like to look at the whole picture of what we're dealing with when it comes to the child and the particular child. For example, if we look at two children on a soccer team, as an example, and the one child the night before hydrated has opportunities to hydrate during the game, has opportunities to take breaks during the game, get some shade during the game, goes home and continues hydration, that child's in a little different situation than another teenager let's say on the same team.

              And say she had a vomiting diarrhea illness the day before, and possibly doesn't have the opportunity to hydrate during the game or take breaks or get rest. And when she gets home she just doesn't feel like drinking, even though the temperature is the same outside and the environmental situation is the same, the specifics are different. So it's hard to give a specific number, I think we have to look at each individual child to see what their situation is at that time to give some good advice to families.

Molly Shroades:

Gotcha. Perfect. Now when concerning really young children babies and toddlers, specifically, they have issues with temperature control correct?

Dr. Paula Sabella:

Absolutely. Their bodies definitely heat up a lot quicker than adult bodies do.

Molly Shroades:

You often hear about the dangers of leaving children in a hot car. Why is that so incredibly dangerous?

Dr. Paula Sabella:

So it's terribly dangerous. And unfortunately we hear about these tragedies every year in the news, we read in the newspapers and we hear on the news about children who get very sick or even die from heatstroke after being left in a car. If you think of babies as I think you mentioned babies their bodies’ heat up quicker than adults. So that's one part of the piece, piece of the puzzle, excuse me. And so when that happens they're at higher risk for their core temperature body to increase. Additionally, if we look at the temperatures within a car even on a beautiful day where it might be 60 or 65 and the sun is out, the temperature still can elevate in a car. It's reported that the temperature within 10 minutes can elevate 20 degrees in a car.

              And those studies even looked at cracked or roll down windows and windows that are fully up. So I don't think a cracked window should give anyone a sense of security when there's a child in the car. So the take home message for that is there truly is no safe length of time or situation or temperature where a child should be left in a car alone, period, exclamation point. It truly it happens and people are human and sometimes our lives get busy, unfortunately, but again it's our job to hopefully help those families to remember. There are some clues and some things that parents can try to do to maybe help the process in not forgetting to get their child out of the car. Some parents will put their purse or their work bag or their cell phone even better yet in the backseat of the car.

              So when they do get of their destination, they'll have to go in the backseat and hopefully then see their child if the child didn't get dropped off. They should probably be hyper-aware when they're having a different routine. If they take a different route, if they have to pick someone else up or stop somewhere before they go to work. Because when we get out of our routines, we get out of our routines and it might be easier to forget a child. Some parents will have a pact with their daycare, "Hey, listen grandma or daycare, if I'm not here in 10 minutes or 10 minutes when I'm supposed to be here, please give me a call."

              And once again, just some reminders to the family that things aren't right today. Additionally, we can help families by reminding them to keep their cars locked at all times and keeping keys away from children, because there are stories where toddlers will play hide and seek and jump into the trunk or into the backseat. And unfortunately the infants and toddlers they can't do what we can do. If we get hot, we can take off the sweater, we can get a drink of water and we can leave the car. So it's preventative care in this avenue can't be overstated.

Molly Shroades:

Those are great tips for parents especially putting your items in the back seat by your kid. Anything that can help you to get into a good routine and make sure you remember what you're doing. So keeping going on this topic of heat does humidity make a difference, dry heat versus really humid air? Does that matter when we were talking safety for kids on a hot day?

Dr. Paula Sabella:

Well, it does. Because if you think of how our bodies try to cool itself sweating is one of the mechanisms. Once again, infants, not so much, but in the older children and adults we sweat, the sweat gets evaporated into the air and then our bodies cool. And if there's a humid air sometimes that sweat doesn't evaporate quite so well. So it might be harder for our bodies to cool. So that's certainly something to consider when we're venturing outside.

Molly Shroades:

And kind of following along with that, let's go into hydration. How important is it to hydrate and what does that exactly look like for most kids?

Dr. Paula Sabella:

So it's golden. Hydration is golden. And not just for athletes for everybody. For children, for athletes, no matter what, if you're outside, you should be hydrating. And hydration is so important to think about before during and after. I like to talk to my families about hydration because just drinking water on the field isn't enough or drinking water at the park isn't enough. I suggest that families make sure that they're hydrating the day before a big activity or even the day before a play date. And this is in the toddlers school age and older children, we recommend water as the main source of hydration. A child in those age ranges their urine should be a light color, a light yellow color. It shouldn't be that gold or dark in color, so that's a quick way for parents just to get an immediate gauge as to, "Hey, do they look hydrated or is their urine concentrated and they need some more fluids."

              So that's just a quick way for a guardian to check that out. Then during the day of playing it's recommended if it's really warm outside or a sunny day that the kids definitely of all ages take breaks every 20 to 30 minutes, 20 minutes is better. Where they can get some shade, maybe get some air conditioning, relax a little bit, get some water and then get back to their play. And then in the after part, once they come in from playing hydration has to keep up. So maybe not every 20 minutes, but ensure that they're getting their water as well as nutrition.

Molly Shroades:

And you've mentioned that water is often the best choice. Are there any other drinks that are also really good or can we even use popsicles, fruits and veggies?

Dr. Paula Sabella:

Absolutely. As a pediatrician, it wouldn't be right of me to say my children can have popsicles. However, we usually don't recommend sugary foods. We don't recommend caffeine and we don't recommend energy drinks. I know that sounded like three big nos and I really try to be positive and not in a negative tone, but for hydration I think that's important. Caffeine is found in obviously coffees and teas and chocolates, but it's also a component of energy drinks. And so caffeine can certainly have an effect where you might lose some water and you might dehydrate more. So caffeine is a definite no. When it comes to hydration.

              Sugary foods, sugary drinks as well we don't recommend. Sports drinks and electrolyte solutions do have a place in hydration in children. Usually that's reserved for... Sports drinks and electrolyte solutions basically have salt and some sugar and electrolytes to try to restore any of those electrolytes that might have been lost through excessive sweating and exercise. So after a significant amount of vigorous active exercise for an hour or so, some teenagers will use energy drinks in con... not energy drinks, sorry, sports drinks in conjunction with water.

Molly Shroades:

Dr. Sabella can you tell us a little bit about how do we know as parents if we're giving our kids enough fluids?

Dr. Paula Sabella:

So the best way to figure fluid intake for children and overall nutrition is when you're at your general well-child checks. For each age group there's just a range of what's expected fluid intake. So a newborn has a different fluid intake expectation than a one year old versus a two year old, versus an 18 year old. So in pediatrics there's a wide range of what normal is. However, we can certainly give you clues as to if you're not taking enough fluid. So for example, in infants the clues might be pretty subtle. So they might just be crying, they might be a little fussy. You may think they have a wet diaper. But if you listen and look a little bit more closely, most caregivers and parents know their children. If they know something's off a little bit, there could be more clues like a lack of wet diapers, a lack of tears when crying, if there's heat involved and they're outside in the heat their face can feel flushed.

              They can be irritable, they can have vomiting, they can have an elevated temperature. And a very large concern would be if the soft spot would be flat or something. So those are some ways in an infant you can see that. In older children if you have let's once again just use an athlete on the field or someone at a playground, the same type of thing, those children their lips might look dry and cracked. They're peeing less and having less urine output. They may have a flushed appearance to their face, vomiting, diarrhea, cramps, fainting, feeling dizzy. So those bladder signs are red flags and with the baby as well that some can find until now or just completely irritable are red flags. And in those instances they should certainly seek medical care.

Molly Shroades:

So when we're outside on these hot summer days with our nice water bottle, staying hydrated, how do we protect our skin from the sun? I know there are a lot of SPF clothing and options like that. What are the merits of those? And can you just talk to us a little bit about sun protection?

Dr. Paula Sabella:

Absolutely. I like to look at sun protection sort of, once again, I know I have my beginning, middle and end and I look at this as an ABC route. I think there's certain ways to look when we protect our patients from the sun and ourselves from the sun for that matter. A, we like to stay away from the day. So between 10:00 AM and 4:00 PM are when the ultraviolet, the UV rays are the highest and at their peak and those are the times of day when we're at risk to get sunburn and problems with sun so that's A. B use sunblock or sunscreen so sunscreen as you know absorbs the ultraviolet rays to protect you from their getting on the baby's skin or on your skin. So if you look at the SPF numbers or the sun protection numbers, factors, they're rated on different numbers 15, 30, 50, and what those numbers indicate is the amount of ultraviolet rays that are absorbed from the sunscreen that then will not get onto the skin.

              So if you look at, for example, an SPF of 15, I believe that has a 93% absorption rate. So then you'll have that depth of coverage. And also the higher the number, the longer the protection you'll have. So an SPF of 30 it's 97% and an SPF of 50 is about 98%. So there's truly not a 100% coverage, so that's why it's recommended between by the AAP between 15 and 50 SPF. And the American Academy of Dermatology recommends an SPF of 30, so therefore that's what we recommend for our children. If we look at using sunblock with kids and with people in general, it's recommended that we apply a good amount of sunscreen to slather over the body and all areas about 30 minutes before you leave and go outside, you want to make sure you protect all of the areas. We recommend on children that you test a spot to make sure that they tolerate it and that they don't really have a rash or any intolerance to it.

              It's recommended that then when you go outside you please reapply the sunscreen every two hours or after swimming, sweating, or if you use a towel to wipe your skin off. So it's truly a protector, but we also have to remember to not forget certain parts like our hands, our fingers, our nose, our ears, if you don't have a brim hat and you're wearing a baseball cap, the back of your neck, the top of your feet. So those are some of the areas that we might forget, but it's a wonderful way to protect ourselves. In babies less than six months of age, sunscreen is not recommended. It's recommended that babies under the age of six are not in direct sunlight. They should use the next avenue or the C letter, the cover.

              And that's wearing lightweight clothing, wearing a hat, getting under shade, wearing an umbrella, wearing those clothing I think that you were referring to with the ultraviolet protection factor and those have a tighter weave so those also can protect the skin. So once again, babies fall into that really we like to use that A and C category for the baby, stay away between the 10:00 and 4:00 PM and use covering lightweight clothing, hats to protect them.

Molly Shroades:

Now, if you're a parent and you are in the sunblock aisle and you see the SPF 70 plus, is that doing anything extra for your child compared to the 30 or 50 as you mentioned before as the recommendation?

Dr. Paula Sabella:

I do not believe it is because if we're at 50 to 98, I don't believe there's a sunscreen that gets to a 100. And once again these are layers of strategies, so I think if you can follow those ABCs and apply as directed within that two hour period, you should have wonderful coverage as well. And the more expensive sunscreens aren't necessarily the best.

Molly Shroades:

Great. So you mentioned this earlier, but can you just clarify for our listeners a little bit what exactly a sunburn is and why it matters when we get them that that it's an important thing to avoid?

Dr. Paula Sabella:

So a sunburn is the effect of the ultraviolet rays on our skin. And what that does is it causes a burn and it affects the cells. And can eventually later it can put someone at risk for melanoma later in their lives. So a blistering sunburn under the age of 18 is a risk factor for melanoma and a skin cancer later in life. So it's very, very important that we educate our young patients to use sunscreen properly.

Molly Shroades:

So I have wondered before about long sleeve swimwear. I know some people are worried that their child might overheat. If they're wearing long sleeve swimwear, they want them to be nice and cool in the summer sun, out in the pool but yet they want their skin protected. What would you advise folks on this?

Dr. Paula Sabella:

Well, I think that's apparent preference. I think that in the water I think the patients would be very cool with that. It's when they get out of the water that you would have to be concerned. Most kids want to take those off to make sure that they remain cool. However, that's when I believe you can get into trouble if you're not sunscreened underneath that shirt. And also we have to remember to use sunscreen on the hands feet head when we wear those protective clothing.

Molly Shroades:

And as you said before it's a combination of strategies.

Dr. Paula Sabella:

Yes.

Molly Shroades:

Wonderful. So in the water, what are some basic safety tips we need to remember? And is there a too young of an age to put your child granted supervised in the water?

Dr. Paula Sabella:

You know, once again, that's a difficult question to answer because every family's different. So as we alluded to before babies less than six months of age should not be out in direct sunlight. So if you're in a pool with direct sunlight, I would not recommend that baby get into the pool. If we look at safety mechanisms and safety advice for swimming, number one is I recommend we never ever swim alone. We always have adult supervision and a water watcher where they can keep their eye on the children, whether it be in your backyard pool, whether it be in your floatie pool, whether it be at your local rec center where there's lifeguards, someone always has to keep their eyes on children. I also suggest that non swimming children wear life vests, and also any time you're on a boat or a watercraft, everybody on that boat, swimmers or non-swimmers where life vests.

              Getting back to the home pools it's important that we remember that there are safety requirements when someone has a home pool. And some of the most important features would be having a fence on all four sides of the pool, not just a fence that covers three sides entering into the home. That fence should be about four foot tall, have a latch that locks. Those are some regulated and some various states have different laws on... and different communities have different laws on that but that's recommended by most. It's also recommended that we don't keep fun toys in a pool, because if you look at the children age that are at most risk of drowning in pools, it's the children between the ages of one and four and one in five. So those children if they see a pretty Flamingo floating in the pool, they might try to get in and get it and we certainly wouldn't want that to happen.

              When we're with children around water, we recommend especially being around toddlers that we're within an arm's length from that child at any time because they're quick. They can get into a pool, they can get into a lake, they can fall into their little tiny blow-up pool in the backyard. They can fall into a bucket. So we should never have freestanding water in our areas. We shouldn't have buckets, floatie pools filled up even bath tubs should be drained because all of those are a risk to toddlers.

Molly Shroades:

Absolutely. Now one old phrase I'm wondering about here is the phrase of don't get in the water for 30 minutes after you've eaten your lunch, that I'm sure most of us have heard throughout our lives. Is there any truth to that and why?

Dr. Paula Sabella:

So the thought was back then and I do, I remember sitting on the side of pools waiting for that stopwatch to go off so we can all jump in. But certainly the thought back then was if we eat a large meal, all of the blood leaves our extremities to go into our gut to help with digestion, and then you might have weakness of your hands and feet and you wouldn't be able to swim. And that has proven to not be the case, so it is fine to swim after you eat. Once again, I think most parents know their children, most guardians know their children. And then we have to look at the child in once again, the unique situations.

              So if a child has some fruit or a popsicle or some watermelon, I think that's different than eating a whole pepperoni pizza and jumping in. So we want the children to be comfortable in the swimming pool. We want them to be able to move around and not just feel very bloated and comfortable. Exercise is great, but I think we just have to have a little bit of expectations when it comes to the individuality and the individual decisions.

Molly Shroades:

Great. So now outside of the pool, we're going to go onto a pesky part of summer bugs. How do we care for bug bites in the summer?

Dr. Paula Sabella:

They are happening and I've already seen patients this year with bug bites, so we know we're in summer. So bug bites definitely happen. They typically are found on the exposed area of our children's bodies or on people's bodies. So when children go out to play, think about it in the summer they're wearing short sleeves, shorts, probably tennis shoes, socks and running and having a good time. So we're bound to see bug bites usually on the lower legs, the arms, and the face, the exposed area. Once again, clothes is protecting us. Bug bites can be as we all know small little bumps, they itch and they usually don't cause too many problems. Once again, we can try to prevent bug bites by not going outside during dusk and dawn or mornings and evenings.

              When most of the bugs and mosquitoes specifically are out, we try to avoid standing water in our homes or outside of our homes. Because standing water, stagnant water, ponds that don't have much movement within them can serve as a breeding ground. Folks who have fountains if the fountain is on that's better because the fountain is moving the water. But if the fountains off and the water is stagnant for a couple of weeks, that certainly could invite mosquitoes. So we can also prevent mosquito bites by using insect repellent, something that contains DEET and the American Academy of Pediatrics recommends no more than 30% concentration of DEET in children over two months of age as an insect repellent.

Molly Shroades:

Great. So when should a parent worry about a sting or a bite? When do they need to call the doctor?

Dr. Paula Sabella:

With bites we would get concerned if there would be with any bite, we get concerned if there would be any redness, warmth, swelling, drainage, red straights, fever or sign of infection. That's a fairly rare complication but certainly can happen. If we're looking more at stings from bees or wasps most reactions to bees and wasps are local reactions, which would mean swelling, itching, redness, pain. Unfortunately, those local reactions are the majority of response to stings.

              There is a systemic or a total body response to stings, and that's a big concern and that's called anaphylaxis where a child can get bitten or stung by a wasp or a bee and they can have hives, tongue swelling, face swelling, runny nose, vomiting, passing out, major problems, loss of consciousness and that is a medical emergency. Those are the patients that if they do know that allergy they would get an EpiPen call 911 and get immediate care as soon as the sting occurs. If unknown, once again, that is a 911 telephone call and those kids are certainly managed by an allergist to make sure that they are safe moving forward.

Molly Shroades:

Great. So for parents at home what are a few ways they can treat the minor stings? The bee sting that just it hurts a little bit, but doesn't cause a reaction or the small bug bite.

Dr. Paula Sabella:

For simple bug bites for the mosquito bites that itch and cause more annoyance than harm, we recommend things like hydrocortisone topically to help with any of the itching and antihistamine like Benadryl or Zyrtec or Allegra, one of the over-the-counter age appropriate antihistamines to help with any itching and then monitor for any signs of infection. For bee or wasp stings you can use the same agents. You can use a cool compress because sometimes those really do get a lot of local swelling. So cool compress, elevation, Tylenol or Motrin for pain. And if there's a lot of itching that goes along with it, once again, one of the antihistamines to help with those symptoms. If the swelling is very severe you can even elevate the extremity to help some of the swelling improve.

Molly Shroades:

Wonderful. So I kind of want to touch on this for a moment, but with kids there are so many small little scrapes and bruises and strains and sprains, and everything that seems to happen when they start playing outside. Can you give us a few tips about playground safety and when you should call your doctor about those little mishaps?

Dr. Paula Sabella:

So first of all on playgrounds safety is paramount of course. So we recommend that when children are playing on a playground they are in proper clothing to play. So flip-flops are probably not a great idea if you're climbing up a slide ladder, and if you're going down the slide, we want to have some support on the feet. So tennis shoes and not slippery sole on the shoe work great. Certainly we also recommend not a lot of strings on hoodies let's say, because going down a slide we wouldn't want a string getting caught on something or on a swing. I recommend for parents when they're looking at playgrounds to look and see if the playground suits their child. So are there small swings for small children? Are there bigger swings for the bigger children? Is there enough room for them to swing where kids aren't going to run and get injured when they run behind them?

              Is the surface of the playground safe? Is it cement? Is it asphalt? Or is it the rubber type of products or mulch which are a much safer environment children. We look to see if there's platforms where the slide is, are there railings and are they appropriately sized railings? So those are just some simple things to just eyeball before you bring your child to that playground. Now we all know bumps and bruises do happen and small scrapes happen. And once again, I usually have parents who know their children very well, listen to their children. So the child that falls and cries and we want to support them and make them feel comfortable. But we also want to assess those children when they do fall. And a parent knows when something's up. There's no doubt. So I usually tell the parents calm them as much as you can and see how they're doing.

              If it's a small scrape, obviously evaluate it, if there's bleeding I'll have you just apply a little bit of pressure. So this is basic first aid and see how the child does. If you remove that pressure and the bleeding is under control and the wound looks okay. If it's like a little scratch or if it's a little knee burn, like a rug burn type of look then I'll have you wash your hands, wash the area real well with soap and water and put a little antiseptic on, little latex free Band-Aid and a lot of times that does the trick. However, if there's significant bleeding, we can't stop the bleeding, the wound is deep or gaping or if you're just not sure it makes sense to get it checked out.

              If we're looking at things like, "I twisted my ankle when I came down the slide," or something along those lines. Once again, listen to the clues your child's giving you. If they calm down and climb up the slide and go down and then walk on the monkey bars and run in the field, you're probably getting the message from them that they're feeling okay. But if they really can't walk, if you see an obvious deformity, if there's color changes to the toes or feet then certainly that's an emergency and we need to get them care immediately.

Molly Shroades:

I like that point about talking to your child and listening to them to see what you need to do next and understanding if it's a break you're going to need to get x-rays, right?

Dr. Paula Sabella:

Absolutely. Absolutely.

Molly Shroades:

Great. So as we wrap up here, do you have any suggested safety rules that just general ones that you really want people to try out this summer?

Dr. Paula Sabella:

Summer is fun. Summer is a lot of fun and certainly can be safe. We all like to go outside. We like to get our exercise, blow off steam, get our vitamin D, it's a wonderful time. And I just really think we need to... My safety conversation would be to just keep close supervision on your children at all time, no matter what they're doing. We don't want to hover, we want them to have fun and run and play, but being mindful that there's extraneous parts of our environment that could potentially be dangerous to them. So be mindful of the sun, keep an eye on the hydration, keep pool safety and water safety in mind. But most of all just have fun, love your children and enjoy the summer.

Molly Shroades:

Thank you so much for taking the time to talk to us and sharing your insights, Dr. Sabella.

Dr. Paula Sabella:

Thank you very much for the opportunity.

Molly Shroades:

To learn more about children's safety and summer fun visit clevelandclinicchildrens.org.