Sun and Water Safety: Don’t take risks. Follow these tips.

Memorial Day signifies the start of summer, the opening of pools and trips to the beach. Regardless of where you’ll be outside or around water, it’s always important to be safe. Make sun and water safety a priority! Bug safety will be covered separately in a future post.

Safe in the sun!

Keep kids safe in the sun with many methods, not just sunscreen.
Keep kids safe in the sun with many methods, not just sunscreen.

Protecting your child in the sun is very important. Make sure you understand how various sunscreens work, how they should be used, and what else you can do to protect your kids from the sun.

Infants under 6 months

Babies under 6 months of age should be kept out of the direct sunlight as much as possible.

Move your baby to the shade or under a tree, umbrella or the stroller canopy. Be careful near reflective surfaces, such as water. Shade may reduce UV exposure by only 50% if there’s reflected sun.

Dress them in lightweight but long sleeved clothing and wide brimmed hats to keep the sun off their skin.

It’s okay to apply sunscreen to small areas of the body that you cannot cover with clothing, such as face and hands.

Make sure infants stay hydrated in the heat. Do not give extra water to infants until they are on solid foods. Breastfeed more often or give extra formula to prevent dehydration.

Mineral vs chemical sunscreens

The sunscreen does not have to be baby specific, but chemical sunscreens are absorbed more than mineral sunscreens. One of the concerns of young infants using sunscreen is they absorb chemicals too much, so mineral sunscreens are preferred for them.

I think most things marketed for babies are really for parent’s piece of mind. They aren’t necessarily better for baby. And they can mark up the cost just because it says it’s for Baby. But one of my favorite sunscreen brands for babies – Blue Lizard – actually prices competitively for the baby product. I like this brand because it was developed in Australia to be used safely at all ages. All of their products are mineral based.

Mineral based products use zinc oxide and titanium dioxide to reflect sun rays. There is minimal absorption. The downsides are they are not as light on the skin and they can wash off when sweating or swimming.


Chemical sunscreens, on the other hand, are absorbed into the skin. They absorb the sun rays that enter the skin. These are best for older children who are exercising outdoors and swimmers since they do not wash off as easily.

What is SPF?

SPF= Sun Protection Factor

The SPF increases the time you can spend in the sun, depending on your skin type. If you would typically burn in 1 hour, an SPF of 15 will keep you from burning for 15 hours, if you reapply every 2 hours. If you would burn in 20 minutes, an SPF of 15 used every 2 hours would protect you 15 x 20 minutes, or 5 hours. This is why fairer skinned people need higher SPF levels.

The sun protection factor (SPF) should be at least 25 and should cover both UVA and UVB rays. The sooner your skin burns, the higher the SPF you should use.

How should sunscreen be used?

For all infants and children over 6 months, be generous with sunscreen. Apply sunscreen at least 30 minutes before going outside, reapply it every 1-2 hours if sweating or swimming (even if it states it is waterproof), and use sunscreen even on cloudy days. One full ounce should be used to cover an adult.

Reapply the sun screen every 1-2 hours.

Try to keep children out of the sun between 10:00 am and 4:00 pm, when the sun’s rays are strongest.

Clouds are not sufficiently protective against the sun. UV rays on cloudy days may be reduced by only 20% to 40%.

Does sunscreen cause cancer?

I don’t know why this is a popular question these days. Well, yes, I know why people question it. The rumor that chemicals in sunscreen are dangerous is commonly circulated online. That’s why it’s questioned, but I don’t know what started this rumor.

Sun causes cancer.

Sunscreens have been studied extensively and have been shown to be safe. Use them.

What about eyes?

We often neglect our eye health, but there are ways to prevent sun damage to our eyes. This sun damage can lead to cancer, cataracts, and growths in the eye.

Sunglasses should be used to protect the eyes from sun damage. Hats with wide brims also keep sun out of the eyes.

Be sure your sunglasses are rated to protect against UVA and UVB 100%. Darker glasses don’t offer more protection necessarily. They must be rated to protect against UVA/UVB.

Bigger frames are better. Especially the ones that wrap around the sides of the face.

Higher cost doesn’t mean better protection – look for the rating! Even inexpensive sunglasses can provide protection. This is good, since most of us need several pair due to them getting misplaced or broken – especially the ones for our kids!

For more on sunscreens:

SMART SUN PROTECTION: UNDERSTANDING THE BEST SUNSCREEN OPTIONS from Dr.Michelle Ramírez at Dream Vibrant Health.

Which Dermatologist-Approved Sunscreen You Should Use To Keep Your Skin Safe from Dr. Dhaval Bhanusali, a medical and cosmetic dermatologist

Sunscreen Safety: Is It Worth The Hassle? from Dr. Nidhi Kukreja at The Growing Parent.

Water

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How can I protect my child around water?

All parents should take a basic CPR course! Young children can drown in only a few inches of water, even if they’ve had swimming instruction.

Children who are swimming – even in a shallow toddler’s pool – should be watched closely. Even if there’s a lifeguard at the pool, there is too much to monitor when there’s a pool full of kids. You must watch your own kids until they’re strong swimmers.

It’s recommended that infants and toddlers have an adult within arm’s reach. For young children, you should continue to pay constant attention and be free from distractions. It’s easy to be distracted when talking to another person or checking your phone. Don’t consider it watching kids if you’re pool side reading a book.

Inflatable pools should be emptied and put away after each play session. (This also reduces unwanted mosquitoes!)

Enforce safety rules – no running near the pool and no pushing others underwater.

Water wings, tubes and other floating devices are not approved flotation devices and should be used only under direct and close supervision. Because they give a false sense of security, I don’t recommend them.

Be sure the deep and shallow ends of any pool your child swims in are clearly marked. Never allow your child to dive in the shallow end.

And then there are teens…

Talk to older kids and teens often about water safety. As they gain confidence in the water, they take more risks.

Teens are especially notorious for risk taking behaviors. Let them know your expectations. Teens might roll their eyes, but studies show they do best with rules and clear expectations from parents.

Of course they should not drink alcohol ever, but risks increase around water. They should never swim alone, even if they are captain of the swim team. If they are going to a river or lake, they need to be careful of inherit risks there, such as diving into shallow waters and boat safety.

As always, be sure you know where they’re going and when to expect them home. If they’re in water they won’t have a cell phone available at all times, so you might want to schedule “check in” times.

Drowning Risks

Drowning is a real risk. Dry drowning? Not so much.

Learn what distress in the water looks like. The movie depiction of drowning with a lot of yelling and thrashing around is not what usually happens.

If someone can verbalize that they’re okay, they probably are. Drowning victims can’t ask for help. There is a video linked to this page of what to look for with drowning that shows an actual rescue. From this site, signs of drowning:

  • Head low in the water, mouth at water level
  • Head tilted back with mouth open
  • Eyes glassy and empty, unable to focus
  • Eyes closed
  • Hair over forehead or eyes
  • Not using legs – Vertical
  • Hyperventilating or gasping
  • Trying to swim in a particular direction but not making headway
  • Trying to roll over on the back
  • Appear to be climbing an invisible ladder

What about swimming lessons?

The American Academy of Pediatrics does not recommend swimming lessons for children under one year of age because they cannot really learn skills to keep them safe.

Even young children who have had swimming lessons should not be unattended at the pool because they are not able to always make safe choices.

How can I protect my child around the backyard pool?

Inflatable pools should be emptied and put away after each play session. (This also reduces unwanted mosquitoes! Who wants mosquitoes in their backyard?)

If you have a swimming pool at home, it should be completely surrounded on 4 sides with a tall fence that has a self-locking gate. The house cannot serve as one side of the barrier. Keep the gate closed and locked at all times. Be sure your child cannot manipulate the lock or climb the fence.

If your pool has a cover, remove it completely before swimming. Never allow anyone to walk on the pool cover. Your child could fall through it and become trapped underneath.

Keep a safety ring with a rope beside the pool at all times. If possible, have a phone in the pool area with emergency numbers clearly marked.

Spas and hot tubs are dangerous for young children. They can easily drown or become overheated in them. Don’t allow young children to use them at all due to these risks. If older children use them, they should be supervised. Be sure they are well hydrated. After using a hot tub, be sure everyone showers. You don’t want hot tub folliculitis!

What about at the ocean or lake?

Talk to kids about the pull of undertow if you’re wading into the ocean. (If you don’t know what this is, walk into the water without your kids first.)

Use coast guard approved life preservers correctly whenever needed. All people should wear a life preserver when riding in a boat unless they are inside a cabin. Children should wear a life preserver when they are near the water’s edge or on a dock, even if the law doesn’t require it.

A life preserver 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 five, particularly the non-swimmer, it also should have a flotation collar to keep the head upright and the face out of the water.

Adults should not drink alcohol when they are swimming or boating. They are not only at risk of dehydration from the alcohol, but they also risk lives. It presents a danger for them as well as for any children they might be supervising. Don’t ruin a fun time with a tragedy.

Keep it fun in the sun!

Sun and water safety are not only important, but if you’re not careful, it can ruin a vacation. Practice sun and water safety every day!

 

Dry Drowning – What Parents Need to Know

I thought about calling this one “We’re drowning in dry drowning phone calls” because we are getting many worried calls about dry drowning, but that’s overly dramatic and I hate headlines that make things seem like the sky is falling…

I had never heard of dry drowning until social media picked it up a couple of summers ago. Maybe I did as a resident, but since I’ve never seen it, I’d forgotten the term. Either way, it isn’t very common at all, but it is an emergency when it happens, so it’s good that we all know that it can happen. People also use the term secondary drowning and some experts differentiate the two by whether or not water actually gets into the lungs, causing swelling of the lung tissue, or if water irritates the vocal cords, causing them to spasm and close off. Either situation is potentially life threatening and they have similar symptoms. Note: Please see the addendum at the bottom. Several articles have emerged since the original writing of this post that clearly indicate there is no such thing as dry drowning.

One of the reasons I think so many parents are worried is that it is common for kids to go under water: in the tub and in the pool. Many get water in their mouth or complain that it went up their nose. Few actually get any into their lungs, which is where it can cause problems. How can you know when you need to worry?

Most of us recall a time we coughed briefly after inhaling liquid, and we were fine. So when is it worrisome? It’s when the water that gets into the lungs causes inflammation within the next day or two. This inflammation makes it hard for the lungs to work – the air tubes are swollen, so air can’t get through. Treatment is giving oxygen, sometimes with a ventilator (breathing tube and machine) until the inflammation goes down.

Symptoms you need to recognize and act upon by taking your child to an ER:
  • Cough: If your child has coughing for a minute or more after being in water, he’s at risk. This indicates that the child is trying to clear the airways. If water got down there and they cough most up, some can remain behind and lead to inflammation over time. Watching your child carefully for the next 3-4 days is important. This can be hard to recognize initially, so a complete evaluation is important if any other symptoms develop.
  • Difficulty breathing: Anyone who is struggling to breathe needs further evaluation. Signs can be rapid breathing, sucking in the ribs or the stomach, difficulty talking, or even a look of fear from difficult breathing.
  • Near drowning: If your child had to be pulled out of the water, he should be evaluated in an ER. Even if he seems fine afterwards. The reaction is delayed, so they can seem to be 100% better and then go downhill.
  • Behavior changes or confusion: If a child is confused, lethargic** or has a change in ability to recognize people, he should go to the ER. Serious illnesses can present with a change in mental status, including significant infections, concussion, heat exhaustion, brain tumors, and drowning. The ER doctor will ask what else has been going on to help identify the cause of confusion.  **Many people misuse the term lethargic. Lethargic isn’t the same thing as being tired after a long day. The medical definition is “Relatively mild impairment of consciousness resulting in reduced alertness and awareness; this condition has many causes but is ultimately due to generalized brain dysfunction.”
  • Vomiting: Vomiting after a day at the pool can be due to infection (from swallowing contaminated pool water), food poisoning (from food left in the heat too long) or dry drowning. It’s best to check it out in the ER.
What will happen in the ER?

Many parents don’t want to go to the ER because of high co-pays. We try to keep kids out of the ER as much as possible. But some issues are better taken care of in an ER. Most offices don’t have the equipment or staff to manage these issues well. Dry drowning can be life threatening, and the evaluation and treatment should start in the ER. I cannot say exactly what the doctor will do, since that will depend on your child’s symptoms and exam. There is no specific treatment for this, only supporting your child’s airway and breathing as the swelling goes down.

  • If the doctor thinks your child may have swelling of the airways, he might order a chest x-ray to look for pulmonary edema (lung tissue swelling).
  • An iv might be started to be able to give adequate fluids, since your child might not be up to drinking well.
  • Oxygen levels will be monitored and extra oxygen might be given.
  • Since the swelling worsens before it gets better, if there is a strong suspicion of dry drowning your child will be admitted for further observation.
  • Some kids need help breathing and are put on a ventilator (breathing machine) until the swelling goes down.
Prevention is important!
swimming
Watch your kids when around water!

As with many things, we should do all we can to be sure our kids are safe around water. This includes the bathtub and toilet as well as swimming pools, lakes, and ponds.

  • Childproof your home when you have little ones who might play in a pet water bowl or the toilet.
  • Teach your kids water safety. Swimming lessons can help them learn skills. Tell them to never try to dunk each other. They shouldn’t pretend they’re drowning because it might distract a lifeguard from a true emergency.
  • Learn infant and child CPR.
  • If you have a pool or pond at home, be sure there is a fence limiting access from your house.
  • Watch your kids closely and keep them within reach when they’re in water until they are strong swimmers. When they are strong swimmers you can let them swim outside your reach as long as lifeguards are present.
  • Learn what distress in the water looks like. The movie depiction of drowning with a lot of yelling and thrashing around is not what usually happens. If someone can verbalize that they’re okay, they probably are. Drowning victims can’t ask for help. There is a video linked to this page of what to look for with drowning that shows an actual rescue.
From this site, signs of drowning:
  • Head low in the water, mouth at water level
  • Head tilted back with mouth open
  • Eyes glassy and empty, unable to focus
  • Eyes closed
  • Hair over forehead or eyes
  • Not using legs – Vertical
  • Hyperventilating or gasping
  • Trying to swim in a particular direction but not making headway
  • Trying to roll over on the back

Addendum:

    • I just read a post that gives references regarding drowning definitions. It appears I didn’t forget learning about dry drowning in medical school.

It isn’t really a thing.

The symptoms listed above that I recommend getting evaluated are still concerning symptoms, but they might be from another cause.

Check these out:

On “Dry Drowning”

Drowning in a Sea of Misinformation: Dry Drowning and Secondary Drowning