Halloween Safety Tips

Halloween should be a fun time for kids. Help keep everyone safe by following a few simple tips.

Halloween is a favorite holiday for many kids – they get to dress as their favorite characters and get treats! But it’s also a time that kids are at increased risk. Consider a few safety tips to help keep it safe for all of our kids.

Food allergies and other health conditions

First and foremost, many kids have medical reasons to not eat many of the treats they get on Halloween.

Keep these kids in mind and have non-food items to give out. Check out my post on Teal Pumpkins to learn more.

Before the big day

Clear your sidewalk of any potential hazards for trick-or-treaters, such as low hanging tree branches, toys, electrical cords, and other obstructions.

Get flashlights, pumpkin lights, or glow sticks for your Jack O Lanterns.

Let kids participate in pumpkin decorating according to their abilities.

  • Toddlers can paint pumpkins. Get creative with rhinestones and glitter.
  • Kids can help remove the seeds after an adult removes the top – though many don’t like the texture of the goo!
  • Let school aged kids help design the Jack O Lantern. An adult should do the carving until kids are mature enough to handle a knife safely. Kids can:
    • Trace a template or their own drawing onto the pumpkin.
    • Use cookie cutters to press into the pumpkin as a template to cut.
    • Try tools designed to punch out pumpkin pieces to create a fun Jack O Lantern – just search online for “Pumpkin Punch Decorating Kit” and look for kid-safe tools.
  • For more pumpkin decorating safety tips, see Safewise.

Trick-or-treating safely

At least one member of each trick-or-treating group should have a cell phone.

Feed kids before going out. This will help keep them from snacking on their treats before you have a chance to check them.

Adults should closely supervise young children.

Don’t force children to trick or treat if they’re not comfortable with it. This does not toughen them up. They can still participate by helping to decorate or by handing out treats.

Talk to older kids about safety as they earn the responsibility to go out with friends.

  • They should know the boundaries in which they can roam.
  • Be clear on when they should check in and when to be home.
  • Do not go to homes without a porch light or otherwise decorated to show they are participating.
  • It should be understood that they should never enter a home without your knowledge.
  • Only accept hand made treats from people you know.
  • Kids should always stick with their group and not fall behind or run ahead of the group.
  • Respect property and people. Be mindful of younger trick-or-treaters and stay out of their way. Don’t try to frighten them and let them go first. Say “thank you” and be polite. Trick or treating does not give permission to trick others. They should respect peers who might be afraid of a haunted house or other things on Halloween and not pressure them to do things they don’t want to do. No one should make fun of anyone for being scared.

If you’re driving, be very attentive to parked cars and other objects that could limit your view of kids about to go into the street.

Keep your own pets safely away from the crowds and watch your kids around unfamiliar animals.

Costume safety

Add reflective tape to costumes to help visibility in the dark.

Masks can hinder the ability to see well – use makeup instead. Test a small patch of skin in advance to be sure your child’s skin isn’t sensitive to it.

Kids can carry a lighted trick-or-treat bucket, wand, or other accessory or wear a glow stick bracelet or necklace.

Avoid costumes that are too long and increase the risk of tripping.

Weather is unpredictable. Make sure you can add layers if it’s cold or remove layers if it’s warm.

If kids are going to be walking for trick-or-treating, be sure their feet will be comfortable and their shoes safe. Plastic costume heels are not safe for our little princesses!

If a sword, magic wand, or other accessory is part of the costume, make sure it’s not sharp or too long for them to safely carry. Talk to kids about how to safely carry it so they don’t accidentally hit other people. Leave it at home if you think they would tire of carrying it or if it could be mistaken for a real threat.

Do not use contact lenses unless they’re prescribed by an eye specialist.

Be safe on Halloween! @pediatricskc

For more

See the following AAP Healthy Children pages: Halloween Safety Tips and Decorative Contact Lenses: What Teens and Parents Need to Know.

Vaping Risks

As we learn more about the risks of vaping, our children are being enticed to try it with tasty flavors and the false reassurance that it’s safe. Learn the facts and what you can do to help those with addictions quit.

Vaping risks have long been unknown, or at least downplayed. It has even been suggested that a smoker who wants to quit could use vaping to kick the cigarette habit.

When a mall kiosk vaping salesperson first called out to me while shopping with my then tween daughter many years ago, he got an ear full from both of us. I’m sure the sales guy targeted me because I was with an impressionable tween and he really wanted to peak her interest but couldn’t approach her directly. My daughter was young, but even her gut feeling was that this inhalational device was not smart or safe and she let him know it.

I’d like to take credit for raising her right, but that would imply that all the parents of kids who have fallen to the “vaping is fun and safe” propaganda somehow did something wrong. They didn’t. I’m just lucky that my daughter thinks for herself and generally makes safe decisions.

Fast forward to today and I can’t keep track of all of the severe lung disease reports and deaths attributed to vaping. When I started writing this, there were 250 cases of lung disease and 2 deaths. Now there are over 350 cases of severe lung disease and 7 deaths. No single device, brand, liquid or ingredient has been tied to all cases. Many of those afflicted have reported vaping THC though some only report using nicotine. It has been recently reported that vitamin E acetate is a potential cause, but investigations continue into the source.

Why are people calling vaping an epidemic?

According to the latest National Youth Tobacco Study more than 3.6 million middle and high school students currently use e-cigarettes. Nearly 5% of all middle school students and over 10% of high school students are current e-cigarette users.

In my state of Kansas alone, as of the first of this year, there have been at least 20 ER visits for patients with a history of vaping and concerns for significant lung disease. In 2017, 10.6% of Kansas high school students reported current use of electronic vapor products. The adult numbers are smaller, with 4.6% of those 18 years and older reporting current use of electronic cigarettes in Kansas.

This is a problem of young people.

Despite the fact that when electronic cigarettes came on the market and claimed to be a way for smokers to kick the habit, they have been marketed heavily to kids with enticing flavors. Many non-smokers have taken up the habit of vaping. After many years of declining nicotine use, the rates are now growing rapidly, mostly due to electronic cigarettes.

Tobacco Product Use Among High School Students – 2018

Tobacco Product Use Among High School Students – 2018

We’re still learning

Since I last wrote about vaping in e-Cigarette Use in Our Kids about a year and a half ago, we are learning even more vaping risks. It’s never too soon to talk to your school children about the dangers.

Once they’re hooked it’s hard to stop, even if they want to. The number of regular adolescent users is growing at an alarming rate.

What we know

The device itself

E-cigarettes, vapes, e-pipes, and other vaping products are battery-powered devices that allow users to inhale aerosolized liquid.

E-cigarettes come in many shapes and sizes. Most have a battery, a heating element, and a place to hold a liquid. They can hide in plain site because they look like common items, such as USB flash drives and pens.

There are many reports of these exploding while charging, in pockets, and even in the mouth of users.

What goes in the device?

E-cigarettes are usually filled with a liquid containing nicotine, which is highly addictive and harmful to the adolescent brain. Nicotine can impact learning, memory and attention span, and contributes to future addiction to tobacco and other substances.

The vape juices are flavored, and each flavor comes with it’s own chemical additives. Some of these are more irritating to the lungs than others, but all have potential side effects.

The FDA is finally working on getting non-tobacco flavored products off the market to help prevent new users from starting the habit.

Flavors of vape juice include chocolate mint, cola, cherry vanilla, cream soda, and more. What kid wouldn't want to try these? @pediatricskc

Some seemingly resourceful people put other substances in their vaping device, but that is now being recognized as increasing vaping risks.

Teens have found that vaping THC, the chemical responsible for most of marijuana’s mind-altering effects, enables them to escape parental detection because they don’t smell like they do when they’ve smoked marijuana. They may vape cannabis-infused oils in place of e-liquids designed for the vaping device. They often end up consuming more THC than they would with a traditional joint.

Unfortunately vaping risks increase when the substance vaporized is not sold by an authorized retailer.

E-cigarette aerosol contains many potentially harmful chemicals regardless of the juice put into the device. These include ultrafine particles, volatile organic compounds, heavy metals (nickel, tin and lead) and other cancer-causing chemicals.

What we’re learning

Vaping risks are much greater than initially recognized.

The vapor can contain substances that are addictive and can cause lung disease, heart disease, and cancer.

For many years there was no monitoring or tracking of complications from e-cigarette devices. After being available for about 10 years, the FDA requested that physicians report any possible lung disease related to e-cigarette use.

In a very short time hundreds of possible cases of lung disease has been linked to vaping from across the US. At least 7 people have died from illness related to vaping.

The majority of people with illness thought to be due to a component of vaping have vaped THC, but some only report vaping nicotine products.

What is this mysterious illness?

News reports are calling the lung problems associated with vaping a “mysterious illness” because no one knows the exact cause or mechanism of lung damage.

Symptoms can include shortness of breath, coughing, or chest pain. Some patients reported vomiting, diarrhea, or other stomach problems, as well as fever or fatigue. If you vape and have these symptoms, it is imperative that you seek immediate medical attention.

Recommendations:

  1. Do not start vaping.
  2. If you smoke or vape and would like to quit, seek professional help.
  3. Never buy vaping cartridges from a non-authorized seller.
  4. Be cautious of vaping from a friend’s device – you cannot be sure where they bought their product.
  5. Do not modify the vaping device. If it appears to be damaged in any way, dispose of it safely.
  6. If you vape and develop a cough, shortness of breath, chest pain, vomiting, diarrhea, or other concerns go to the Emergency Department.
  7. Do not charge your vaping device while you sleep or with a charger that is not designed for your device.
  8. Do not allow your vaping device to come into contact with metallic objects (such as coins or keys).

If you suspect you have an illness related to vaping, after you’ve been to a doctor, file a report with the Safety Reporting Portal.

Where to get help:

Unfortunately parents can’t use standard discipline techniques to get their kids to stop vaping once they are addicted. Addiction treatment is complex and difficult. Work with professionals.

Your child must be invested in stopping the habit or any treatment will fail.

A pediatrician might know local resources, such as therapists who have expertise in addictions. Your physician may also recommend medications to help stop the habit or refer to a physician who specializes is addiction.

Check out the many helpful tips on SmokeFree.gov for teens.

For More Information:

Vaping: What you need to know (KidsHealth)

America’s e-cigarette epidemic (Pediablog)

Know the Risks: e-cigarettes and young people (Surgeon General)

Vaporizers, E-Cigarettes, and other Electronic Nicotine Delivery Systems (ENDS) (FDA)

CDC Vaping Information

Bike safety

Bike safety starts before you even get on the bicycle.

Summer’s in full swing. I love to see neighborhood kids out playing. We don’t see that enough these days. I want kids to have fun outdoors for fresh air and exercise. Bike safety should be taught early on and encouraged every time people young and old are on bikes.

Twice already this summer kids have told me about friends who had ugly accidents due to wearing flip flops or sandals on a bike. My patients hear the message to cover their heads with a helmet and feet with proper shoes before bikes and scooters. These kids listened but not their friends.

My favorite bike safety tips are in this easy to read and share infographic.

Bicycle safety is important. Start even before the ride by making sure the bike is in good shape and the right fit and that the rider is prepared. @pediatricskc

Lawnmower safety

Lawn mowers send many kids and adults to the ER every year. Learn to use them safely with the tips below.

As the winter months (finally) end and the weather warms up, we need to get our lawns in order again. I haven’t written about lawn mower safety in a long time, but as I drive around my neighborhood I’m reminded just how many people don’t realize the dangers.

We need to respect lawn mowers and use them safely.

In 2016, more than 86,000 adults and 4,500 children in the U.S. were treated in emergency departments for injuries related to lawn mowers according to the U.S. Consumer Product Safety Commission. Riding mowers lead to the most injuries, but even walk behind mowers are dangerous.

People can suffer minor and serious cuts, burns, broken bones, eye injuries, loss of limbs, and death. A lawn mower can eject a rock, piece of metal, or wood up to 100 miles per hour, leading to injuries of people in the yard but not near the mower.

Lawn mowers send many kids and adults to the ER every year. Learn to use them safely. #lawnmowersafety @pediatricskc

Safety Tips

  • Only use a mower that has protection over hot and sharp parts. Never remove these protective coverings.
  • Teach kids to never touch a lawn mower. Many are burned by touching a hot mower, even when it is off.
  • Add fuel only to mowers when they are cool and off.
  • Never operate a mower when under the influence of alcohol or drugs that impair your level of alertness.
  • Never leave a running mower unattended. Turn it off before walking away.
  • Wear protective gloves, goggles, sturdy shoes, and long pants when you use lawn mowers. Never mow barefoot or in sandals.
  • No one under 16 years should ride on or operate a riding mower.
  • Riding mowers should have the reverse switch behind the driver, forcing the driver to look behind when placing the machine in reverse.
  • Push mowers should be used only by people over 12 years of age.
  • Push mowers should have a control that stops forward motion when the handle is released.
  • If children must be in the yard during mowing, they should remain at least 20 feet away at all times. Ideally children should not be allowed in the yard when the grass is being cut due to the possibility of flying debris.
  • Remove stones, toys, and debris from the lawn before mowing to prevent injuries from flying objects.
  • Mow across slopes with a push mower to avoid pulling the mower over your feet if you happen to slip.
  • Mow up and down slopes with a riding mower to prevent the mower from tipping over.
  • Do not cut wet grass.
  • Use hearing protection. Do not listen to music through your ear buds. The high volume required during mowing is harmful to your hearing.
  • Do not talk on your phone when mowing. It is a distraction that can lead to accidents.

For more information:

Lawn Mower Safety Tips from the American Academy of Pediatrics

Plan for Vacation – especially if you’re going outside the US

A little planning and preparation can help everyone in your group stay healthy while traveling. Some preventative treatments take up to 6 months to complete, so talk to your doctor early!

When families are able to travel, it can be a wonderful time of exploration and bonding. Don’t let illness get in the way. Many locations have diseases that you don’t typically see in your home town. Take a little bit of time to learn what you need to do to prepare for your vacation. Insurance doesn’t usually cover travel medicine, so be sure to consider these extra costs when planning a trip.

Keep track of everything

It is a great idea to take pictures of everyone each morning in case someone gets separated from the group. Not only will you have a current picture for authorities to see what they look like, but you will also know what they were wearing at the time they were lost.

Take pictures of your passport, vaccine record, medicines, and other important items to use if the originals are lost. Store the images so you have access to them from any computer in addition to your phone in case your phone is lost.

Have everyone, including young children, carry a form of identification that includes emergency contact information.

Create a medical history form that includes the following information for every member of your travel group. Save a copy so you can easily find it on any computer in case of emergency.

  • your name, address, and phone number
  • emergency contact name(s) and phone number(s)
  • immunization record
  • your doctor’s name, address, and office and emergency phone numbers
  • the name, address, and phone number of your health insurance carrier, including your policy number
  • a list of any known health problems or recent illnesses
  • a copy of current medications and supplements you are taking and pharmacy name and phone number
  • a list of allergies to medications, food, insects, and animals
  • a prescription for glasses or contact lenses

Prepare everyone for local specs

Learn what the local healthcare options are if someone in your travel group gets sick or injured. For several tips, see this travel information from the CDC.

Find out how you can use your phone overseas. Be sure to bring a charger that will work with local electrical outlets.

If you’re traveling with young children, plan ahead for where they’ll sleep. Infants will need a safe place of their own with a firm surface. Everyone will need time to adjust to new time zones.

Vehicle safety risks vary around the world. Know local travel options and risks. Only use authorized forms of public transportation. For general information, see this International Road Safety page. Learn local laws prior to traveling.

If you’re going to be somewhere above 8000 feet above sea level, prepare for the change in altitude with these tips.

Be sure to talk with your teens about drug and alcohol safety prior to travel. Many countries have laws that vary significantly from the United States, and some teens will be tempted to take advantage of the legal nature of a drug or alcohol.

Remind everyone to stay in groups and to not venture out alone.

Dress appropriately for the area. Some clothing common in the United States is inappropriate in other parts of the world. Americans are also at risk of getting robbed, so do not wear things that will make others presume you are a good target.

Wear sunscreen! It doesn’t matter if you’re on the beach or on the slopes, you need to wear sunscreen every time you’re outside. Don’t ruin a vacation with a sunburn. For sunscreen tips, see Sun and Water Safety.

For more safety tips, see this helpful brochure.

Prevent bug bites

When you travel be sure to protect against bug bites! #travel #prevention #vacation #questforhealthkc

Mosquitos, ticks and other bugs not only cause itchy rashes but they can carry diseases. Using insect repellant properly can help to prevent getting bit.

Use insect repellent with at least 20% DEET to protect against mosquito and tick bites. Follow package directions and reapply as directed. Do not use combination bug sprays with sunscreen. They should be applied separately.

Wear long sleeves and pants. Consider treating your clothes with permethrin and tucking your pants into your socks. Sleep in areas that are screened against bugs.

Vaccines

Extra vaccines may be needed when you travel, especially in infants who are too young to get a measles vaccine on our usual schedule and adults who have not gotten vaccines that are now on the regular schedule.

Before you travel you can look at destination-specific advice on the CDC’s Destination page.

MMR

The news routinely reports outbreaks of measles these days. Many of the US outbreaks are related to an unvaccinated person returning from abroad. The MMR protects against measles, mumps, and rubella.

While our standard vaccine schedule does not recommend the MMR until 12 months of age, the vaccine can be used in infants as young as 6 months. It is considered safe to use in infants, but we don’t know when their immunity from their mother goes down. If the maternal immunity is still active the vaccine won’t work. This immunity typically falls between 6 and 12 months. After 12 months the vaccine is more likely to be effective, so when the risk is lower, it is recommended to wait until that age for the vaccine.

Between 6 and 12 months of age the MMR is recommended for infants considered high risk for being exposed to measles. This is because if their immunity has fallen, we don’t want them to be unprotected. International travel is considered to be high risk. If your baby’s maternal immunity is still high, the vaccine won’t provide protection, but he or she is still protected until that maternal immunity falls.

Because we don’t trust that the vaccine is effective before a year of age, babies who get an early MMR will still need two after their first birthday.

Talk to your baby’s pediatrician about getting the MMR if your child is over 6 months of age. Ideally it will be given at least 2 weeks prior to travel to give the body time to develop immunity.

Hepatitis

Both hepatitis A and hepatitis B vaccines are now on the routine schedule for children in the US, but many adults did not get these vaccines as children. These vaccines are recommended for travel to many locations. Verify if your family has had both hepatitis A and hepatitis B vaccines before you travel.

It is recommended that infants start hepatitis B vaccines at birth. The series is completed at 6-9 months of age. There are catch up schedules for those who haven’t completed the series on time.

Children do not get the hepatitis A vaccine until 12 months of age. If they have not yet started the series and they are over a year, they can start at any time. The booster is given 6-12 months later.

It takes at least 6 months to complete each of these series, so plan early!

Typhoid

Typhoid is not a vaccine routinely given in the US but it is recommended for travel to many parts of the world. There are two main types of typhoid vaccine, injectable and oral.

Children 2 years and older can get an injectable typhoid vaccine, ideally at least 2 weeks prior to travel. It is only one dose and lasts 2 years.

The oral vaccine is only for people 5 years and older. It is given in 4 doses over a week’s time and should be completed at least a week prior to travel. It must be given on an empty stomach (1 hour before eating and 2 hours after eating). Antibiotic treatment can make this vaccine ineffective, so discuss any current medicine you are taking with your doctor. The oral vaccine lasts 5 years.

Neither vaccine is 100 % effective so even immunized people must be careful what they eat and drink in areas of risk.

Meningitis

Meningococcal disease can refer to any illness that is caused by the type of bacteria called Neisseria meningitidis. Within this family, there are several serotypes, such as A, B, C, W, X, and Y. This bacteria causes serious illness and often death, even in the United States.

In the US there is a vaccine against meningitis types A, C, W, and Y recommended at 11 and 16 years of age but it can be given as young as 9 months of age. MenACWY-CRM is approved for children 2 months and older.

There is a vaccine for meningitis B prevention recommended for high risks groups in the US but is not specifically recommended for travel.

Meningitis vaccines should be given at least 7-10 days prior to potential exposure.

Travelers to the meningitis belt in Africa or the Hajj pilgrimage in Saudi Arabia are considered high risk and should be vaccinated. Serogroup A predominates in the meningitis belt, although serogroups C, X, and W are also found. There is no vaccine against meningitis X, but if one gets the standard one that protects against ACWY, they will be protected against the majority of exposures. Boosters for people traveling to these areas are recommended every 5 years.

Yellow Fever

Yellow fever is a mosquito-borne infection that is found in sub-Saharan Africa and tropical South America. There is no treatment for the illness, but there is a vaccine to help prevent infection. Some areas of the world require vaccination against yellow fever prior to admittance. Yellow fever vaccine is recommended for people over 9 months who are traveling to or living in areas with risk for YFV transmission in South America and Africa.

Most physician offices do not offer this vaccine. A special license is required to be able to provide it. Check with your local health department or a travel clinic in your area. This vaccine should be given at least 10 days prior to travel.

Influenza

Remember that influenza hits various parts of the world at different times of the year. The southern hemisphere tends to finish their flu season just as ours is starting. Check to see when it’s flu season and vaccinate as needed.

Medications for your trip

Aside from bringing your routine prescription medications and over the counter medicines in their original prescription container, there are some medications that are recommended for traveling to various parts of the world.

Malaria

Malaria transmission occurs in large areas of Africa, Latin America, parts of the Caribbean, Asia (including South Asia, Southeast Asia, and the Middle East), Eastern Europe, and the South Pacific. Depending on the level of risk (location, time of year, availability of air conditioning, etc) no specific interventions, mosquito avoidance measures only, or mosquito avoidance measures plus prescription medication for prophylaxis might be recommended.

Prevention medications might be recommended, depending on when and where you will be traveling. The medicines must begin before travel starts, continue during the duration of the travel, and continue once you return home. There is a lot of resistance to various drugs, so area resistance patterns will need to be evaluated before choosing a medication. Review the area-specific travel recommendations with your doctor.

Anti-diarrhea medicines

I am commonly asked to prescribe antibiotics to prevent traveler’s diarrhea. This is discouraged due to growing bacterial resistance to antibiotics. It is best to prevent by avoiding local water, choosing foods wisely, using proper handwashing techniques, and considering bismuth subsalicylate or probiotic use.

Traveler’s diarrhea is often from bacteria, but it can also be from a viral source. Maintaining hydration with clean water with electrolytes is the most important treatment. Many cases of traveler’s diarrhea do not require antibiotics. See details of treatment recommendations in the Yellow Book.

After you return…

If you’ve been in an area of the world that has increased risk for tuberculosis (TB) or if you have suspected exposure to TB, testing for exposure is recommended.

Tuberculosis occurs worldwide, but travelers who go to most countries in Latin America, the Caribbean, Africa, Asia, Eastern Europe, and Russia are at greatest risk.

Travelers should avoid exposure to TB in crowded and enclosed environments. We should all avoid eating or drinking unpasteurized dairy products.

The vaccine against TB (bacillus Calmette-Guérin (BCG) vaccine) is given at birth in most developing countries but has variable effectiveness and is not routinely recommended for use in the United States. Those who receive BCG vaccination must still follow all recommended TB infection control precautions and participate in post-travel testing for TB exposure.

It is recommended to test for exposure in healthy appearing people after travel. It is possible to have a positive test but no symptoms. This is called latent disease. One can remain in this stage for decades without any symptoms. If TB remains untreated in the body, it may activate at any time. Typically this happens when the body’s immune system is compromised, as with old age or another illness. Appropriately treating the TB before it causes active disease is beneficial for the long term.

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Prevent Drowning

Drowning is one of the most common preventable causes of death in infants, kids, and teens. Learn how to protect against this tragedy!

Summer is on its way. We’ll soon be visiting lakes and pools to cool off from the heat. Unfortunately drowning is the leading cause of unintentional injury-related death in children between ages 1 and 4. It continues to be a top cause of unintentional death among other age groups through the early adult years. Fortunately there are many precautions we can take to help lower the risk.

I wrote about Sun and Water Safety last summer, and want to remind everyone about the risks of drowning. I also wrote about Dry Drowning previously, but it seems that it isn’t really a thing – see the addendum in that post.

What are the risks?

About 1 in 5 people who die from drowning are children 14 and younger. Each year about 300-500 children under 5 years of age drown.

For every child who dies from drowning, another five receive emergency department care for nonfatal submersion injuries. Even though they’re not fatal, they have significant consequences.

Over half of drowning victims treated in emergency departments require hospitalization for further evaluation and treatment. These nonfatal drowning injuries can cause severe brain damage that may result in long term disabilities such as memory problems, learning disabilities, and a permanent loss of basic functioning.

What increases the risks?

  • Lack of Swimming Ability: Many adults and children report that they can’t swim. Swimming lessons can reduce the risk of drowning among children. See the link at the bottom for more on swim lessons.
  • Lack of Barriers: Barriers, such as pool fencing and alarm systems, prevent young children from gaining access to the pool area. A 4-sided fence reduces a child’s risk of drowning 83% compared to 3-sided fence with the house as the forth side. A great guide on barriers is from the US Consumer Protection Service.
  • Lack of Close Supervision: Drowning can happen quickly and quietly anywhere there is water. This includes bathtubs, swimming pools, pet water bowls, and buckets. This is why non-swimming times account for most drowning accidents.
  • Location: Most children 1-4 years of age drown in home swimming pools. More than half of the drownings among those 15 years and older occurred in natural water settings, such as lakes.
  • Failure to Wear Life Jackets: Most boating deaths are caused by drowning, with 88% of victims not wearing life jackets.
  • Alcohol Use: Among adolescents and adults alcohol use is involved in up to 70% of deaths associated with water recreation. 
  • Seizure Disorders: For persons with seizure disorders, drowning is the most common cause of unintentional injury death, with the bathtub as the site of highest drowning risk.

How can you recognize drowning?

Movies show people splashing around and yelling for help as they drown.

Don’t let that fool you. Movies are not reality.

Signs of drowning:

  • Head low in the water, mouth at water level
  • Eyes glassy and empty, unable to focus
  • Head tilted back with mouth open
  • 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
  • Appear to be climbing an invisible ladder
  • Trying to roll over on the back

Most drowning victims are silent. They don’t splash to get your attention. Watch this video from Inside Edition that captures several drowning victims:

Assign a water watcher to keep an eye on young children in water. #drowning @pediatricskc

Teach water safety

Learn how to swim and teach your children to swim as well. If your child(ren) are good swimmers, be sure to still have rules about pool use and limit pool access. Even strong swimmers can drown. See the link in the resources below for infomation on swim lessons.

No one should swim alone. If your children are not able to follow that rule, the pool should not be accessible to them. Gates and alarm systems can be used to limit access to home pools and hot tubs.

Not all teens are safe swimmers, but they don’t often fess up to their friends. They are also at risk of making impulsive decisions to drink alcohol near water, forego their life vest on a boat, jump off a cliff into water, or other things that could put them at risk. Talk to your teens about safety – in and out of the water! Encourage teens to learn CPR.

Water safety in easy-to-see graphic form

From https://twitter.com/DrEmMontgomery/status/1109249128712810497

The @AmerAcadPeds updated their policy statement on #drowning prevention this week. #watersafety pic.twitter.com/8B57ZprmvJ— Emily Montgomery, MD (@DrEmMontgomery) March 23, 2019

Making home water safer

All pools should have a 4 foot fence around all sides. This includes below-ground pools as well as portable pools. It is much less safe to use the house as one of the borders, since young children can escape out the door and into the pool, but if you must use your home, take precautions. Install an alarm system to alert you if the door to the pool area is opened. Use a pool or spa cover when the pool or spa is not in use.

A short word on portable pools. They can include inexpensive blow up pools and larger pools. Portable pools present a real danger to young children because they are often not seen as a threat. Portable pools account for 10% of the total drowning deaths for children younger than 15 . They should be drained, covered, or fenced to protect children. Don’t leave them in the yard unattended.

Ask neighbors to put a proper barrier around their pools or hot tubs.

Ensure any pool or hot tub (spa) you use has anti-entrapment safety drain covers.

Have life saving equipment such as life rings, floats or a reaching pole available and easily accessible.

If you have a home pool, be sure that it's protected from your kids. @pediatricskc
From https://downloads.aap.org/DOPA/Drowning-Prevention/pool_safety_english.pdf

It’s not just pools that are risks…

Bowls and buckets

Keep pet water bowls out of reach of young children.

Drain any buckets of water after they’re used.

Toilet dangers

Close bathroom doors and toilet lids to keep young ones from playing in the water.

Bath time

Monitor young kids and those with seizure risks in the bath the entire time. Do not leave the room even for a few moments.

Don’t read or check your phone when you’re watching kids in the tub, just like at the pool.

Drain the bath tub before young kids even get out. This not only helps your kids not climb back in (a common reason to need stitches when kids slip trying to climb in), but it also prevents them from drowning in left over water.

For more:

Swim Lessons: When to start and what parents should know

Infant water safety: protect your new baby from drowning

Drowning Prevention for Curious Toddlers: What Parents Need to Know

Water safety: Tips for parents of young children

Water safety for teens

Teen drowning can be prevented with safety measures: Teens don’t always follow the rules. Their impulsivity and thrill seeking behaviors put them in a unique risk for dangers.

For pool barrier guidelines and suggestions, see the Safety Barrier Guidelines for Residential Pools Preventing Child Drownings from the US Consumer Product Safety Commission. This is important for all pools and hot tubs, including portable pools.

Pool Dangers and Drowning Prevention – When It’s Not Swimming Time: Remember to keep all pools, tubs, and buckets of water secure at all times.

Centers for Disease Control and Prevention, National Center for Injury Prevention and Control. Web-based Injury Statistics Query and Reporting System (WISQARS)

Momo. Hoax or not, scary things happen online.

It’s not just Momo… Even if she started as a hoax, we DO need to protect our kids online.

The news is full of stories about Momo and other scary things our kids are exposed to online. Many stories say this is a hoax. YouTube has said this would be against their rules. It doesn’t really matter if this started as a hoax or if it’s against the rules. The fact is that our kids are exposed to things online.

Our kids do see inappropriate things

I recently saw a preschool aged child for a well visit. During the visit it came up that the child had been exposed to Momo online. When the mother learned that the child saw scary Momo videos, she came up with a great plan. They took images of Momo and transformed her into funny faces, much like what I did for the image above.

I think this mother’s idea is great. She took a character that was scary to her child and made it funny. She used the opportunity to talk to her child. It became a great teaching moment.

Our kids can never “un-see” what they’ve seen, but we can help them to not view it as so scary. If you are unable to do this alone, talk to your pediatrician or a therapist.

We know that traumas impact a child’s development. They can develop significant anxieties and suffer if things are not quickly and adequately addressed.

When things happen we need to find ways to help our kids process them. If your child’s mood or behavior suddenly changes, it is quite possible that they have experienced a traumatic event of some sort. If they won’t talk to you, seek professional help.

What can we do to prevent online exposures?

We can’t stop all exposures, but we can do many things to help protect our kids. This includes monitoring software, anti-virus software, and teaching our kids how to behave responsibly and safely.

Increasing responsibility

Our kids will be online, whether it’s at home or at school or at a friend’s house. They are growing up with the world at their fingertips through the internet, so we must teach them to use it wisely.

Like in other benefits and responsibilities of growing up, our kids should have fewer limits and less monitoring as they show maturity. We cannot expect them to be responsible online at 18 years of age if they never practice with supervision along the way.

Give your kids age-appropriate allowances for games, videos, and other online experiences. I love to use Common Sense Media to learn about movies, games, and other media.

Set up parental controls.

Research parental control software. It’s easy to search “parental control apps” or “parental control software reviews” to find the pros and cons to various brands.

One of my favorite sites that exposes safety concerns has a great post for parents: 5 tips for setting up your child’s device for safety from a tech mom.

Learn to safely monitor phones and specific apps.

Choosing the best for your family is not easy, but read several reviews to find what is best for your family’s needs.

Adult supervision and guidance

If our kids are playing outside, they will have close supervision when they’re young, less as they get older.

Online use should be no different.

Your 3-4 year old should not go to the park alone and they shouldn’t go online alone. If they are online, project the screen to the television so you can watch along or sit with them and play along with them. They should not be online when you are busy doing something else. It is not a safe babysitter.

As kids get older and can understand how to navigate the internet more safely, they can have less and less direct supervision. This does not mean they can have a free for all. Parents can still help them choose age-appropriate sites and have software to keep blocked sites from being accessible.

You can’t just avoid online use

Several parents over the years have tried to end the conversation when I bring up social media safety by saying, “we don’t allow any of that.”

It is not sufficient to simply not allow any social media. Our kids and teens will come across it, whether it’s their own account or a friends.

What things did you do as a teen that your parent didn’t know about? It’s even easier for kids to hide social media accounts than it is for them to do many of the things we used to do as kids.

As kids grow

Talk to older kids and teens about why pornography sites are harmful.

Have discussions about oversharing. Predators look for ways to identify where kids hang out. Kids shouldn’t give a team name or mention that their soccer game is tomorrow morning at 9. That innocent information can help a predator find them. Even photos with identifying information, like a school shirt or team jersey, can be risky if shared publicly.

Kids sometimes get tricked into sharing photos that are inappropriate. This includes pornographic images as well as snapshots identifying where to find them.

Talk about their digital footprint. Schools and employers will look at your child’s online history. It needs to be positive and what they post today will be there forever.

Teach kids basic right and wrong

We cannot protect our kids from everything, but we can teach them to be good decision makers.

Use real life examples and daily experiences to help your kids learn to make safe choices. Let them accept more responsibility and make more choices as they get older. Allow them to make the wrong choice sometimes. They’ll learn from these little mistakes much more than they would if you refuse to let them do that little mistake. This helps to prepare them to make the right choice with the riskier options as they grow.

For example, if your middle school child wants to stay up late to watch a movie but you know he has an early soccer game, discuss the situation with him. Let him make up his own mind in the end – without being judgmental. If he struggles getting out of bed and disappoints his teammates because he’s too tired, is that really the worst thing in the world? I bet the next week he won’t beg to stay up late so much. Just don’t play the “I told you so” game or give attitude about it. That will make him mad at you.

Let kids learn from their own mistakes without discussion or lecture. Kids learn from things like this if we let them. Trust me, there are lots of opportunities for them to learn to make safe, responsible choices as they grow.

In the end, if our kids want to find an inappropriate site or do something they’re not supposed to do, they will. If they use good judgement and make safe choices in other aspects of life, they are more likely to do so online too.

Be vigilant

It’s not just Momo… Even if she started as a hoax, we DO need to talk to our kids about risks online.

We need to keep up with online challenges and apps.

Follow your kids on their social sites. Talk about what sites they can and cannot use, but remember that it is easy for them to set up hidden accounts. That’s why it’s so important to talk to your kids and let them make their own choices as they grow. If you don’t allow options and never let them fail, they will not learn. The more you restrict them, the more they’ll hide from you.

Monitor for new apps. Learn how kids hide them. If your child has an iphone, they can be hiding them in these ways.

Keep track of the time your child spends online. Go to your app store and search “time on phone tracker” or check out these popular apps that track time:

For more:

In addition to the many links above, these articles are highly recommended:

New Car Safety Guidelines 2018

The #1 killer of our children over 4 years of age is vehicle crashes. New car safety guidelines are based on safety data to keep our kids safe.

The AAP recently released new car safety guidelines for kids. The number one killer of our children over 4 years of age is vehicle crashes. These new guidelines are based on safety data and research about how to keep our kids safe. They are not meant to keep kids happy. They will be hard to enforce at the beginning, but it’s worth it to keep our kids alive! Once kids know this is not negotiable, the fighting will decrease. Spread the word to your friends with kids so yours don’t feel like they’re the only ones who must stay in a safety seat. Plus you might save a life!

A big thank you to Molly Blair for the colorful photos!

General car safety tips

Car seat choice and maintenance

  • The best seat is not necessarily the most expensive. Choose a seat that fits your child and your car.
  • Car seats expire. Write when your seats are close to expiring on your calendar.
  • You should not buy a used car seat from anyone you don’t know. It is not possible to verify that it hasn’t been in an accident in this situation.
  • Register your car seat so you will be notified in case of recalls.
  • If you’re in an accident, your car seats may need to be replaced. Insurance may cover this cost.
  • Do not remove the stickers that provide important information, such as the height and weight limits of the seat.
  • Always review the size minimum and maximums of your car seat. Make it a habit to check the seat’s limitations after each well visit check to be sure your child’s height and weight still fit in the seat as it is being used.

Car seat use and mis-use

  • Bring your child and the car seat to a certified car seat installer with each change in seat and change in vehicle.
  • The most common mistake other than installing a seat improperly is to move a child to the next seat too quickly. Keep your child in the seat until they meet the height or weight limit. Each transition (from rear-facing to forward-facing, forward-facing to booster, and booster to lap/shoulder belt) lowers the child’s protection.
  • Do not use attachments, such as a head roll, in a seat unless it was tested and sold with your seat.
  • Keep bulky clothing and padding out of the car seat. Layer clothing if it’s cold. 
  • Rear facing allows the head and spine to be protected in case of a crash. It is the safest way to travel. The head, neck, and spine are all supported by the hard shell of the car safety seat. They all move together, with little relative movement between body parts.
  • When children ride forward-facing, their bodies are restrained by the harness straps, but their heads can be thrown forward in an accident. This can lead to more spine and head injuries.
Bulky clothes and winter coats are not for use in car seats!
Molly Blair makes a lot of great images for her mother, Dr. Kim Burlingham, and has given me permission to share. 

Potential problems with following the guidelines

Motion sickness

If your child suffers from motion sickness (car sickness) when rear facing, talk to your pediatrician.

Resistance

Kids will resist many things, including properly buckling up. It is worth it to insist that they’re safe. Try various parenting strategies.

Kids like choices, so offer choices about climbing in or getting put in the seat or if they want to help do the buckle. The choice is never whether or not to ride safely. Find acceptable choices that end with them properly buckled. There are more ideas in 5 Tricks to Get an Uncooperative Toddler Into Their Car Seat.

Older kids can learn about why they need this level of safety seat to remain safe. I know my kids are both shorter than classmates, so it was a regular discussion in my house. They always ended up agreeing that it was necessary when we looked at age-appropriate crash pictures and safety data. (Do an online search to preview sites without your kids so they aren’t exposed to more than they can handle.) I ask kids in my office all the time if I should ride a motorcycle without a helmet – it’s legal in my state. They all say “no” and then seem to comprehend that just because it’s legal doesn’t make it safe.

Summary of 2018 car safety guidelines

Infants through preschool years

Infants should always remain rear facing. Both rear-facing only seats and convertible seats can serve this purpose.

Infants should remain rear facing until they outgrow the limits of their car seat.

Rear-facing only seats

Rear-facing only seats are convenient because they can be snapped in and out of bases. This allows various drivers to have bases installed in their vehicle and the seat can be used in multiple vehicles.

Rear-facing only seats tend to have lesser weight and height allowances, but as infants become toddlers they do not need a carrying seat. Not to mention the safety issues with carrying a heavy kid in a heavy seat – we don’t need parents to hurt themselves!

Although these infant rear-facing carrying seats can be used to carry infants in and out of buildings to the vehicle, it is not recommended to use them long term outside of the vehicle. They are not approved for overnight sleeping.

Convertible seats

Convertible seats are able to be used rear facing until a child outgrows the weight or height maximum.

The minimum weight recommended to turn forward facing is now 40 pounds unless the seat has a lower maximum for rear facing.

This means most toddlers and preschoolers should be staying rear facing.

When kids turn forward in the car, they should stay in their harness.
 When kids turn forward in the car, they should stay in their harness.

School aged kids

Convertible seats

Convertible seats will accommodate children rear facing until they are 40-90 pounds.

Keep ’em rear facing longer!

The earliest it is now recommended to turn kids forward facing is 40 pounds. I know kids will fight this, but it’s worth it based on the safety studies.

This means that kids who are school aged might still fit best rear facing.

Rear facing is the safest way to travel, and remember that the #1 killer of our kids over 4 years is automobile crashes. Let’s change that and keep kids rear facing longer.

When kids are over the rear-facing maximum of their seat, turn them around, but leave the harness on. There’s a reason race car drivers use a harness and not just a lap and shoulder belt. Harnesses are safer! Use it until your child outgrows the limits of the seat.

Race car drivers still use a harness seatbelt - your kids should use one too until they're big enough to fit without.
 Race car drivers still use a harness seatbelt – your kids should use one too until they’re big enough to fit without.

Booster seats

Booster seats help keep the lap and shoulder belt positioned properly until a child is tall enough and old enough to not require it. It is generally around 4 foot 9 inches that kids are big enough to sit in most vehicles without a booster. Most kids are not this tall until 10-12 years of age, even though many state laws allow much younger kids to sit without a booster.

Age is not the main factor in deciding when a child should move out of  a booster. Use the 5 point test to see if your child fits properly in the vehicle. I always say it’s the size of the child as well as the size of the vehicle’s seat that matters.

Don't let kids move out of the booster seat too soon! Age doesn't matter as much as fit.
 Don’t let kids move out of the booster seat too soon! Age doesn’t matter as much as fit.

Seat belt alone

When kids fit properly in the vehicle’s seat without a booster seat, they still should sit properly.

If your child cannot sit upright in the seat, a booster is still recommended to keep the belt properly positioned.

No one should slide their hips away from the back of the seat to slouch in the seat. This allows the seat belt to ride up onto the abdomen, which increases the risk of injury in a crash.

Use seat belts properly and have kids sit in the safest seat always! Only teens and adults should sit up front.
 Use seat belts properly and have kids sit in the safest seat always! Only teens and adults should sit up front.

Front seat

All children less than 13 years of age should remain in the back seat.

It’s easy to remember that only teens and adults can sit up front.

This is not based only on height or weight. Physical maturity makes a difference as well.

And remember…

Don’t rush your kids to grow up too soon!

Will Standing Hurt a Baby’s Feet or Legs?

“Will standing hurt my baby’s legs?”

I’m surprised how often I’m asked if having a baby “stand” on a parent’s lap will make them bow-legged or otherwise hurt them. Standing and jumping while being held and supported is a natural thing babies do, so why do so many parents worry if standing will cause bow legs or other problems?

Old Wives Tales are ingrained in our societies and because they are shared by people we trust, they are often never questioned.

Bowed legs from allowing babies to stand with support is one of those tales.

If an adult holds a baby under the arms and supports the trunk to allow the baby to bear weight on his legs, it will not harm the baby.

Many babies love this position and will bounce on your leg. It allows them to be upright and see the room around them.

Supported standing can help build strong trunk muscles.

Other ways to build strong muscles in infants:

Tummy time

tummy time, prevent flat heads
Supervise tummy time when Baby’s awake!

This is a simple as it sounds. Place your baby on his or her tummy. Be sure s/he’s on a flat surface that is not too soft.

I think the earlier you start this, the better it’s tolerated. You can even do it before your newborn’s umbilical cord stump falls off!

Initially babies will not lift their head well, so be sure they don’t spend too much time face down. This can cause problems with their breathing. A brief time doing this is safe though as long as they aren’t laying on fluffy stuff. This is a major reason to never leave your baby alone on his stomach.

Use this as a play time.

Move brightly colored or noisy objects in front of your baby’s head to encourage your baby to look up at it. Older siblings love to lay on the floor and play with “their” baby this way!

Many babies will look like they’re taking off trying to fly. Others will put their hands down and look like they’re doing push ups. Around  4 months they can support their upper body weight on their elbows. All of these are good for building muscles.

Parents often avoid tummy time because their babies hate it. It’s hard to hear babies cry, I know. You can progressively make it harder for your baby without being a mean drill sergeant! Increase the time on their tummy as they gain strength. Start with just a minute or two several times a day. If you never do it, they’ll never get better.

Bonus: Tummy time helps to prevent flat heads!

Chest to chest:

From day one babies held upright against a parent’s chest will start to lift their heads briefly. You will most likely go to this position to burp your baby sometimes.

The more babies hold their head up, the stronger the neck muscles get. Chest to chest isn’t as effective as floor tummy time for muscle strength development, but it’s a great cuddle activity!

The more reclined you are, the more they work. Think of yourself doing push ups. If you do push ups against the wall, it’s pretty easy. If you put your hands on a chair, they get a little harder. Then if you put hands and feet on the floor, they’re even harder. Lift your feet onto a higher surface and it’s even harder.

Chest to chest time can be an easy version of tummy time, but I don’t want it to replace tummy time completely. Make time for both each day!

Lifting gently:

When your baby is able to grasp your fingers with both hands from a laying position, gently lift baby’s head and back off the surface. This can usually start around 6 weeks of age.

Babies will get stronger neck muscles by lifting their head and strong abdominal muscles by tightening their abs even though you’re doing most of the lifting. You could call these baby sit ups!

Be careful to not make sudden jerks and to not allow the baby to fall back too fast.

Kicking:

Place your baby on his back with things to kick near his or her feet.

Things that make a noise or light up when kicked make kicking fun!

You can also give gentle resistance to baby’s kicks with your hand to build leg muscles.

Bicycling:

When you ride a bike, you get exercise, You can help your newborn stretch and strengthen leg muscles by making the bicycle motion with his or her legs.

When babies are first born they are often stiff from being in the womb. They will learn to stretch their legs, but you can help by moving them in a bicycle pattern. They usually find this to be great fun!

I also suggest doing this after they get their first few vaccines to help with muscle soreness, much like you move your arm around after getting shots. Generally by 4 months, babies kick enough that they can do this on their own.

Sitting:

Allow your baby to sit on your lap or on the floor with less and less support from you.

You can start this when your baby has enough head and trunk control to not bop around constantly when you hold him or her upright for burping. Don’t wait until 6 months to start – by this age some babies can already sit for brief periods alone if they were given the opportunity to practice when younger.

A safe easy position is with the parent on the floor with legs in a “V” and baby at the bottom of the “V” – this offers protection from falling right, left, and back.

When your baby is fairly stable, you can put pillows behind him or her and supervise independent sitting. Never leave babies unattended sitting at this stage.

Big benefits

“Will standing hurt my baby’s legs?” is the wrong question.

Parents should ask more about what you can do to help your baby develop strong muscles. Standing with proper support is not only safe, but also beneficial!

What are your favorite activities to help your baby grow and develop strong muscles?
Will standing hurt a baby's feet and legs? What about hips?

Summer Penile Syndrome

Did you know there’s a name for the super swollen male parts from bug bites? Actually two names: Summer Penile Syndrome and Lion Mane’s Penis. Doctors might even call it seasonal acute hypersensitivity reaction. If you’ve ever seen it, you know it can be quite impressive.

What is summer penile syndrome?

Summer penile syndrome is a fairly common concern during the summer months. It’s usually due to a chigger bite on the sensitive skin of the penis or scrotum. You can often find a small bug bite near the center of the swelling.

They can itch like crazy, but usually don’t interfere with urinating.

Despite the significant swelling, there isn’t usually much pain, only itching. Unless there’s a secondary infection, there won’t be any fever.

What is a chigger?

Chiggers are a type of mite, which is an arachnid in the same family as spiders and ticks. They are also called harvest mites, harvest bugs, harvest lice, mower’s mites, or red bugs. Chiggers are so small they often go unnoticed until several hours after they attach to our skin. They can attach even under clothing, and the most common places that we notice chigger bites are in the areas of our pants.

Chiggers live in moist, grassy and wooded areas. They are commonly found in the warm summer months.

Adult chiggers don’t bite. It’s the larvae that cause itchy problems. The larvae are red, orange, yellow, or straw-colored, and no more than 0.3 millimeters long.

File-Chigger bite
Chigger. Source: https://commons.wikimedia.org/wiki/File:File-Chigger_bite.svg 
After crawling onto the skin, the larvae inject digestive enzymes into the skin that break down skin cells. They do not actually bite the host even though the bumps are called chigger bites. They form a hole in the skin called a stylostome. Their saliva goes into deep skin layers, which results in severe irritation and swelling.

People usually start to itch within a few hours and often scratch the feeding chiggers away. A hot shower with plenty of soap will kill chiggers and prevent them from finishing their meal, so showering after being in grassy or wooded areas can help prevent deeper reactions.

The good news is that in the US, chiggers are not known to carry diseases.

Prevention

Even though they don’t cause disease, chigger bites are something to avoid because they can cause significant itching for weeks.

Bug sprays with DEET will deter the chiggers. DEET is approved for use in children over 2 months of age.

Clothing can be treated with permethrin to avoid ticks and chiggers. Permethrin can be purchased at sporting goods stores to pre-treat your clothing. It should not be used directly on skin. Once dried into the clothing, permethrin will last for about six washings. You can also treat your shoes, which makes a lot of sense since chiggers are usually found in the grass and crawl up onto your skin.

Even untreated clothing can help a little if you don’t have time to pre-treat with permethrin. Wear long sleeves and long pants. Be sure to tuck the pant legs into your socks so they can’t enter from the bottom leg hole.

For more on bug sprays, including citronella, picaridin, oil of lemon eucalyptus and more, see the EPAs information on registered and unregistered products. You can even use this handy tool to find the right product for your needs.

How do you treat chigger bites?

Much like any bug bite, control of the itch is important. If kids scratch any itch, it can become secondarily infected from the break in the skin allowing germs in.

Antihistamines

Antihistamines are used for allergic reactions. We commonly use them for seasonal allergies, but they can help most allergy reactions.

Bug bites itch when our bodies react to the saliva injected into our skin with histamine. Histamine is our body’s allergic response and it itches. If you aren’t allergic to the bite, you won’t itch from it. This is the way we react to allergies, which is why we get itchy eyes and noses with allergies to pollen.

Diphenhydramine (Benadryl) is a short acting antihistamine that can help control allergic reactions, but tends to make kids tired or wired. It also only lasts a few hours, which can require frequent dosing.

I don’t like topical antihistamines, which are often sold to treat bug bites. I worry that kids will get too much of the medicine when it is applied to each bite. It’s a low risk, but still a risk. Just because they aren’t taking it by mouth doesn’t mean it isn’t absorbed. Children using a topical antihistamine for an extended time over large areas of the skin (especially areas with broken skin) may be at higher risk, especially if they also are using other diphenhydramine products taken by mouth or applied to the skin.

I am a fan of using an oral long-acting antihistamine, such as cetirizine or loratadine, to treat bug bites. Most kids with one bug bite have many. One dose of an oral antihistamine helps to control the overall histamine reaction, making each bite itch less.

Antibiotics

Despite the significant swelling, these usually do not require prescription antibiotics.

If your child has open areas from scratching the skin, you should keep the area clean and consider using a topical antibiotic ointment to help prevent infection.

Steroids

Over the counter topical hydrocortisone is a very low dose steroid. It can be used on insect bites to help stop the itch.

Stronger steroids that require prescriptions are occasionally used, but you will need to see your physician to discuss the risks and benefits of prescription steroids.

Oatmeal baths

Soaking in an oatmeal bath might help the itching. It works very well for dry skin conditions and sunburn relief as well.

You can buy commercially made oatmeal bath products or you can grind regular plain oats to make it fine enough that it dissolves in bath water. Test a small amount in a cup of water to see if it’s finely ground enough before putting 1 cup of oats into the bath water.

Some people have even made a paste of oats and applied it directly to the itchy skin for relief.

Baking soda

Another kitchen remedy for bug bite itch relief is baking soda. Mix a pinch of baking soda with a few drops of water to make a paste. Put this paste on the bites. Reapply as needed.

Ice or cool cloth

One more kitchen treatment is ice. Many kids won’t tolerate this one, but if they can’t tolerate an ice pack placed over clothing, you can try applying a cool wet washcloth directly to the skin.

When should you see your doctor?

If your child has any of the following symptoms, talk with your doctor.

  • Trouble urinating.
  • Pain or itch not controlled with the above measures.
  • Fever.

Fear has big eyes
By Robbie Grubbs from Houston (What????) [CC BY-SA 2.0 (https://creativecommons.org/licenses/by-sa/2.0)], via Wikimedia Commons