SUMMER
SAFETY!
I
would like to discuss three things that are important for
the summer: sun protection, insect bite treatment and prevention,
and water safety.
Sun
Protection
Suntans are generally associated with good health and beauty;
however, the sun can cause a lot of damage. The first 20 years
of life are the most important time to avoid excess sun exposure,
because it is these years that are the most important time
to have adequate sun protection. Most skin cancers develop
because of sun exposure the first 20 years of life. Skin cancer
is becoming a more common cancer. In the early 1900's there
was a 1 in 1500 risk of developing skin cancer. Now the risk
is 1 in 87 people. This is all due to the outdoor lifestyle
with tanning and inadequate sun protection.
Children are at the highest risk for sun damage because they
spend a lot more time outdoors than adults. 80% of a person's
sun exposure comes within the first 20 years of life. Also,
children's skin is comparatively thin with less protective
melanin than adults, increasing their risk of sun damage.
Because of this, it is important to know your child's risk
for sun damage so that you can provide adequate protection.
Children's
skin type can be broken down into six types. The amount of
melanin in your child's skin determines the type. The amount
of sunscreen can be based on the skin type.
| Skin
Type |
Ethic
Background |
Sunburn
Frequency |
Type
of Tan |
Recommended
SPF Suntan Lotion |
| I |
Celtic,
Irish |
Always |
None |
15+ |
| II |
Caucasian |
Often |
Minimal |
15 |
| III |
Darker
Caucasian |
Sometimes |
Gradual |
8-10 |
| IV |
Mediterranean,
Asian, Hispanic |
Occasional |
Good |
6-8 |
| V |
American
Indian, Hispanic, Middle Eastern |
Rare |
Profuse |
4 |
| VI |
African
American |
Never |
Deep |
None |
Taken
from Contemporary Pediatrics July 1997
Because
of the risks of sun damage it is important to be prepared
for the summer sun. The sun emits radiation called ultraviolet
A, B, and C (UVA, UVB, and UVC). UVA is constant throughout
the day and this causes most of the damage to the skin. UVB
peaks between 10 am-4 pm and causes mostly redness or tanning,
UVC is absorbed by the ozone layer. Sunscreen SPF takes only
UVB into consideration . SPF addresses how long a person can
stay in the sun without damage with sunscreen applied compared
to without sunscreen. For example if it takes 15 minutes to
burn without sunscreen, then SPF 4 will allow 1 hour before
burning. It is important to apply sunscreen and to use the
correct SPF.
Sunscreens come in two types, physical and chemical. The physical
sunscreens completely block the sun's radiation, however,
they are very difficult to apply. These include zinc oxide
or titanium oxide. Usually people will apply these to a particularly
prone area of the body such as the nose. Chemical sunscreens
are much more common. They absorb the suns rays and disperse
it to a more harmless form. These include para-aminobenzoic
acid (PABA) Octyl methoxycinnamate and many others. PABA is
an excellent block for the UVB radiation, which causes most
of the damage. Unfortunately, about 4% of the population is
allergic to this. This would be my first choice if there is
no allergic reaction. Allergic reactions include redness and
itching.
Sunscreens should be applied 30-45 minutes before sun exposure
and should be reapplied every 2 hours, sooner if there was
swimming or heavy perspiration. Sunscreen with an SPF of 15
will block about 95% of all radiation. An SPF of 30 will block
about 97% of all radiation so sunscreen higher than 15 SPF
won't generally give any more protection. The frequent application
is more important than the SPF once you are up to 15 SPF.
Although the use of sunscreen is very important, other safety
measures must be considered. First, children under the age
of 6 months should not need sunscreen because they should
not be in direct sunlight. The FDA recommends against sunscreen
in the first 6 months of life for this very reason. We don't
want to get a false sense of security. Baby's skin is just
too thin and too prone to injury to be in direct sunlight.
Use hats, umbrellas, and avoid direct sunlight in that age
group. Most people either don't use sunscreen at all or they
don't reapply it enough. Studies show that almost 50% of all
children use no sunscreen at all and less than 10% reapply
the sunscreen after 2 hours. You have to use the sunscreen
for it to work. Also, clothing type can be very important.
If the clothing does not block the sun, then sunscreen should
be applied beneath the clothing. For example a typical white
cotton T-shirt provides an SPF of around 7. The more tightly
wound the fabric, the better the protection. Sunglasses should
block both UVA and UVB. The darkness of the lens does not
equate to the ultraviolet protection. Make sure the glasses
are labeled for UVA and UVB protection.
Helpful
hints.
-
Limit
your child's exposure to the sun, especially between the
hours of 10 am and 4 pm.
-
Have
your child wear protective clothing such as a hat, long
sleeved shirt, and long pants in a tightly woven fabric.
-
Avoid
sunscreens in children younger than 6 months of age. Instead
use protective clothing and an umbrella.
-
Use
sunscreens from May through September.
-
Apply
sunscreen daily. Use SPF 15 and make sure it provides
protection for both UVA and UVB radiation. Use the sunscreen
30-45 minutes before sun exposure and reapply every 2
hours.
-
Use
sunglasses that protect both UVA and UVB radiation.
-
Use
more protection at higher altitudes. Every 1000 feet increases
exposure 5%.
-
Cloudy
days can be dangerous. 80% of radiation can get through
the clouds. Be sure to use sunscreen on cloudy days as
well.
-
Do
not use tanning beds.
-
Examine
your child's skin for burns or moles. See your physician
if there are new moles or changes in the size of existing
moles.
Treatment of sunburns is limited. Sunburns usually occur 2-4
hours after the damage has been done and the peak of pain
is 24 hours after exposure. Redness without blistering is
a first-degree burn and redness with blistering is a second-degree
burn. Advil, Motrin, or Tylenol can be used. Hydrocortisone
cream 1% or moisturizing creams can relieve some of the pain.
Wet compresses or cool baths with 2 oz of baking soda added
can also provide some extra relief. It is important to drink
plenty of fluids and of course, stay out of the sun. Do not
use Vasoline or butter on sunburns. They prevent heat and
sweat from escaping the skin and they are difficult to remove.
If a blister breaks, remove the dead skin with a fine scissors
and apply an antibacterial ointment twice a day for three
days. If there is fever or if your child acts sick, call your
physician.
Insect
Bite Treatment and Protection
Summertime
is time for fun for children but insects can make things miserable.
Not only can insects cause itchy, painful bites, but they
can also cause allergic reactions, Lyme disease, impetigo,
and infections. It's important to be prepared for the onslaught
of insects in the summer to minimize suffering and prevent
complications.
There are many ingredients that are used in insect repellant.
These include N,N-diethyl-m-toluamide (DEET), citronella,
soybean oil, or permethrin.
| Product
Name |
Form |
Active
Ingredient |
| OFF!
Skintastic for Kids Unscented |
Pump
Spray |
Deet
5% |
| OFF!
Skintastic for Kids Scented |
Lotion |
Deet
8% |
| Skeedaddle |
Lotion |
Deet
6.5% |
| Repel
Soft Scented |
Gel |
Deet
7% |
| Natrapal
|
Lotion
and Pump |
Citronella
10% |
| Buzz
Away |
Towelette
and Pump |
Citronella
5% |
| Bite
Block |
Lotion |
Soybean
Oil 2% |
| Repel
Permanone Spray |
Aerosol
Spray |
Premethrin
0.5% |
Taken
from Contemporary Pediatrics June 1998
When
applying an insect repellant it is important to remember that
clothing can rub it off the skin, evaporation, heat, sweating,
or water can decrease it's effectiveness, and higher temperatures
lessen the time of effectiveness.
The most effective insect repellant is Deet. Deet protects
against mosquitoes, flies, gnats, chiggers, and ticks. It
does not protect against stinging insects such as bees, wasps,
or fire ants. Deet has been associated with side effects but
only in very high concentrations such as 10-20% in children
with excessively repeated applications. At concentrations
of 10% or lower there have been no reported adverse effects.
For this reason the concentration used in children should
be 10% or less. Also, it should be reapplied infrequently.
It should be applied no more than twice in a 6-hour period.
Because of reported side effects, some people like to use
the other products. Citronella is the active ingredient in
Avon Skin So Soft. This will work, but only for a very short
period of time. And since the safety of repeated applications
is unknown, only use this if outdoor activity will be less
than 1 hour. Soybean oil is the new product on the market.
The makers report excellent study result with 97% protection
3.5 hours after use compared with 86% protection for Deet
6.5% in the same time frame. Since this is a newer product
without a long history and multiple studies, the true efficacy
and safety is not yet known for sure. Permethrin, which is
used in the treatment of scabies and head lice, really should
not be used since the safety of repeated application is just
not yet known. Thiamine (vitamin B1), which showed promise
in some studies, apparently doesn't work.
Once an insect bites a child, side effects can be anything
from a small itching lump to a systemic allergic reaction
requiring immediate treatment. For the simple insect bites,
an anti-itch cream such as Calamine, Benadryl, Aveeno, or
hydrocortisone can be used. Oral Benadryl can also be given
if the creams are not helping enough. For severe reactions
including any difficulty breathing, immediate medical treatment
is necessary. In these children epinephrine injections may
be needed for future insect bites. If a bee bites a child
and the stinger is left in place, scrape off the stinger with
a credit card or other flat object. Grabbing and pulling out
the stinger will inject more toxins into the body. Apply ice
immediately and give a dose of Benadryl. If there is any trouble
breathing give a shot of epinephrine if available and call
911. For ticks, the tick should be removed with tweezers.
In areas of the country with a high prevalence of Lyme disease,
a blood test or treatment may be necessary. There is a vaccine
for Lyme disease. Check with your physician to see if you
or you child would be eligible for this.
The best and most effective active ingredient with the longest
studies proving safety and efficacy is Deet. Use this in concentrations
of 10% or less for all children and reapply no more than twice
in a six-hour period. With good prevention, insect bites can
be avoided.
Water
Safety
Drowning
is the second leading cause of death in pediatrics. About
4000 people drown each year in the USA with about 1000 deaths
in children less than 15 years of age. The male to female
ratio is 3:1. According to the U.S. Consumer Product Safety
Commission (CPSC) the swimming pool is the most common place
for drowning, accounting for about 1/3 of all deaths. In adolescents
alcohol is involved in 50% of all drowning. The national rate
is 1.5/100,000 people.
Drowning
can occur in a pool, body of water such as lake, ocean, river,
or stream, buckets and pails, ice chests with melted ice,
bathtubs, hot tubs, spas, whirlpools, irrigation ditches,
post holes, wells, fountains, fish ponds, thin ice over any
body of water, and toilet bowls. Basically, if it contains
water it can be hazardous. Children have drowned in less than
3 inches of water.
The
best way to prevent drowning is to follow some simple safety
tips:
