Summer Safety for You and Your Kids

When it comes to summer, Olivia Kane, 36, mostly remembers the happy times: eating crabs on the beach, chasing flickering fireflies at night, and playing softball with friends. But there are other memories the Arlington, Va., resident wishes she could forget. Like the rash from poison ivy that broke out on her face, neck, and arms two days before she had to walk down the aisle in her sister's wedding. Or the time she went to the beach to get a tan before high school graduation. "What I got was a bright red sunburn," she says. "I had blistered cheeks, a blistered chest, and I was the graduation speaker."

But her worst summer memory was when she took a sip from a can of soda and gulped down a bee that had crawled into the can when she wasn't looking. "I knew I swallowed something," Kane says. "I got so hysterical that I threw up." Out came the bee, and she went straight to the emergency room where she was treated for difficulty breathing.

There's a lot you can do to minimize the risks of health problems related to summertime activities. While treatment with the proper medicines and procedures is good, prevention is better. So before you pack your swimsuit or hit the hiking trail this year, brush up on these summer hazards.

Sunburn

As a child in Pratt, Kan., Linda Talbott got frequent, blistering sunburns while playing outside all day. Then in her college years, it was cool to be tanned. "Everyone wanted a tan, and I thought tanned skin looked beautiful," Talbott says. "But it's not beautiful when you're 65 and you've had melanoma."

In 1997, Talbott noticed a dark spot under her left eye. "I thought it was mascara, but it grew to the size of a raisin and started to bleed" after about six weeks. Her doctor said it was melanoma, a serious form of skin cancer. Another lesion on her cheek, previously misdiagnosed as an age spot, also turned out to be malignant. She needed immediate surgery on her face to remove the cancerous tissue and save her life.

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Everyone is at risk for skin cancer, but especially people with light skin color, light hair or eye color, a family history of skin cancer, chronic sun exposure, a history of sunburns early in life, or freckles, according to the American Cancer Society. Ultraviolet rays from tanning booths as well as smoking also increase the risk of skin cancer.

Sunburn prevention and treatment

Limit sun exposure, especially between the hours of 10 a.m. and 2 p.m., wear protective clothing, and use sunscreen. Remember that sunscreen is formulated to protect the skin against the sun's ultraviolet light (UV), not to help the skin tan.

Babies younger than 6 months should be kept out of direct sunlight. If that is not possible, sunscreen may be applied to small areas including their faces and backs of their hands after testing to see if the baby is sensitive. To test, try a small amount on the baby’s wrist.

For older children, apply sunscreen liberally 30 minutes before going outdoors and reapply at least every two hours, more often if sweating or getting in and out of the water. Use a sunscreen with a sun protection factor (SPF) of at least 30 and offers broad-spectrum coverage (protects against UVA and UVB rays).

Some medications can increase sensitivity to the sun. Examples are tetracycline antibiotics like doxycycline or minocycline, sometimes used for acne; sulfonamides such as Bactrim or Septra (trimethoprim-sulfamethoxazole); non-steroidal anti-inflammatory drugs such as ibuprofen; and some fluoroquinolones like ciprofloxacin and levofloxacin. Cosmetics that contain alpha hydroxy acids (AHAs) may also increase sun sensitivity and the possibility of sunburn. Examples are glycolic acid and lactic acid. It is important to protect your skin from the sun while using AHA-containing products and for a week after discontinuing their use.

Along with regularly using sunscreen, it's smart to wear wide-brimmed hats and seek shade under a beach umbrella or tree. Sunscreens alone may not always protect you, and it’s possible to get a sunburn even on a cloudy day.

Don't forget sunglasses, which protect the sensitive skin around the eyes and may reduce the long-term risk of developing cataracts. Look for sunglasses that offer at least 99% UV protection for children. People who wear UV-absorbing contact lenses still should wear UV-absorbing sunglasses since contact lenses don't completely cover the eye.

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If you or your child does get a sunburn, don't put ice or butter on it. Use a cold compress or a pack of frozen vegetables. Over-the-counter pain relievers like ibuprofen may also be helpful. Mild and moderate cases of sunburn may be helped by topical corticosteroids such as hydrocortisone. Severe cases may require oral steroids, such as prednisone, and should be evaluated by a doctor.

Applying 80% to 90% aloe vera gels, now readily available where sunscreens are sold, can also lessen the pain of a sunburn and prevent burns from deepening if applied early. The actual juice squeezed from an aloe vera plant works the same way. This natural remedy is widely used in tropical countries around the world.

Damage from sun exposure and sunburn builds up over the years. Be on the lookout for moles that change color or size, bleed, or have an irregular, spreading edge -- all potential signs of skin cancer.

Mosquito and Tick Bites

Rob Baxley of Savage, Md., never saw the tick, but thinks he came into contact with one when he helped his brother build a deck in June 2003. "Soon after that, I noticed a little red spot on my thigh," Baxley says. "But then it grew." He estimates the rash was about the diameter of a grapefruit when he sought medical help a month later.

About 80% of people who get Lyme disease develop a large rash that looks like a bull's-eye or wheel. Baxley experienced other classic Lyme disease symptoms, such as muscle aches and stiff joints. His doctor also found a similar rash on Baxley's calf.

After a blood test confirmed Lyme disease, Baxley took an oral antibiotic followed by intravenous treatment with a second antibiotic. In addition to the physical symptoms, he also experienced depression. Baxley calls the whole experience frustrating. "It's taken a toll on the whole family," he says.

Ticks are usually harmless. One of the biggest disease threats from tick bites is Lyme disease, which is caused by the bacterium Borrelia burgdorferi. The bacteria are transmitted to humans by the black-legged deer tick, which is about the size of a pinhead and usually lives on deer. According to the CDC, there were about 27,000 confirmed cases of Lyme disease reported nationwide in 2013. The disease is most prevalent in the Northeast and Upper Midwest (Minnesota, Wisconsin).

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Another insect-borne illness, West Nile virus, is transmitted by infected mosquitoes and usually produces mild symptoms in healthy people. But the illness can be serious for older people and those with compromised immune systems. In 2014, about 2,200 cases of West Nile virus in humans were reported to the CDC. A small number of those infected with West Nile virus develop severe illness. The symptoms are flu-like and can include fever, headache, body aches, and skin rash.

Rarer but also dangerous diseases like Rocky Mountain spotted fever and equine encephalitis can also be transmitted by ticks or mosquitoes respectively.

Mosquito, tick bite prevention and treatment

There are no vaccines for West Nile virus or Lyme disease. If you're spending time in tall grass or woody areas, use insect repellent with DEET to ward off mosquitoes and ticks. Do not use insect repellent on babies younger than 2 months. Insect repellent used on children should contain no more than 30% DEET. Follow directions carefully.

Check yourself and your children for ticks before bedtime. If you find a tick, remove it by grasping it as close to the skin as possible with tweezers and pulling gently but firmly. Early removal is important because a tick generally has to be on the skin for 36 hours or more to transmit Lyme disease. The CDC recommends cleansing the area of the tick bite with antiseptic. You don't have to save the tick to show it to the doctor. If you really want to have the tick tested, you could check with the local health department, but not all of them offer tick testing. Lyme disease is more common in the summer and fall months.

Over-the-counter antihistamines, such as Benadryl or Claritin, can bring itch relief. Read dosing directions carefully, and for children under age 6, check with a doctor. Hydrocortisone cream on the affected area also may help, especially with children. It’s also a good idea to keep children’s fingernails short and encourage them to rub, not scratch, itchy skin. Scratching can lead to broken skin followed by a bacterial infection.

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Bee Stings

In the summer of 2003, the Nebraska Poison Center in Omaha received a call about a 4-year-old girl who was stung on the tongue by a bee while sipping from a soda can. She was treated in the emergency room for swelling not only to the tongue, but to her lips and up to her eyes -- signs of a serious allergic reaction.

Other symptoms of an allergic reaction are hives, itching, rash, difficulty breathing, vomiting, and shock. Most reactions to bee stings are mild, but severe allergic reactions lead to between 40 and 50 deaths each year. An allergic reaction can occur even if a person has been stung before with no complications.

Bee sting prevention and treatment

To keep bees away, wear light-colored clothing and avoid scented soaps and perfumes. Don't leave food, drinks, and garbage outdoors uncovered. Treat a bee sting by scraping the stinger away in a side-to-side motion with a credit card or fingernail, and then washing the area with soap and water. Pulling the stinger or using tweezers may push more venom into the skin. For any bug bite or sting, ice or a cold compress and over-the-counter pain-relieving creams or oral Benadryl can help. The aloe gels mentioned above can also help ease itching.

Watch for signs of allergic reaction to stings, which typically happen within the first few hours. If your child’s lips or tongue begin to swell, or if he or she complains of tightness of the throat or difficulty breathing, go to the emergency department or call 911 immediately. If you or your child has ever had a severe allergic reaction to a sting (meaning trouble breathing or throat swelling), experts recommend carrying two epinephrine auto injectors such as EpiPen. Epinephrine supports blood pressure, increases heart rate, and relaxes airways. Any time you have to use epinephrine, you should immediately call 911 or go to the emergency room.

Heat Illness

In August 2001, Tracey Jaurena, an athletic trainer in Coalinga, Calif., was working on a football field when a friend called her cell phone number. The caller said Jaurena's son Abe, 12, had collapsed during practice nearby with his youth football league.

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"When I got there, Abe's face was blotchy and I kept calling his name, but he couldn't answer me," she says. Jaurena cooled Abe down until emergency workers arrived and he was treated for dehydration at the hospital.

Normally, the brain’s thermostat regulates body temperature by increasing blood flow to the skin and sweating. During heat illness, the body's cooling system malfunctions, and core body temperature goes up. Mild symptoms of heat exhaustion include thirst, fatigue, and cramps in the legs or abdomen. Left untreated, heat exhaustion can progress to heat stroke. Serious heat-related symptoms include dizziness, headaches, nausea, vomiting, rapid heartbeat, decreased alertness, and a temperature as high as 107o F. In severe cases, the liver, kidneys, and brain may be damaged as proteins in the body break down. About 400 people die each year from heat stroke, according to the CDC.

The risk of heat illness goes up during exertion and sports and with certain health conditions such as diabetes, obesity, and heart disease. Alcohol use also increases the risk. So do medications that slow sweat production such as antihistamines.

Young children are especially vulnerable to heat illness. During the summer of 2003, at least 42 children in the U.S. died after being left in hot cars. What some people don't realize is that the temperature inside a car can climb much higher than temperatures outside during a sunny day. Heat stroke in children can occur within minutes, even if a car window is opened slightly. The same is true for pets.

Heat illness prevention and treatment

Air conditioning is the No. 1 protective factor against heat illness. If you don't have air conditioning, spend time in public facilities, such as libraries and malls, that have air conditioning. Fans can help too although less than air conditioning.

Reduce strenuous activities or do them during early mornings and evenings when it's cooler. If you're outside for long stretches of time, carry a water bottle, drink fluids regularly, and don't push your limits. People who play sports should wear light, loose fitting clothes and drink plenty of fluids before, during, and after activity. For example, a 90 pound child needs to drink about 6 ounces every 15 minutes during warm weather exercise. Cold water and sports drinks are good for hydration, but avoid soda and juices. If you see someone showing signs of heat illness, have the person lie down in a cool place and elevate the legs. Use water, wet towels, and fanning to help cool the person down until emergency help comes.

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A word about heat and cars

Sadly, cases of children being accidentally left behind in cars by distracted caregivers are not rare. Since 1998, there have been about 623 such deaths, according to statistics compiled by Jan Null, a meteorologist at San Francisco State University. And he says the problem doesn’t seem to be getting any better. Over the past 16 years, the 5-year annual average has stayed flat at around 38 deaths each year.

About half the deaths happened as a result of a caregiver forgetting a child in the back seat, according to Null’s statistics. About 30% happened when kids were playing in an unattended car, and 18% were as a result of parents intentionally leaving a child unattended in a car. Here are tips for avoiding tragedy:

  • Leave a purse, briefcase, or cell phone in the back seat. That way, you get in the habit of checking in the back seat before leaving the vehicle.
  • Make an arrangement with your child’s daycare to have them call you if the child doesn’t show up as expected.
  • Always lock your car and car trunk, even if the car is parked in the driveway at home, and always keep keys and fobs out of the reach of little ones.
  • If you see a child unattended in a car, call 911.

Burns From Fireworks and Grills

July 4, 2002, Sia Karpinski of Akron, Ohio, stepped on a discarded sparkler with bare feet. She was treated for serious burns at the Burn Center at Akron Children's Hospital as an outpatient for about six weeks.

According to the National Fire Protection Association, in 2013, an estimated 11,400 people were treated in U.S. hospital emergency rooms for fireworks-related injuries. Most injuries involved the hands, head, and eyes.

Two more causes of serious summer burns are children playing around grills or throwing objects into campfires.

Burn prevention and treatment

Stick with public firework displays handled by professionals. Children should always be closely supervised when food is being cooked indoors or outdoors. Be aware that gas leaks, blocked tubes, and overfilled propane tanks cause most gas grill fires and explosions. Teach children to cover their faces, stop, drop, and roll if their clothes catch fire.

Generally, minor burns smaller than a person's palm can be treated at home. But burns bigger than that, and burns on the hands, feet, face, genitals, and moving joints usually require emergency treatment. For a minor injury you can run cool water over it and cover it with a clean, dry cloth. Don't use ice, which can worsen a burn. And don't apply petroleum jelly (Vaseline) or butter, which can hold heat in the tissue. Consult your family doctor if a minor burn does not heal in a couple of days or if there are signs of infection, such as redness and swelling or worsening pain.

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Foodborne Illness

Summer is prime time for weddings, picnics, graduation parties, family cookouts -- and foodborne illness. Feeding the large groups involved can make food safety especially challenging. After one graduation celebration, at least 81 students from E.C. Drury High School in Milton, Ontario, reported signs of food poisoning. Stool samples confirmed E. coli as the cause of illness, though the exact food source of the bacterium was not confirmed. Known sources of E. coli include undercooked beef, sausage, and contaminated produce.

Typical signs of food-borne illness include nausea, vomiting, cramps, and diarrhea. In serious cases, high fever, bloody stool, and prolonged vomiting may occur. Young children, pregnant women, older people, and those with compromised immune systems are hit hardest.

Bacteria grow faster in warmer weather. You need to be aware of more than just the potato salad or egg dishes, experts say. You need to exercise care with any food, including melons and lettuce. Since 1996, there has been multiple outbreaks of foodborne illness for which fresh lettuce or fresh tomatoes were the confirmed or suspected source. The causes included E. coli, salmonella, cyclospora, campylobacter, and hepatitis A virus. Keep in mind that unpasteurized honey poses the danger of botulism to young children. Babies under 12 months of age should never be given raw honey.

Foodborne illness prevention and treatment

It seems so basic, but not everyone does it. Wash your hands well and often with soap and water, especially after using the bathroom and before cooking or eating. Also wash surfaces when cooking, keep raw food separate from cooked food, marinate food in the refrigerator, cook food thoroughly, and refrigerate or freeze food promptly. Never defrost and then refreeze foods. The FDA suggests never leaving food out for more than one hour when the temperature is above 90 degrees. Any other time, don't leave food out for more than two hours. Keep hot food hot and cold food cold Wash off fruits and vegetables with cool running water. Also, scrub fruits with rough surfaces like cantaloupe with a soft brush.

When you are packing food for a picnic, place cold food in a cooler with plenty of ice or commercial freezing gels. Cold food should be held at or below 40 degrees and the cooler should be stored in shade. Hot food should be wrapped well, placed in an insulated container, and kept at or above 140 degrees.

Keeping a child with food-borne illness hydrated is the most important job. Electrolyte solutions like Pedialyte are good, but not all children like the flavor. Sports drinks are a reasonable alternative in the short term. Popsicles and ice chips are also acceptable when all else fails. Encourage the child to drink small amounts frequently, and watch to be sure that he or she urinates at least every six to eight hours. Once vomiting stops, return the child to a regular diet as soon as tolerated, but be aware that milk and fruit juices can sometimes prolong diarrhea. Seek emergency treatment if severe pain accompanies the illness, if vomiting doesn't stop in a few hours, or if blood appears in diarrhea.

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Poison Ivy, Poison Oak, and Poison Sumac

Betsy Dunphy, 44, enjoys living in a woody area in Herndon, Va. But she could do without the poison ivy. She once missed a week of work when a rash from the vine spread all over her face and chest. In another summer, she developed a poison ivy rash on her wrist after moving azalea plants, and was careful to keep it from spreading.

Rashes from poison ivy, oak, or sumac are all caused by urushiol, a substance in the sap of the plants. Poison plant rashes can't be spread from person to person, but it's possible to pick up a rash from urushiol that sticks to clothing, tools, balls, and pets.

Poison plant rash prevention and treatment

Dunphy says she's been able to avoid an outbreak in the last two years mainly by learning what poison ivy looks like and avoiding it. According to the American Academy of Dermatology, while "leaves of three, beware of me," is the old saying, "leaflets of three, beware of me" is even better because each leaf has three smaller leaflets.

"I also wash my garden tools regularly, especially if there is the slightest chance that they've come into contact with poison ivy," Dunphy says. If you know you will be working around poison ivy, wear long pants, long sleeves, boots, and gloves.

Hikers, emergency workers, and others who have a difficult time avoiding poison ivy may benefit from a product called Ivy Block. It's the only FDA-approved product for preventing or reducing the severity of rashes from poison ivy, oak, or sumac. The over-the-counter lotion contains bentoquatam, a substance that forms a clay-like coating on the skin.

If you come into contact with poison ivy, oak, or sumac, wash the skin with soap and cool water as soon as possible to prevent the spread of urushiol. If you get a rash, oatmeal baths and calamine lotion can dry up blisters and bring relief from itching. Treatment may include over-the-counter or prescription corticosteroids and antihistamines.

Poisoning in Children

The parents of a 2-year-old boy called the Nebraska Regional Poison Center in Omaha when he accidentally sprayed cleaning disinfectant into his eye. He developed a burn in the cornea. Another 2-year-old boy spent several days in the hospital and survived after drinking charcoal lighter fluid that had been left by the barbecue pit. In another case, a 3-year-old girl got into a bottle containing insecticide and died several days later.

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Calls to the poison center go up every spring and summer. Children may accidentally ingest sunscreens, berries, cleaning solvents, insect repellents, pesticides, plants and mushrooms, and hydrocarbons in the form of gasoline, kerosene, and charcoal fluid.

The American Academy of Pediatrics (AAP) no longer recommends that syrup of ipecac be used routinely to induce vomiting in poisoning cases. The main reason for the policy change was that, although it seems to make sense to induce vomiting to empty the stomach contents after a poisoning, research hasn't shown that ipecac-induced vomiting is beneficial in improving the clinical outcome of accidental poisoning cases.

The continued vomiting caused by ipecac could also prevent children from keeping down the activated charcoal they may be given in the emergency room. Charcoal binds to poison and keeps it out of the bloodstream. There are also some substances, such as drain cleaner, that shouldn't be made to come back up because they do more damage.

The FDA in 2014 recommended that ipecac syrup continue to be sold as an over-the-counter product in bottles of 1 fluid ounce.

Poisoning prevention and treatment

Dangerous substances, including medication, should be kept out of reach of children. In addition, substances should be kept in their original containers to avoid confusion or mistakes.

Children who have ingested poisonous substances may experience difficulty breathing, throat pain, or burns to the lips and mouth.

If you suspect that a child has ingested a poison, call the poison center immediately and tell them what type of poison was ingested so you can get advice on what to do. If you dial the nationwide poison help line -- 800-222-1222 -- you'll be connected to your regional poison center. Convulsions, loss of breathing, or loss of consciousness require calling 911 immediately. If you know what your child ingested, take it with you to the emergency room, whether it's a part of a plant or the chemical's container.

Skin Reactions

Henna tattoos: The FDA has received complaints from people who have received products marketed as henna temporary tattoos, especially so-called "black henna," at places such as salons and kiosks at beaches and fairs. There have been reports of allergic reactions, skin irritation, infections, and even scarring. "Black henna" may contain the added "coal tar" color, p-phenylenediamine, also known as PPD, which can cause allergic reactions in some people. Henna itself is made from a plant and typically produces a brown, orange-brown, or reddish-brown tint. Other ingredients must be added to produce other colors. Even brown shades of products marketed as henna may contain other ingredients intended to make them darker or make the stain last longer. While the FDA has approved henna for coloring hair, and PPD is used in cosmetics as a hair dye, neither of these color additives is approved for direct application to the skin.

Depilatories: The FDA also has received complaints about skin burns and scarring from some chemical hair removal products. If you use this type of product, always do a patch test in accordance with the directions. Don't use it on broken or irritated skin, and keep the product away from eyes. Cosmetics don't go through FDA approval before they are marketed, though the agency can take action to get unsafe products off the market.

WebMD Medical Reference Reviewed by Roy Benaroch, MD on July 09, 2015

Sources

SOURCES:

Mayo Clinic: "First Aid."

KidsHealth: "First Aid & Safety.

American College of Emergency Physicians: "About Emergencies."

Family Doctor.org: "Heat Exhaustion and Heat Stroke."

KidsHealth: "Summer Safety."

American Academy of Pediatrics: "Summer Safety Tips."

Centers for Disease Control and Prevention: "Summertime Safety."

Environmental Protection Agency.

National Fire Protection Association: "Fireworks."

CDC.

FDA.

Jan Null, meteorologist,  San Francisco State University, San Francisco.

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