Summer and Animal Bites: A Pediatrician’s Perspective Part II

One Decision, Tragic Results: Please Look Before You Lock (Video)

“It could never happen to me.” “I would never leave my child alone in the car – not for a minute.” “No GOOD parent would ever forget their child!”

But it happens every day. According to The National Safety Council on average 37 children die in hot cars each year, about one every 10 days from heat-related deaths after being trapped inside motor vehicles. This year already there have been 3 child vehicular heat-stroke deaths. And this is not counting the life-altering injuries experienced by the children who survive.

It happens…

Children climb into unlocked cars to play. A child is sleeping in the back-seat and a parent “cracks open the window” and runs into the store for “just one thing” (…illegal in some states but in a NHTSA survey, 25% of parents admitted they had done this at least once). A spouse / partner / caregiver carefully buckles the baby into the car seat to drop them off at daycare. Maybe it wasn’t their day to drive…or maybe something distracts them for just one second. It’s just a little departure from the usual morning routine – only this time they forget the baby sleeping in the back seat (…more likely now since the American Academy of Pediatrics changed their guidelines to recommend that children remain rear-facing in car seats until they reach the age of two. A parent looking in the rear-view mirror no longer sees their child’s face – just the back of the car seat – whether their child is in it, or not).

It happens…

…and it doesn’t have to be 100 degrees outside for the consequences to be devastating. According to NHTSA’s Consumer Advosory: “NHTSA Issues an Alert to Prevent Child Heatstroke in Cars“, even cool temperatures in the 60s can cause the temperature to rise well above 110 degrees Fahrenheit inside your car. The inside temperature can rise almost 20 degrees F within the first 10 minutes”. Within an hour the temperature jumps around 50 degrees F. If the outside temperature is in the low 80’s F, the temperature inside the vehicle can reach deadly levels in only 10 minutes. Slightly rolling the window down has almost no impact on these temperature increases.

Take a look at this simulation produced by the SafeKids organization of how fast a car can heat up when exposed to direct sunlight

Children’s bodies – in particular infants and children under 4 years of age – are at greatest risk for heat-related illness. They absorb more heat and are less able to lower their body heat by sweating. Because a child’s thermoregulatory system is not fully developed, their bodies warm at a rate 3 to 5 times faster than an adult’s. Hyperthermia occurs when the body produces or absorbs more heat than it can dissipate. A core body temperature of 107 degrees F is considered lethal because cells are damaged and internal organs shut down.

It happens…

To the most loving, caring parents…the most responsible caregivers. These are not “those horrible people who should never have been allowed near children”. Take a minute to read Kristie Reeves-Cavaliero’s story about the day her husband Brett took one wrong turn and drove to the office instead of dropping their beloved daughter Sophia (Ray Ray to those who loved her) off at daycare. It wasn’t until they met for lunch later in the day that they realized something was wrong. By that time Ray Ray had been in his truck for 3 hours. An hour and 19 minutes later she was gone.

But this isn’t just Ray Ray’s story. More than 1 in 5 kids who die of heatstroke in a car were supposed to be dropped off at daycare that morning – and no one questioned their whereabouts until it was too late. Other parents have had similar experiences. They share the story of their children’s tragedies here, in interviews, in every public forum possible – in the hopes of saving just one family the pain they have endured.

SO WHAT CAN YOU DO TO PREVENT ANOTHER TRAGEDY??

• Child Vehicle Heatstroke Prevention Tips from NHTSA:
  • Never leave a child unattended in a vehicle. Never leave infants or children in a parked vehicle, even if the windows are partially open.
  • Do not let your children play in an unattended vehicle. Teach them that a vehicle is not a play area.
  • Make a habit of looking in the vehicle – front and back – before locking the door and walking away.
  • If you are dropping your child off at childcare, and normally it’s your spouse or partner who drops them off, have them call you to make sure the drop went according to plan. Ask your childcare provider to call you if your child does not show up.
  • Do things to remind yourself that a child is in the vehicle, such as:
    • Keep a large object such as a stuffed animal in the car seat when it’s empty. Move the stuffed animal to the front seat when you place the child in the seat as a visual reminder.
    • Place your purse, briefcase or something else you need in the back seat so that you will have to check the back seat when you leave the vehicle
  • If you see a child alone in a hot vehicle: call the police. If they are in distress get them out as quickly as possible and cool the child rapidly. Call 911 or your local emergency number immediately
• Download the KidsandCars Safety Checklist and keep it handy
• Friday May 30th is National Heat Awareness Day: Please Help Us Raise Awareness!
  • Post on every social media platform…and use the hashtag #heatstroke to spread the word – child vehicular heatstroke is the leading non-traffic, non-crash cause of death for children.

“If you think it can’t happen to you, then it could and it might… Tell yourself it COULD happen to me, and then do whatever it takes to make sure it doesn’t.”
…kidsandcars.org

And if you ever catch yourself saying…”I’ll only be gone for a moment”… please do two things:

1. Consider the following question: If someone gave you a million dollars – would you leave it sitting there unattended in your car – even for a moment? Isn’t your baby’s life worth more?
2. Consider watching this video…and then maybe even share it:
   Before you do, know that it is very graphic and may be upsetting…so please think twice before you watch it.

Please also know that this was a re-enactment – no one was harmed in the making of this film

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Editor’s Note: This post was originally published in July of 2013. We are republishing it today to commemorate this year’s National Heat Awareness Day.

Summertime Bugs, Bites and Burns: A Pediatrician’s Perpective

The beginning of summer signals a time of spending more active hours outdoors. The weather is warming up, the days are longer and children are getting out of school and probably staying up longer than they did during the school year. It is a time to let loose and enjoy the sunshine and freedom that comes with the season.

Certain issues should be addressed and some summer safety tips followed in order to keep everyone as healthy as possible.

Burns: While exposure to sunlight is important to the innate production of vitamin D and hence calcium metabolism, there are dangers that our dermatology friends have been warning about for quite some time: too much sun can be as dangerous as too little. The highest rates of Melanoma (serious form of skin cancer) occur where there is an increased and constant exposure to sunshine, such as the southwestern part of this country. Why is this? It has been determined that both UVA and UVB light frequencies can at times alter the structure of DNA, that is the microscopic building blocks for forming all types of life forms. This is most prominent in the largest organ in our bodies, our skin. This can lead to the formations of all types of skin growths- melanoma being the most serious as it can shorten one’s life.

So avoiding sunlight would be the best way of avoiding this problem, but this is virtually impossible. Therefore try to avoid the maximum sunlight times of the day and spend more time outdoors before 10 AM and after 3PM, and cover up as much as is practical. At all times children should have a good sunblock on their skin- one that will block both UVA and UVB frequencies, and if continued exposure to sunlight is taking place or if one enters the water, this sunblock should be re-applied; the higher the SPF the less often it need be applied.

One blistering sunburn in a child can raise the chances of developing melanoma as an adult manifold. Once a sunburn is present there is practically nothing you can do except to keep your child comfortable with cool compresses and Tylenol if he/she is very uncomfortable.

Bug Bites and Stings: Not only are bugs a nuisance but some may carry diseases. Just as an example, the increase in concentration on the Zika virus in 2016 highlighted the need to be alert to insects (mosquitoes), as the Zika virus was not even recognized 5 years before. In 2024 we started to see a rise in West Nile virus in the United States, also caused by mosquito bites. There are other known illnesses that can be transmitted through the bites of insects, but as a rule these are not very common- it still makes sense to wear appropriate clothing and use insect repellent at appropriate times. These repellents should contain DEET in concentrations up to 30% for children and should not be used under the age of 6 months – use lower concentrations (10%) if kids will only be outside for an hour or two.

In general the ubiquitous honey bee usually will not be interested in stinging humans unless they are threatened- inadvertently sat on, or a child is actively trying to catch them. Even the large black and yellow bees seen buzzing around certain plants and flowers are not particularly aggressive.

This is not necessarily true of other stinging insects in the same family (hymenoptera). Hornets and wasps can be aggressive depending on the situation, and the fairly new “Africanized bee” population has grown in size- they tend to swarm and have been responsible for deaths in the past. So better off to avoid these creatures altogether. Of course if there is a known bee allergy present in your child certainly more stringent avoidance procedures should be undertaken as this can be a life threatening situation. Be sure to consult your pediatrican about what precautions you should take if you believe your child might be allergic to bees.

So summertime is a wonderful time for families and especially children; be sure to keep your child safe from the indigenous dangers that summer presents.

Other summer topics to be discussed in my next article include water hazards, plant contact (poison ivy, etc), heat exposure and dog and cat bites, not to mention animal safety in general.

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Editor’s Note:

We have also seen an increase in Lyme Disease here in the United States. Lyme disease is a bacterial infection spread to people through the bite of blacklegged ticks. Typical symptoms include fever, headache, fatigue, and a characteristic skin rash called erythema migrans. If left untreated, infection can spread to joints, the heart, and the nervous system. If your child has come into contact with a tick (or if you think they may have, but are not sure) and they experience these symptoms or a characteristic rash, please contact a health-care professional as soon as possible.

Summer Camp Health Tips – a Pediatrician’s Point of View

Letting go of your child for a day, a week or even a month of camp during the summer is often a very difficult thing for parents to do, and initially, might be very difficult for the child. Most children, however, when they return from such an experience almost invariably have enjoyed themselves and gotten the first taste of living without parents. This can be an extraordinary experience for your child as he or she learns to live and be accountable for certain rules and restrictions.

Of course, you as a parent will worry the first couple of times your children go off “by themselves”. It may help to know that every camp is equipped with fairly up to date equipment and at least a very experienced nurse or Doctor. I myself did this (physician for an overnight camp for a 6 week period) just as I completed my Pediatric Residency and prepared to enter the Air Force. It was a rewarding experience for me and my family.

Most incidences of a medical nature are minor although very rarely a serious issue may occur. When you first apply for the camp for your child they will ask for a complete medical history including chronic or serious conditions that your child may have and any and all allergies, medication or non-medication related. This is an extremely important bit of information so try to be as specific as possible.

Teach your child ahead of time about the importance of such simple things as the proper use of insect repellents and sun blocks as these constitute the causes of the majority of the “problems” in the camp setting. They must also need to be taught the importance of reporting to the nurse or physician any issues they are worried about or are experiencing, as some children will do all they can to avoid seeing these people. If your child has a chronic disease such as asthma, he or she must be aware of the problems they can experience as a result of their illness and report such occurrences to the medical staff. Of course, the medical staff will also be familiar with such individual problems. They should also know about how to self-medicate (inhaler, etc.) if necessary.

Poison Ivy is also a very common occurrence as children spend more time outdoors, they should be told what it looks like and feels like so they can see the medical staff when necessary.

Other “problems” are injury-related and should be brought to the attention of the medical staff – fortunately the majority of these are also of a minor nature.

Finally, they will likely be taught about insects and other critters that can be encounter in the wild during the first days or weeks of camp; snakes, small mammals, spiders, etc. The camp staff will be very particular and complete when describing such encounters and will err on the side of conservatism while they are in charge of your child.

Wishing you and your kids a happy, healthy, and safe summer.

6 Summer Illnesses Parents Must Know: How to Spot & Treat Them

You may not think of summer as a major season for sickness, but there are a number of illnesses that occur only in the warm months — and most often in kids. These viruses and bacteria live and breed where kids like to hang out: in lakes, pools and wooded areas.

The main culprits are enteroviruses (which are transmitted through the digestive tract) and viruses carried by deer ticks, says Dr. Jeremias Murillo, an expert in pediatric infectious disease at the Children’s Hospital of New Jersey at Newark Beth Israel.

There are no vaccines for these viruses, so parents need to be vigilant and prudent, advises Murillo. Steer clear of dirty-looking lakes and overcrowded pools, which can be contaminated with infected feces and sewage. Avoid wooded areas where tick-carrying animals live. And if you’re going hiking, wear white clothing with long sleeves and pants, and check frequently for ticks.

Here’s how to spot and treat the six most common summer ailments:

Summer Sickness No. 1: Enteroviruses

Enteroviruses include Coxsackie viruses; ECHO virus; and hand, foot and mouth disease.

• Source: Water contaminated by human feces, such as lakes and under-chlorinated pools.
• Signs: Upper-respiratory infection; diarrhea and vomiting; pinkeye; skin rashes; and blisters in the mouth and on the hands and feet. Can lead to viral meningitis. Symptoms develop three to seven days after infection.
• Treatment: None. Clears up after a few days.

Summer Sickness No. 2: Lyme Disease

• Source: Bacteria spread by infected ticks.
• Symptoms: A single bull’s-eye rash, body-wide itching, fever, chills, muscle pain, stiff neck and headache. Symptoms come and go. If not treated, Lyme disease can spread to the brain, heart, and joints.
• Treatment: Antibiotics.

Summer Sickness No. 3: Babesiosis

• Source: Parasites spread by infected deer ticks.
• Symptoms: Shaking, chills, very high fever, loss of appetite, and a type of anemia that can lead to jaundice and dark urine. Often misdiagnosed as malaria.
• Treatment: Antimalarial medications and antibiotics.

Summer Sickness No. 4: Ehrlichiosis

• Source: Bacteria spread by infected ticks.
• Symptoms: Fever, headache, fatigue, muscle aches, diarrhea, flat red rash, and tiny areas of bleeding on the skin. Can also cause anemia and blunt the immune system, leading to other infections. Symptoms develop seven to nine days after the bite.
• Treatment: Antibiotics.

Summer Sickness No. 5: Rocky Mountain Spotted Fever

• Source: Bacteria spread by wood.
• Symptoms: Prominent, generalized rash that starts in hands and feet and spreads to the rest of the body. Also, chills, fever, severe headache, muscle pain, mental confusion. Can affect organs if not treated immediately. Symptoms develop two to 14 days after the bite.
• Treatment: Antibiotics.

Summer Sickness No. 6: E-coli

• Source: Bacteria found in sewage-contaminated lakes and other water
• Symptoms: Sudden, severe and bloody diarrhea. Also, fever, gas, loss of appetite, and stomach cramping. Symptoms develop 24 to 72 hours after infection.
• Treatment: None. Sickness disappears in a few days.

Most cases of these illnesses are fairly mild, but some can lead to serious complications — and very rarely, death. Being aware of the causes and signs can help you protect your kids — and ensure your summer fun.

Summer Hazards: Part II – Insects & Spiders & Snakes, Oh My!

Summer Hazards Part I focused on counteracting the effects of the sun: remaining well hydrated during the time of the year when fluid loss through activities can cause significant problems and minimizing the potential harm that can be caused by direct exposure to the sun. Part II focuses more on keeping your family healthy and safe this summer from the pests that come around summer – the insects, spiders and snakes – and the problems that often come along for the ride.

Insect bites:

Most insect bites are benign unless one is allergic to that particular insect. Unfortunately it is not possible to tell who is allergic prior to the first episode of reaction, however, most reactions are of a minor nature, e.g.: hives, general itchiness and red itchy eyes. These can easily be treated with an antihistamine by mouth such as Benadryl and cold compresses to the skin or the eyes. Of course the more serious reactions (usually due to vespids- bees, wasps and hornets) can be fatal but fortunately, they are rare, and usually do not occur with the first reaction. If you are one of the unfortunate few who are known to have serious reactions you will carry with you medicines that can significantly change the outcome of the reaction, e.g.: epipen or epipen jr. which is a form of epinephrine injected just under the skin for maximum (what can be life-saving) effect.

Other insects known to produce reactions or painful side effects include spiders and small insects such as ants. There are certain species of ants, such as fire ants, that are responsible for a painful bite that usually occurs after someone has stepped on a nest. Cold water or ice on the area along with such antihistamines as Benadryl, will help the stinging sensation. Certain large black ants can also bite but are usually not found in this country.

Only 2 spiders in this country should be avoided:

Black widow, notable for an hourglass orange imprint on the abdomen, is responsible for a very painful bite that can cause muscle spasm notably in the abdomen- usually not deadly but very painful. The other spider of note is the brown recluse spider which although looking very benign to the naked eye yields a very painful and tissue destroying toxin that can cause problems over the next several weeks. Ideally, the best treatment is avoidance as is true of everything discussed prior to this point.

Snake bites

also tend to occur when a human being inadvertently steps on or disturbs the animal. Although most snake bites are non-venomous in this country all bites can be painful and if you plan to spend any prolonged time outdoors (camping etc.) It would be well worth your while to study up on types of snakes and animals indigenous to the area and be prepared for a plan of action if an incident occurs. In general, an imprint consisting of two rows of teeth are usually from a non-venomous snake while 2 prominent puncture wounds are produced by a fanged snake usually producing a toxin of some kind. These bites tend to be very painful from the onset and only get worse with time. Other side effects can be very nasty and at times life-threatening. This person needs medical attention as promptly as possible.

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