Playing It Safe
Summer is a time of fun and freedom. Homework is finished, school is out, families pack up their cars for a vacation or a day at the beach. As the days grow longer and warmer, outdoor play is on everyone’s mind—kids and adults alike. Life can change in an instant, turning fun in the sun into a nightmare. But with simple precautions, families can ensure they are doing their best to enjoy the season to the fullest—and safest—extent possible.
It’s a hot day in Houston. Several families gather at a neigh- borhood pool. Laughter and shrieks of excitement from the kids fill the hazy summer air, as parents stand by chatting about the end of the school year and comparing the latest silly cellphone pictures of their children. Suddenly, one of the older kids calls out, “Wait, where is Emily?”
One of the most common summertime activities is spending time in the water. Wading, swimming or boating; pool, river or ocean; especially in hot climates like Houston, anywhere cool and wet is prime relaxation real estate. While water activities are common, drowning becomes a significant danger, particularly for children.
“Drowning is always heart-wrenching,” said Sam Prater, M.D., medical director of emergency services at Memorial Hermann-Texas Medical Center and an emergency medicine physician at McGovern Medical School at The University of Texas Health Science Center at Houston. “In terms of injury-related causes of death in children, it’s the number one cause for kids under five.”
Drowning can occur for a number of reasons:
1. Lack of supervision.
“There is no substitute for active supervision,” Prater said, “especially in today’s world, when we’re really tied into our phones and get distracted easily.”
For any adult responsible for children, this means being 100 percent engaged in what is going on in the water and within arm’s reach of young swimmers. It doesn’t take much water or time for a small child to drown.
“One strategy when you have several adults is to always have one person specifically assigned to watch the kids,” Prater said. “For 15 minutes, he’s totally engaged, not distracted and 100 percent responsible. Then he gets a break, because you can’t do it forever, and someone else takes over.”
Kristen Beckworth, manager of Texas Children’s Hospital’s injury prevention team, calls this the “water watcher” system, and suggests providing something like a badge or a hat to ensure the designated adult is clearly identified at all times.
“I’m watching the kids in the water, I know how many went in, and I can visually see that they’re still in the water and safe,” Beckworth said. “As water watcher, I’m not drinking, I’m not texting, reading a magazine or a book, these are all distractions. Usually when a drowning occurs, adults are present, but no one was actively watching the children in the water. A water watcher at a pool gathering assumes responsibility for a set period of time until it’s assigned to the next adult.”
2. Using unsafe swimming equipment and apparel.
“Some parents get lulled into a sense of safety with floating play toys, noodles, things like that,” Prater said. “If the child can’t swim, that is not a substitute for active supervision or a life jacket—it doesn’t take much for a kid to let go of that and sink beneath the water.”
Even while at the pool, and particularly for young children, or people of all ages who can’t swim, life jackets are encouraged. “All non-swimmers and people near open bodies of water—lakes, rivers, or the ocean—should wear a U.S. Coast Guard-approved life jacket,” Beckworth said. “Water wings and inflatable toys are not sufficient. Look for a label that provides a USCG Approval Number.”
That label clarifies that the product has been approved by the U.S. Coast Guard as being made of naturally buoyant material, so it will float in water. It’s an officially designated lifesaving device, versus products like water wings that are filled with air. All it takes is for some air to seep out, for it to pop or for it to slip off the child’s arms to be no longer effective.
3. Reckless boating practices.
“Life jackets are also crucial for boats, kayaks and canoes,” Prater said. “Whether you’re on a boat, jet skis or getting towed behind a boat on a raft, you should have a life jacket and you should have it on.”
While this rule is actually a law in Texas for children under 13, adults are also strongly encouraged to wear life jackets while boating, regardless of how good they are at swimming.
“If you hit your head or are thrown overboard, you won’t be able to grab a life jacket and put it on,” Beckworth said. “Even if you’re a great swimmer, if you’re unconscious or struggling for some reason, it will save your life.”
Additionally, anyone operating a boat should take an approved boater’s education course. These are offered by a variety of different outlets. To find an officially state-approved course, visit the Texas Parks & Wildlife Department’s website.
4. Gaining access to water unexpectedly.
“If there is a pool in the home and you’re leaving your child there, how is that pool guarded?” Beckworth said. “Is there fencing that surrounds the pool? Are there alarms on windows and doors that keep kids from getting outside unnoticed, or notify you if a door or window opens?”
These questions are part of a larger campaign Texas Children’s is holding called “The Big ASK.”
“One of the concerns when children are out of school and parents are working, is parents have to find alternative childcare,” Beckworth said. “We’re trying to encourage parents to ask those really important questions about where their kids are going to be playing and staying while they are at work.”
A mom has just buckled her child into his car seat after a lengthy trip to the grocery store when she realizes that somehow, among the dozens of items purchased, she forgot an ingredient she needs to make dinner. Taking her son back into the store seems like an exhausting prospect, so she considers, “Maybe I can just run in real quick. It’s not that hot, and it’ll only be a few minutes…”
Every parent has been in a situation where they just need that one item, and getting a child out of and back into a car seat will make the errand twice as long. Leaving a child alone in a car for longer than five minutes in the state of Texas, however, is illegal—with good reason. The National Highway Traffic Safety Administration says when temperatures are in the low 80s, the temperature inside a parked vehicle can reach deadly levels in just 10 minutes. This can be especially catastrophic for children, whose body temperature can increase three to five times as fast as an adult.
“It doesn’t take very long for kids to have really rapid rises in their body temperature because they don’t dissipate heat as well as adults do,” Prater said. “It’s never acceptable to leave anyone who can’t care for themselves alone in a closed, parked vehicle. Whether it’s someone who is elderly, or a small child, or your pet for that matter.”
Occasionally, a child is unintentionally left in the car. Something as simple as a change in routine, a different parent dropping the child off at daycare, for example, can result in disaster. Especially now that car seats have children facing the rear of the car for longer than ever, forgetting a child in the car is a real possibility for even the most attentive parents.
“Put something in the backseat where the car seat is—your diaper bag, your purse, your cellphone—something that you’re going to need at the next destination,” Beckworth said. “When you get out, you’re forced to go to the backseat, and it gives you an opportunity to make sure there’s not a child in the car seat.”
Other precautions include setting an alarm at a certain time every morning to check that a child has been safely delivered to daycare, or making an arrangement with daycare providers for them to call if a child hasn’t arrived by a certain time.
Additionally, if you’re going about your day and happen to see a child left alone in a car, don’t hesitate to call for help.
“Call 911, stay with the vehicle, and the 911 communicators are trained to help you know what to look for to determine if that child is in enough distress that you need to do something or you can wait until help arrives,” Beckworth said.
After a couple hours of enjoying a day at the beach, a dad surveys his children playing in the sand and surf, thinking it might be time to reapply sunscreen. But some large clouds have rolled in, and as he looks at the sky he thinks, “It’s not even sunny out anymore. I can wait a little longer, they won’t get burned.”
“There are two types of rays: the UVB rays give you sunburn and the UVA rays tan you, but the UVA rays also go deeper and cause wrinkling and brown spots and aging of skin,” said Carol Drucker, M.D., a professor of dermatology at The University of Texas MD Anderson Cancer Center. “The UVA are consistent throughout the day. They’re just as strong in the morning as they are at noon and the afternoon.”
This means it’s important to apply broad spectrum sunscreen with a sun protection factor, or SPF, of 30 or higher at all times of day and in all types of weather.
“Broad spectrum indicates that the sunscreen blocks both UVA and UVB rays,” said Raegan Hunt, M.D., chief of pediatric dermatology at Texas Children’s and assistant professor of dermatology and pediatrics at Baylor College of Medicine. “SPF 30 blocks approximately 97 percent of UV rays if applied appropriately. Higher SPF sunscreens block a bit more UV light, but no sunscreen blocks 100 percent.”
Ensuring you cover all exposed parts of the body is essential for full protection. Commonly neglected areas are the ears, the back of the neck, the back of the hands and any exposed scalp. Furthermore, studies by the Centers for Disease Control and Prevention (CDC) have shown that even when people apply sunscreen, most don’t apply enough.
“The rule of thumb is that to cover your body, you should use about a shot glass of sunscreen,” Drucker said.
Additionally, sunscreen should be applied 30 minutes before going out into the sun and reapplied every two hours, whether it’s cloudy or sunny. Sun exposure can raise your risk of skin cancer, and it has a cumulative effect, so even small amounts of unprotected exposure have consequences.
“For 10 minutes a day, going from your house to the car or your car into a building, 10 minutes a day adds up to over an hour a week,” Drucker said. “It is important to put sunscreen on every morning.”
For children in particular, Hunt recommends special clothing for additional protection.
“UV protective swimwear can be tremendously helpful to keep their skin safe and reduce the effort needed from parents to frequently reapply sunscreen,” she said. “Also, don’t forget to protect them with hats and UV-safe sunglasses.”
Between an endless variety of sunscreen brands and types, from sprays and lotions to sticks and creams, what type of sunscreen is best? Drucker has a simple response to patients who ask that question.
“The best one is the one you will use,” she said. “You have to find something that feels good on your skin. If it leaves you feeling too oily or too dry, you’re not going to like it and you’re not going to want to use it.”
A high school football team is practicing outdoors on a typical Houston summer day. As temperatures soar into the 90s, one player starts acting strangely. Complaining of a headache, he seems disoriented and is having trouble walking straight. “Are you OK?” his teammates ask. “What do you need? When did you last drink water?”
Here in Houston, where the average high temperature hits 90 degrees in June, July and August, heat illness is common. This doesn’t mean Houstonians should confine themselves indoors all season long. With proper precautions, it’s possible to enjoy being active outdoors all year round.
“In the summer, the number one issue on our radar is looking for problems surrounding heat illness,” said Vijay Jotwani, M.D., a Houston Methodist primary care sports medicine physician.
Jotwani described Houston as having “the perfect setup” for heat-related illnesses.
“In addition to the heat from the sun, Houston has high humidity levels,” he said. “High humidity inhibits the body’s ability to lose heat from sweat as well.”
A number of other factors can also increase a person’s risk, including age, being out of shape, certain medications, such as those to manage blood pressure and antihistamine allergy medicines, and underlying medical conditions.
Jotwani also noted that one of the biggest factors in managing heat illness risk is acclimatization—or simply getting used to the heat.
“For athletes, the highest risk of heat illness is that first week of practice,” Jotwani said. “Our bodies will get used to the heat, their bodies will adjust when they have a little time, but it can be
a major issue if you are really pushing yourself the first day.”
Symptoms of heat illness include nausea, headache, dizziness and muscle cramps. If a person starts having mental issues— they’re confused, disoriented, acting strangely—it can indicate that the illness has progressed beyond heat exhaustion to heat stroke.
“It can get very serious,” Jotwani said. “Especially if it’s not recognized by someone around them and they’re not cooled quickly, heat illness can lead to organ failure, breakdown of muscles and kidney damage.”
To prevent heat illness, make sure to hydrate before and throughout outdoor activities and to take occasional breaks in a shaded or air conditioned area. If someone starts exhibiting signs of heat illness, get them cooled off—into the shade, indoors, into an ice bath, if necessary—and rehydrated. Jotwani also emphasized the importance of starting off slowly as the weather warms up and getting used to the heat.
“The number one thing is getting used to and acclimatizing to the weather before pushing yourself exercise-wise,” he said. “If you do that, we encourage people to stay active and enjoy the outdoors even in the summer. Being physically active is one of the healthiest things you can do.”
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