The following information is provided so parents might better understand and more accurately follow the instructions given by our office for the care of their children.

Summer Safety for Children

Advice from the Doctors and Nurses at Garden City Pediatrics:

SUN PROTECTION includes several strategies for shielding the skin from the harmful rays of the sun, in order to avoid damaging sunburns. Children are at greatest risk from sunburns; research has shown that a bad sunburn early in life increases the risk for future skin cancer. The suns rays are strongest from 10am until 3pm, so special attention should be paid at these times. Try to eat lunch indoors or in a well-shaded area. Also be careful at the beach or pool, as the sun’s rays will also reflect upward off of the water and sand. Lightweight clothing and a hat with a brim should be worn to cover as much of the skin as possible, and babies should be shaded under a canopy or sun umbrella. For all children, sunblock should be applied to all exposed areas of skin. Look for an SPF of 15-20 or more (though very high numbers are not significantly better than those in the 20-30 range), and reapply after swimming or prolonged exercise. Use a lotion that is PABA-free or hypo-allergenic to minimize the chances of a skin rash. Sunglasses that filter out UV rays are a good idea; consider unbreakable, plastic sunglasses for children. When it is very warm outside be sure your children are drinking plenty of non-caffeinated fluids to prevent dehydration.

INSECT BITES, most commonly from mosquitoes, can cause a very dramatic red, swollen, itchy area in many children. If your child is bothered by insect bites, briefly rubbing the bite area with an ice cube may help reduce the swelling. The itching may be relieved by topical application of products like Calamine lotion, Aveeno cream, and similar generic brands. Severe itching may also be treated by a dose of an over-the-counter oral antihistamine at bedtime. (For babies and young children, avoid topical diphenhydramine products, e.g. Benadryl or Caladryl, because you can not accurately measure how much is being absorbed through the skin, and repeated applications can lead to an overdose.) Trim your child’s fingernails to minimize scratching of the bites, because the scratched areas can become infected. To prevent bites, keep children covered with long-sleeved, long-legged clothing in bug-infested areas.

INSECT REPELLENTS DEET (N,N-Diethyl-m-toluamide) is a very effective insect repellent, but it can be toxic to the neurologic system if too much is absorbed through the skin. DEET should not be used on children under 2 years old. For older children, only products with less than 10% DEET (e.g. Skintastic and Skeedaddle) are recommended for use, and it should be washed off after it is no longer needed. Less DEET is absorbed if it is applied to the outside of a child’s clothing rather than directly to the skin. Repellants with soy bean and geranium oils, such as Bite Blocker are a more effective, natural DEET-free alternative that is safe, even for young children.

TICK BITES do not always cause Lyme disease. Only the deer tick can pass along this infection, and the risk is minimized if you can remove the tick quickly. Experts agree that it takes 24-48 hours before a tick passes along the infection. It is a good idea to perform a “tick check” after a day outside or in the woods, by looking over your child’s skin at bath time. The best way to remove a tick is to grab it with tweezers close to the skin and pull it out whole. Be sure all parts are removed from the skin and wash the area with soap and water. Observe the area of the bite for the telltale “bulls-eye” rash, which should develop over the next couple weeks if Lyme disease has been transmitted. The rash looks like a large red circle around the bite area, without redness in the middle; it does not look like the red welt of a mosquito bite. In this early stage, Lyme disease can be easily treated with standard antibiotics. (Amoxicillin, or Doxycycline).

WATER SAFETY should be reviewed with children and adolescents. It is not safe for anyone to swim alone; children should have constant adult supervision and teenagers should always swim with a “buddy” when there is no lifeguard. Approved life-jackets or PFDs should be worn in boats and for motorized water sports. Remind teenagers that alcohol increases the risk of drowning and boating accidents. Children who do not know how to swim are not safely supported by inflatable floating devices and rafts, as these can all be accidentally overturned. Drowning can occur even in very shallow water, so empty and overturn small plastic pools when not in use. If you own a pool, be sure it is surrounded by a fence that is locked. This can prevent unsupervised use of the pool and accidental drownings.

POISON IVY cacauses a distinctive itchy, raised, red rash that may look weepy and may cause localized swelling. The rash is caused, in those who are sensitive, by contact with a resin on the plant leaves. The risk may be minimized by wearing long clothing when in the woods, and washing hands with soap and water immediately after returning. Avoid touching the poison ivy plant (which is notable for groups of three leaves), and avoid touching the face while in the woods. Also wash clothing that has come in contact with the plant. Once the resin has been washed off of the skin, the rash is not contagious. Keep fingernails trim to avoid scratching, and use creams to relieve the itching (e.g. Calamine, Aveeno, etc.). Also apply 1% Hydrocortisone cream twice daily to areas of significant rash, in order to decrease the inflammation and itch. If there is severe swelling, especially of the face, contact your child’s doctor who may prescribe oral steroids.

HELMETS have have clearly been demonstrated to save lives, and minimize head injuries. Helmets should always be worn when bicycling, especially when riding on the road with cars. Likewise for in-line skating (rollerblading), skateboards and scooters (razors). The wrist is the most common site of a broken bone caused by in-line skating, so wrist guards are the most important of all the safety pads for the arms and legs. There are many fun outdoor sports in which children can safely participate during the summer. Regular exercise has numerous health benefits, and should be encouraged year-round.

Trampolines are unsafe for home recreation. Numerous injuries have been reported from trampoline use, including broken bones, head and neck injuries. The doctors and nurses at Garden City Pediatrics strongly recommend that trampoline not be purchase for home use and that children be educated not to use trampolines at friends’ houses.

Winter Safety

The physicians and staff at Garden City Pediatrics would like you to have a safe and happy winter. We always advocate that children be active and play outside, even during the winter season. With the right clothing and some careful planning outdoor winter activities can be safe and enjoyable for children of all ages.

Always dress children in layers for outdoor play. Newly available synthetic materials provide wonderful heat retention and avoid one’s getting soaked from sweat or snow play. Wind and wet clothes are dangerous during snow play so include a water and wind proof outer layer when you dress your child. Fingers and toes will stay warmer if the child’s torso and head are toasty.

Remember that activity helps kids keep warm. Encourage your child to walk and run while outside to help stay warm. Younger siblings who are just sitting and watching are much more likely to get cold and should be carefully monitored.

Keep your child well fed and hydrated during the winter. High calorie snacks like granola, dried fruit and peanut butter provide good fuel for winter play. Encourage your child to drink lots of water as well.

Winter play, while lots of fun, is tiring so make sure your child is well rested.

Enjoy a safe and gloriously fun winter season.

Car Safety

Nationwide, more than 80% of children are improperly restrained while riding in cars. Our goal at Garden City Pediatrics is to educate our families about car safety so that all of our patients are as safe as they can possibly be in cars.

Infants should be in rear facing car seats until they are both one year old and weigh 20 or more pounds. Either infant only seats which clip into a base left in the car or convertible seats which may be rear facing to 30 pounds are appropriate for infants. All seats should have a 5 point harness. Infants should be buckled very tightly into their seats. There should only be enough room to insert one finger. The chest clip should be positioned at the level of the armpits, across the nipple line and the breastbone. Do not put infants into bulky winter clothes before buckling them into their seat because you will not be able to buckle them in tightly when dressed like this. Instead put them in a regular outfit, buckle them in tightly, and then cover them with as many blankets as are needed to keep them warm. Infant car seats and seat bases should be very firmly installed in the car. Kneel in the seat or base while tightening the seatbelt. For rear facing seats make sure the seat is level using the level indicator on the seat. There should be very little wobble of the seat once it is installed. All cars made in 2002 or later have clips between the seat and the seat back, which allow you to install seat using the LATCH system. This system makes installation easier and safer.

Children older than one year and 20 to 40 pounds should always ride in a car seat with a 5-point harness. These should be tightly installed as the infant car seats above using the seat belt or LATCH system and a tether if available. Again, there should be very little room under your child’s shoulder straps once they are buckled.

Children 40 to 80 pounds should ride in a booster seat, which adjusts the car seat belt to fit the child who is not adult size. Children should be in a booster seat until they are 8 years old and 4 feet 9 inches tall. Massachusetts law now requires a booster seat for children under 8 years old. Many of the current booster seats are intended for use to 80 pounds and keep children safer in the car than just using the car seat belt.

Once adult sized, children should wear a seat belt at all times while in to car. Most car accidents happen within a few miles of home, so it is not a safe choice to be unbelted even while running errands close to home. Parents should wear their own seat belts both for their own safety and to set a good example. Children under age 13 or 5 foot 2 inches should sit only in the back seat. Children are not safe in front of an airbag because the airbag can seriously injure someone small as it forcefully inflates during an accident.

If you have questions about car seat or seat belt use please call your pediatrician, your local police or state police or look at the website