Summer Safety Reminders

July 2021

Water Safety:

• Children should have adequate adult supervision closely around any type of water.
• Swimming aids and life jackets are not substitutes for supervision.
• Wading pools, water buckets and anything else which can contain water should be emptied and turned over after use. This means that rainwater will also not collect.
• Children older than 3 years of age should learn how to swim.
• Children in boats should be closely supervised and should remain seated. If the boat is towing an object (i.e. fishing, water skier), one additional adult should be in the boat to monitor the towing in addition to the adult driving the boat.

Life Jackets: There are different life jackets for different situations -

• For example, it can be different for fishing, boating, water-skiing, etc.
• Age. Weight and Height of child can vary from state to state depending on the type of activity.
• Under California law, every child under 13 years of age on a moving recreational vessel of any length must wear a Coast Guard-approved life jacket in serviceable condition and of a type and size appropriate for the conditions and the activity
• Places to find information about life jackets include the US Coastguard, as well as each state’s department of boating and waterways.  In California, that site is http://dbw.parks.ca.gov/?page_id=29182
• Don’t depend solely on the salesperson at the sporting goods store to give you this information as they may not be aware of specific information for children who, in this case are not simply “little adults.”

Summer Heat and Clothing:

• Light weight and light-colored clothing makes it easier for children not to be overheated.
• Layers (i.e. layering of clothing) can keep children warm early in the morning or late in the evening or on cooler days.
• When practical, wet clothing should be replaced with dry clothes in the summer since children can become hypothermic depending on the water temperature, environmental temperature, altitude, speed of the wind and child's level of activity and constitutional make-up.
• Children should be allowed to adjust to increased heat. Limit the initial physical activity over several days and gradually increase it particularly if beginning a strenuous exercise program.
• Practices, games and other activities are best done in the early morning or later afternoon or evening when temperatures are cooler if possible.
• Children should be encouraged to “pre-hydrate” (or drink ahead of activities) rather than waiting to feel thirsty before drinking fluids, as thirst is an indication that a child is already becoming less hydrated.
• Frequent fluid intake is important as well as providing shade or mist to cool children.
• Depending on their age, children should be urinating every 2-6 hours at a minimum.

Outdoor Cooking:

• A grill should be placed where children and animals cannot accidentally contact them
• Do not add lighter fluid to any fire pit or grill that is already lit.
• Extra flammable materials such as gasoline, matches, lighter fluid etc. should be kept away from grills or open flames.
• We recommend skipping fireworks because the risks outweigh the benefits.
• Equipment to extinguish a fire should be kept close to your cooking area so that it can be retrieved if a fire erupts.

Summer Heat and Food: 

• Eating to provide calories to stay active is also important.
• Uncooked food should be cooked to the proper temperature and maintained at that temperature until eaten. Food should then be promptly cooled and stored.
• Chilled prepared foods should be kept chilled and properly stored until eaten.

Insects:

• Repellents should be applied before going outside even for brief time periods.
• Repellents should be used on clothing as much as possible with the lowest amount possible that is effective for the conditions.

The CDC emphasizes that avoiding mosquito bites requires multiple strategies, such as wearing long-sleeved shirts and pants when outdoors. Mosquito repellents are essential, too. “Using an insect repellent is one of the best ways you can protect yourself from Zika and other diseases transmitted by mosquitoes," says Harry Savage, chief of ecology and entomology activity at the CDC's Division of Vector-Borne Diseases.

The most effective products against Aedes mosquitoes were:

• Ben’s Tick & Insect Repellent Wipes ($6) proven to repel disease-carrying insects, including ticks and mosquitoes that may carry Lyme disease, Zika virus, West Nile virus, and dengue fever.
• Bens 30% Deet Tick-Insect Repellent ($8) kept mosquitoes from biting for 8 hours.
• Total Home (CVS) Woodland Scent Insect Repellent, which contains 30% Deet ($6.50) kept mosquitoes from biting for about 8 hours.
• Ben’s Tick & Insect Repellent Wilderness Formula Aerosol ($6)
• Repel Lemon Eucalyptus, containing 30 percent lemon eucalyptus ($5), stopped them for 7 hours.

Insect repellents that use deet come in varying concentrations, ranging from 4 percent to 100 percent. Previous tests by Consumer Reports show that concentrations of 30 percent provide the same protection against mosquitoes as higher percentages for up to 8 hours. But higher concentrations of deet have been linked to rashes, disorientation, and seizures. That’s why Consumer Reports says you should avoid mosquito repellents with more than 30 percent deet and not use it at all on infants younger than 2 months. Products that contained 5 percent picaridin or 10 percent deet also did not make the list. In addition, products that contain IR3535 are less effective than those containing deet or picaridin.

NOTE: The Ben’s products were more effective at repelling ticks than the other products tested, making it their top insect repellent overall. The Ben’s products can be found at Target, Walgreens and Amazon.  

Consumer Reports also advises skipping products made with natural plant oils, such as:

• California Baby Natural Bug Blend (a blend of citronella, lemongrass oil, cedar oil, and other ingredients)
• EcoSmart Organic, (which includes geraniol, rosemary oil, cinnamon oil, and lemongrass oil).

The above products did not last for more than 1 hour against Aedes mosquitoes, and some failed almost immediately. In addition, these products are not registered by the Environmental Protection Agency.

NOTE: The CDC recommends using EPA-registered insect repellents. To see if a mosquito repellent is registered by the EPA, look for its registration number ("EPA Reg.") on the back of the label. 

Here are tips from the EPA on how to use insect repellent:

• Apply repellents only to exposed skin or clothing—never put it on under clothing. Use just enough to cover and only for as long as needed; heavy doses don’t work better.
• Don’t apply mosquito repellents over cuts, wounds, or irritated skin or immediately after shaving.
• When applying to your face, spray first on your hands, then rub in, avoiding your eyes and mouth, and using sparingly around ears.
• Don’t let young children apply. Instead, put it on your own hands, then rub it on. Limit use on children’s hands, because they often put their hands in their eyes and mouths.
• Don’t use near food, and wash hands after application and before eating or drinking.
• At the end of the day, wash treated skin with soap and water, and wash treated clothing in a separate wash before wearing again.

• For those of you who would like to see the Consumer Reports rating chart, please Google Consumer Reports and Insect Repellant Ratings;
• Women who are pregnant or breast feeding can safely use deet, picaridin, lemon eucalyptus, and IR3535, according to the EPA, if they are applied properly.

Additional commentary from CHMA pediatricians

• Picaridin is our preferred repellent.
• It doesn’t melt plastic
• It does however, since it’s essentially a pepper, sting like the dickens when you get it in your eye. Of course, DEET doesn’t feel too great either.
• CHMA would like to remind parents that the toxicity from DEET is related to the frequency of application, not the concentration.  Also, duration of action is related to concentration, so that high percentage DEET products (ie 30%, not higher), applied less often, are actually safer.
• DEET-Sunblock combos should definitely be avoided since the frequency with which the sunscreen should be reapplied is much greater than you would want for the DEET component.

PLEASE BE REMINDED: the CDC has urged pregnant women to talk to their healthcare provider prior to traveling as there are many countries where Zika has been reported, mostly in Latin America and the Caribbean, including Puerto Rico and the U.S. Virgin Islands.  There have been cases in the past reported in the United States as well. 

Sunscreens: Many parents are finding the recommendations for using sunscreen and sunblock in children confusing. To help you sort out this confusion, we are pleased to offer our interpretation of the recommendations from the American Academy of Pediatrics and Consumer Reports.

Facts worth considering:

• The risk of a child developing skin cancer by adulthood is now one in 33.
• The risk is from both intermittent and continuous sun exposure.
• One blistering burn in childhood doubles the risk of melanoma later in life.
• Children less than 33 months are particularly at risk due to less melanin and skin thickness.
• Glass blocks UVB but not UVA (except the front windshield of a car and tinted glass at home). Since both UVA and UVB can cause skin cancer, parents need to provide protection for their kids inside the car or the house.
• UVA and UVB can penetrate clouds on a cloudy day.
• In short, the best way to protect your child is by applying a layer of sunscreen daily.

For infants less than 6 months of age:

• We prefer a physical sunblock, as it may be less irritating and it eliminates any concern that avobenzone might be absorbed.  The FDA has called for more research on the safety of this.
• Parents can apply a minimal amount of sunblock to small areas, such as the infant's face and the back of the hands." (Tops of the ears and back of the neck are also a good idea.)
• There's no need to cover a baby's whole body with sunblock if she's properly dressed with a wide brimmed hat and light long clothing. Infants don't perspire as efficiently as adults, and covering too much of the baby’s skin can interfere with their cooling mechanism.
• Choose a sunblock with either zinc oxide or titanium dioxide
• Choose a sunblock with both UVA and UVB protection and an SPF of at least 30.
• Keep your infant out of direct sunlight and check him constantly for reddened or pinkish skin. Use a canopy as much as possible. When in the stroller, put the canopy up. You can also consider a portable crib with mesh sides and turn it upside down on a blanket while the baby naps. This keeps the sun as well as the bugs away!

For infants and children over 6 months:

• Broad-spectrum products contain one of three active ingredients: avobenzone, zinc oxide, and titanium dioxide.
• Avobenzone is a chemical sunblock, while zinc and titanium oxides are physical sunblocks.
• For full-body protection, apply 1 to 2 tablespoons of lotion (older children should apply 2 to 3 tablespoons) 15 to 30 minutes before going out in the sun. Reapply every two hours or after swimming or sweating.
• Watch your clothes. All of the products stained when applied directly to various fabrics and left to sit for a day.
• Discard sunscreen that is more than two years old because it might have lost its potency. If it has no expiration date when you buy it, mark one yourself with a permanent marker.
• Apply lip balm to protect the lips.

For all infants, children, teens and adults:

• Your best protection from the sun is sun protective clothing, a wide brim hat and sunglasses with UVA and UVB protection.
• If you are worried about skin sensitivity, consider doing a "patch test" on your child by applying sunblock to a small (quarter-size) area of skin with the sunblock, and wait a day or two to see if there's any irritation.
• Choose a waterproof or water-resistant formula, and reapply at least every two hours while your child is outdoors.
• It doesn't matter whether you use a lotion, gel, or spray. Many parents like a stick product, which is easy to apply and doesn't run into the eyes and sting.
• The proper way to use a spray is to hold the nozzle 4 to 6 inches away from your skin and spray until your skin glistens, then rub it in. Do this even if a spray is labeled “no rub”; smoothing it into skin increases its protection.
• Look for baby/child-friendly words such as non-irritating, fragrance-free, and hypoallergenic on the label.
• Look for the Skin Cancer Foundation seal as a sign of this independent organization’s approval.
• Infants and children need extra fluids in the heat to make sure they do not become dehydrated.
• Up to 85 percent of the sun's rays may be reflected off the water or sand, so try to rig up protection to help avoid this indirect yet potent source of burning. We suggest that you try enjoying the shaded areas around the water during peak sun hours (10am to 4pm) while saving the water time for later in the evening.

For 2021, Consumer Reports continues to warn consumers that mineral-based sunscreens containing only titanium dioxide or zinc oxide (frequently referred to as "natural" or “sunblocks”, are not the best option on the market today — noting that in tests they frequently perform far worse than the chemical-based sunscreens. However, there are two sunblocks that performed average in the 2021 tests that you can consider using for infants less than 6 months of age:

• California Kids Supersensitive Tinted Lotion SPF 30+ Sunscreen ($35.99): contains titanium oxide.
• Badger Kids Clear Sport Natural Mineral Cream SPF 40 ($17.99): contains zinc oxide

For optimum sun protection, Consumer Reports advises consumers to choose a chemical sunscreen with a 30 or higher SPF. These were the best-rated lotions for 2021:

• Equate (Walmart) Sport Lotion SPF 50 ($4)
• Alba Botanica Sport Mineral Lotion SPF 45 ($13)
• Banana Boat Ultra Sport Lotion SPF 50+ ($7)
• Aveeno Positively Mineral Sensitive Skin Lotion SPF 50 ($10)
• Neutrogena Pure & Free Baby Lotion SPF 50 ($13)

If you prefer spray, here are the top five performers: 

• Hawaiian Tropic Island Sport Spray SPF 30 ($9)
• Alba Botanica Hawaiian Coconut Clear Spray SPF 50 ($11)
• La Roche-Posay Anthelios Lotion Spray SPF 60 ($25)
• Banana Boat Ultra Sport Spray SPF 100 ($9)
• Australian Gold Botanical Natural Spray SPF 50 ($16)

NOTE: The FDA has said it is exploring the risks of inhaling spray sunscreens. Do not spray them directly on your face. Instead, spray sunscreen onto your hands, then apply it to your face. Children are more likely to inhale the mist, which could cause lung irritation. Consumer Reports recommends using a lotion on kids rather than a spray, but if you choose to use a spray, be very careful when applying it. The best thing to do is spray it into your hands and rub it onto your child’s skin.

In the future, Consumer Reports hopes that the Food and Drug Administration (FDA) will review its sunscreen requirements. They currently only require manufacturers to test their own products, and don't routinely conduct their own tests.

Travel Tips:

• Leave a message with someone about your route, time left and expected time of arrival.
• Take a cell phone with you if possible, but realize it may not work in all locations.
•  Be prepared to stay with your car by packing appropriate emergency supplies.
• Check the local road conditions and warnings. Follow local laws regarding safety such as road or trail use during certain seasons.
• Always keep the children in an approved child safety seat or booster.
• Keep the car in good repair and fill-up the gas tank when less than 1/4 full.
• Check that normal safety equipment such as first aid kit, flares, safety triangles, and jumper cables are in good repair, and water is stored in the car. Some people also have a towrope stored. A small shovel can help if the car is stuck.

Supervision:

• Children are usually less supervised in the summer because they are more active and have more opportunities to move away from adults.
• Teach children the “if they can’t see you, you can’t see them” rule.
• Remind children that an adult must verbally answer them if they are asking permission to leave your supervision. Parents may not have heard what the child had asked.
• In a new location, pick a place to meet if separated.
• Teach children which type of adults you want them to ask for help if lost. For example, the store employees wearing the matching shirts, a bus driver, etc.

Picking the right clothing for the right summer activities:

• Clothing should be properly sized so children don’t injure themselves. Baggy shorts and pants can get caught up in the bicycle chains.

Sports Equipment:

• Check all equipment and have it fitted for the year. Also check again each time it is used making sure it is not broken or damaged.
• Make sure all the equipment properly fits the child.
• The child should have proper safety equipment such as helmets, goggles, wrist guards, mouth guards, etc.
• Warm up and cool down with each session.
• Appropriate adult supervision is recommended for the number of participants and their ages. Activities should not be done alone.
• Use of alcohol by participants and/or supervisors is never recommended.

Bikes, Skates and Skateboards:

• Check that the bicycle fits the child. Recheck before riding that its brakes, etc. all work properly.
• Wear a bike helmet when riding at all times.
• Adults should supervise children and teach them the “rules of road.”
• Children should consistently demonstrate that they can follow safety rules before they are allowed to ride alone.
• Ride with the flow of traffic, separate from cars, etc. if possible.
• Skate in approved places only.
• Skate in the same direction as the crowd

Lawnmowers and other gardening equipment: should be properly stored and locked.

• Children should not be allowed to play in, or be in adjacent areas to where lawn mowers are being used. Children < 6 years old should be kept indoors during this activity.
• Children should not be allowed to ride as passengers or be towed behind mowers in carts or trailers. They should not be permitted to play on or around mowers when in use or in storage.
• Most children and adolescents will not be able to operate:
  • A hand mower until at least 12 years of age
  • A walk-behind power mower until at least 12 years of age
  • A ride-on power mower until at least 16 years of age