Patient Presentation
A 4-year-old male came to clinic for a health supervision visit. His mother had several questions about safety equipment for bike riding and boating. They were going to visit relatives who lived on a lake during the summer and she wanted to know about what size life jacket to purchase. The resident physician felt comfortable offering information about bike helmets, and general information about supervision for bike riding and boating, but was unsure about sizing life jackets. He spoke with his attending physician and together they found information from the United States Coast Guard on the Internet to offer the mother and they learned from also.
Discussion
With the summer comes numerous opportunities for children and families to be outdoors and enjoy many recreational activities. Many of the activities are done each year such as grilling or bike riding, but some may be new and families need education to stay safe and have a good time. The heat and sun also provide additional challenges, but usually with attention and care should not interfere with summertime pleasures.
Seasonal safety information for winter can be found here.
Learning Point
Below are some of the anticipatory guidance that can be offered to parents about summer safety.
- Prevention
- Taking breaks
- Children and adults may tire more quickly after playing or doing other outdoor activities. Take frequent breaks. Have something to drink and cool down. These simple steps can prevent many problems.
- Clothing
- Light weight and light colored clothing makes it easier for children not to be overheated. Materials that wick moisture away from the skin can also keep children drier and more comfortable. Usually one layer is needed but additional layers (i.e. layering of clothing) can keep children warm early in the morning or late in the evening or on cooler days.
- Wet clothing should be removed if possible and replaced. Even in the summer children can become hypothermic.
- Clothing should be properly sized so children don’t injure themselves. Oversized shirts or baggy shorts can get caught in sports equipment such as bikes.
- Hypothermia
- Hypothermia is when the body temperature falls below normal. This occurs more easily in children than adults. Lethargy, somnolence, difficulty talking and shivering are some of the signs.
- Wet clothing should be removed if possible and replaced. Clothing should be layered to remain comfortable.
- When swimming or participating in other water sports, frequent breaks to warm up can prevent problems.
- Hyperthermia
- Children should be allowed to acclimatize to increased heat. Limit the initial physical activity over several days and gradually increas 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.
- Frequent fluid intake is important as well as providing shade or mist to cool children.
- Fluids and food
- Children need to maintain their hydration especially when they are playing outside.
- Providing access to water and other fluids is a must. Many children need to be reminded to drink. Depending on their age, children should be voiding every 2-6 hours at a minimum.
- 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 be promptly cooled and stored.
- Chilled prepared foods should be kept chilled until eaten. Food should again be promptly stored.
- 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 concentration that is effective for the conditions. More than 50% DEET does not offer additional protection. For children, the highest concentration recommended is ~10% DEET.
- Information about how to use insect repellents can be found here.
- Sun
- Children should wear light clothing, hats, and sunglasses.
- Sunscreen should be used for most children. More information about sunscreen can be found here.
- Taking breaks
- Traveling
- 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.
- New Surroundings
- If you are traveling to an unfamiliar location, ask about other possible hazards. For example, what should you do while traveling in a flash flood zone?
- Car
- 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..
- Safety
- Fires
- Grills should be used by adults and be closely monitored. They should be placed where children and animals cannot accidentally contact them, and they should be proper cleaned and tested regularly.
- Open fires should be made and constantly monitored by adults.
- Extra flammable materials such as gasoline, matches, lighter fluid etc. should be stored away from grills or open flames.
- No flammable material should be added to an open flame once it is burning.
- Equipment to extinguish a fire should be readily available to extinguish a fire
- Fire safety drills should be regularly practiced.
- Home fireworks are discouraged because of the fire and explosive risks.
- Lawnmowers
- 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
- Information about lawnmower safety can be found here.
- Sports
- 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
- 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. Information on how to fit a bike helmet can be found here
- 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.
- Inline or Rollerskating
- Skate in approved places only.
- Skate in the same direction as the crowd.
- Bikes
- Water
- Children should be supervised closely around any type of water. Enough adult supervision should be present to properly watch the children. 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 from the adult driving the boat.
- Information about how to choose life jackets and boating safety can be found here.
- Fires
Questions for Further Discussion
1. What are the recommendations for children’s use of all terrain vehicles and motorcycles?
2. What are the recommendations for children using personal water craft or waterskiing?
Related Cases
- Disease: Summer Safety | Child Safety
- Symptom/Presentation: Health Maintenance and Disease Prevention
- Specialty: General Pediatrics
- Age: Preschooler
To Learn More
To view pediatric review articles on this topic from the past year check PubMed.
Evidence-based medicine information on this topic can be found at SearchingPediatrics.com, the National Guideline Clearinghouse and the Cochrane Database of Systematic Reviews.
Information prescriptions for patients can be found at MedlinePlus for this topic: safety
To view current news articles on this topic check Google News.
To view images related to this topic check Google Images.
American Academy of Pediatrics. Summer Safety Tips – Part 1.
Available from the Internet at http://www.aap.org/advocacy/releases/summertips.cfm (rev. 2010, cited 4/1/11).
American Academy of Pediatrics. Summer Safety Tips – Part 2.
Available from the Internet at http://www.aap.org/advocacy/releases/summertips-p2.cfm (rev. 2010, cited 4/1/11).
ACGME Competencies Highlighted by Case
1. When interacting with patients and their families, the health care professional communicates effectively and demonstrates caring and respectful behaviors.
2. Essential and accurate information about the patients’ is gathered.
5. Patients and their families are counseled and educated.
6. Information technology to support patient care decisions and patient education is used.
10. An investigatory and analytic thinking approach to the clinical situation is demonstrated.
11. Basic and clinically supportive sciences appropriate to their discipline are known and applied.
12. Evidence from scientific studies related to the patients’ health problems is located, appraised and assimilated.
13. Information about other populations of patients, especially the larger population from which this patient is drawn, is obtained and used.
15. Information technology to manage information, access on-line medical information and support the healthcare professional’s own education is used.
16. Learning of students and other health care professionals is facilitated.
Author
Donna M. D’Alessandro, MD
Professor of Pediatrics, University of Iowa Children’s Hospital
Pediatric Education 