Being prepared is the first step to staying safe in the outdoors. Before venturing out on your trip, spend some time researching the potential hazards of terrain, weather, and wildlife that you might encounter, and pack items that will promote your safety and comfort.

• Know first aid: On a casual family outing, at least one responsible adult should be skilled in first aid. Manual skills such as mouth-to-mouth breathing, cardiopulmonary resuscitation (CPR) and the application of bandages and splints, should be practiced beforehand. Become familiar with the rescue techniques pertinent to the environment in which you will be traveling.
• Carry the right equipment: Be prepared for foul weather conditions. Always assume you will be forced to spend an unexpected night outdoors. Carry warm clothing and waterproof rain gear. Carry survival equipment such as maps, a GPS or compass, waterproof matches, a knife, nonperishable food, a flashlight and first-aid supplies.
• Carry a first-aid kit: First-aid kits should be designed according to the environment to be encountered, number of travelers, medical training of the party leaders, and distance from sophisticated medical care. Remember to bring along pediatric doses when traveling with children. First-aid supplies should be packed to be readily accessible and marked clearly to allow for quick identification. It’s helpful to organize supplies in resealable plastic bags by categories such as “wound care” and “allergic reactions.”

Whether swimming in the ocean or on a boat in a lake, follow these tips for staying safe by the water.

• Anticipate ocean stings: Stings from contact with jellyfish, fire coral, hydroids, or anemones can range in severity from mild burning to severe pain with generalized illness. Make sure your beach bag includes a small bottle (labeled) of half vinegar, half rubbing alcohol that can be used to decontaminate wounds and provide pain relief. Seawater can also be used to rinse a sting, but fresh water or ice can worsen the effects of sea-life venom. Also, adults and children can both use a combination sunblock and jellyfish protective lotion to help prevent the stings of many species.
• Avoid shark attacks: One of the most obvious ways to avoid shark attacks is to avoid swimming in shark-infested waters, particularly at dusk and after dark. When swimming in the ocean, swim in groups. Sharks tend to attack single swimmers. When diving, avoid deep drop-offs, murky water, or areas near sewage outlets.  If you do encounter a shark, do not provoke it.  Leave the water with slow, purposeful movement and do not splash or panic.
• Manage motion sickness: Most boaters and divers adapt to motion after a few days, but may require treatment until they do. If you become nauseated on board a ship, stay on deck. Splash your face with cold water and keep your eyes fixed on a steady point in the distance. Anti-nausea medications can be taken as a preventive, and wristbands that apply pressure or electrical stimulation to acupuncture points can be used before or after symptoms begin.

Check in tomorrow for tips on how to be prepared for your outdoor adventure.

Follow these tips for a fun and safe excursion, whether playing in a park or hiking up a mountain.

• Prevent blisters: Foot blisters have probably ended more outings than all major illnesses combined. To minimize the friction generated by walking, limit the load you are carrying. Use a padded insole or arch support to evenly distribute pressure over the bottom surface of the foot. Make sure shoes fit properly and are broken in, and try on new shoes in the evening because feet tend to swell during the day. Wearing a synthetic liner sock under an outer sock can wick moisture away from the skin surface and prevent friction on the skin.
• Check for ticks: Search the skin and scalp thoroughly for ticks after hiking in wooded areas or walking through grassy fields, and remove any ticks with a tweezers by grasping the tick close to its mouthparts and pulling it straight out. Even if you are dressed appropriately for “tick country” tiny ticks may sneak under gaps in clothing protection and latch on to their human hosts.
• Treat poison ivy, sumac, and oak: After contact with poison ivy, sumac, or oak, wash the affected area of the skin with soap and cool water, or use rubbing alcohol to remove the resin (the substance in the plants that causes rashes). Commercial poison ivy washes are also available. Wash all clothes, sleeping bags, and pets with soap and water because the resin can persist for years, particularly on woolen garments and blankets. Once a rash has occurred, calamine lotion can be used to soothe, cool, and dry the skin. Soaking in an oatmeal bath or in a bath of tepid water with baking soda and linnet starch may also calm itchy and irritated skin.
• Avoid altitude sickness: When hiking in the mountains, avoid sudden or direct ascent to a sleeping altitude above 9,020 feet; the rate of ascent should not exceed 1,500 feet per day at altitudes above 8,000 feet. Adjusting to high altitude requires gradual exposure to the lower oxygen content of the air. When traveling at high altitudes, avoid the use of alcohol, stay warm, stay hydrated, avoid exhaustion, keep out of the wind, and eat regularly to avoid weight loss.

Tomorrow, I’ll give tips on staying safe by the water.

Good fortune favors the well-prepared. Severe weather, wild animals, rugged terrain, and equipment failure all conspire to create or complicate medical hardships that must be diagnosed swiftly and remedied with certainty. However, with some advance preparation, individuals and families planning vacations or outdoor excursions can become familiar with adverse situations and be prepared to handle them.

• Use common sense: Many accidents occur because people ignore warning signs or don’t anticipate problems. Pay attention to rangers, posted warnings, weather reports, and the experience of seasoned guides. The art of outdoor medicine absolutely depends on observation, anticipation, and resourcefulness. The cardinal rule is to act conservatively and not take unnecessary risks when making the decision to continue a journey or to postpone travel and seek formal medical attention.
• Stay hydrated: Most people underestimate their fluid requirements. The average minimum recommendation for an adult man is two to three liters of liquid a day, but this requirement can double in hot temperatures, during heavy exercise, at high altitudes, or in cold, dry air. Carry supplies for water disinfection if natural sources of safe drinking water will not be available.
• Protect your skin: Sunscreen should be applied to cool, dry skin for optimal absorption, and at least 10 minutes before swimming. In general, most sunscreens should be re-applied every 20 minutes to two hours. Be aware that use of insect repellent containing DEET lowers the effectiveness of sunscreen by a factor of one-third. On the other hand, taking aspirin or ibuprofen six hours before sun exposure may help protect the sun-sensitive person. Mild to moderate sunburn may be treated with cool, wet compresses applied for 10 to 20 minutes.

Stay tuned for tomorrow’s tips on staying safe while playing, hiking, or climbing outdoors.

Every Thursday, it’s bike-to-school day. Every Thursday, I’m terrified of what might happen. Every Thursday, we triumph upon arrival at our charter school, 2.5 miles from my house.

We started out in bike lanes. They stretch over most of the route, although there’s one block where we go in the left lane to continue straight. Frequently, we get screamed at by motorists at this spot.

“That’s not safe!” they scream out their car windows, even though we are cycling legally and have a bright orange flag for visibility. One time a school bus driver even weighed in.

So, all this verbal pressure pushed us to start riding on the sidewalks.  Now we startle pedestrians with our bells, and wait (impatiently) at crosswalks.

But to be honest, another thing pushed us up on the sidewalks: I stumbled across news of this pregnant mom who died during a bicycle accident. She had an empty kids’ bike attached to hers, because she was on her way to pick up her son from kindergarten.  Jack up the Terror-ometer. My daughter’s bike is attached to mine, too, with a great “Trail Gator” device that lifts and stabilizes her front wheel.

I don’t want to stop bike commuting. So what do we do about it?

• If drivers all cycled now and then, we would be better drivers.
• We all have to brush up on the rules of the road, and cyclists need to follow them, as well (I’m textbook with the kids but often skirt the rules alone)
• Let’s keep pushing for better bike infrastructure—bike lanes & bike racks, for starters. Why are these still seen as “extras” in most parts of the U.S.?

Look forward to hearing your stories and seeing more families biking legally and safely out there.

As I stepped off the platform onto the first mid-air obstacle, 15’ off the ground, I felt what my daughter feels all the time…

“I’m scared!”

Raising kids, you hear that a lot. But you don’t realize how often kids face their fears and dive into something new until you do it yourself…adults just aren’t used to getting out of their comfort zones. But kids do it all the time.

I was mid-air at the Sandy Spring Adventure Park, a fantastic operation of zip-lines and obstacle courses for all levels of humans above the age of 7. It’s safe–you are harnessed and clipped in at all times. But that doesn’t erase the fear factor.

Suddenly my daughter’s trepidation at riding her bike unassisted, and swimming in the deep end, and skiing a little faster—it all became viscerally clear. People can tell you “you’re safe” and “it’ll be okay” all day long, but when you have to rely on your physical skills and you have this fear to overcome…it’s scary.

My boyfriend is a strapping, 6’4” athlete, yet his fear of heights had him sweating like crazy halfway through the first basic obstacle course at Sandy Spring. Maybe his parents didn’t let him get hurt enough as a child. This recent article from the New York Times highlights the research showing “A child who’s hurt in a fall before the age of 9 is less likely as a teenager to have a fear of heights.”

Eureka! A New York Times article that makes me feel smug about something I’d feel super guilty about otherwise!

I work on playgrounds for a living, which means working on how children learn by overcoming various physical and social challenges.  I love seeing my kids gain new skills. Last month, my daughter mastered the monkey bars. And since basketball season started, my son has been dribbling incessantly around the house.

I appreciate it all the more since I worked my way up to the black diamond obstacle course. Next year, the double-black.

“Mama, will you play with me?”

These six words instantly snap me to attention here, now, in the present. They are usually uttered by my 5-year-old, and usually when I’m buzzing around doing something “important” like cooking, packing or cleaning the litter box.

As I’ve learned over time, play is the work of children. Their childhood zips by so quickly, I have to remember to stop doing stuff and instead just play with them, especially when they are good enough to ask.

Being present is a constant practice (and an instantly rewarding one)! Kids are the masters of this. I learn so much from them.

For two years, we lived in an apartment building, where we had to be more creative about play.  We zoomed around the halls on bikes and scooters, we played “basketball” in the basement (using our arms as the hoops), we tagged and chalked and shot marbles and dressed up and built forts and did handstands.

Last spring we moved to a house, and now I have a whole yard of play infrastructure. My cousin Marcus built an amazing treehouse … including a deck, 7 windows and 2 retractable ladders. My insistence on using recycled materials spurred his creativity, resulted in gorgeous elements like a terra cotta tile roof and kept costs low (For materials, check out architectural salvage yards. My fave in the DC region is the non-profit Community Forklift).

Kids need daily exercise, of course (the NY Times Well blog recently covered the link between exercise and academic performance) but in addition, they need unstructured time to play.  Dr. Jenn Berman posted on this blog a summary of the Alliance for Children study outlining the importance of play…check it out.

Now that I’m with KaBOOM! I’ll be advocating for the cause of play, including constructing playgrounds and building communities. Back in 2006 I helped KaBOOM! build the playground at my kids’ Latin American Montessori Bilingual Public Charter School in Washington, D.C. Every day LAMB-PCS’s 200 students use the equipment before school, during recess and after school, a critical element of their education and an enduring testament to the powerful gift of play.

Mosquitoes bite infants and children more than any other insect.

Mosquitoes can transmit dangerous blood-borne illnesses including West Nile Virus, malaria, encephalitis and many other diseases.

Only female mosquitoes bite. They need a blood meal to acquire the protein they need to produce eggs.

The irritation from a mosquito bite comes from a reaction to the saliva, which includes digestive enzymes and anticoagulants.

Sensitivity to mosquito bites varies greatly. Some kids become less sensitive to the bite with age; others become increasingly allergic.

Taking a non-sedating antihistamine such as Claritin (loratadine) or Zyrtec can help lessen the effect of a bite if taken beforehand or lessen the severity of the reaction if taken after a bite.

The most effective bug repellant compounds contain DEET, picaridin and oil of lemon eucalyptus. Consumer Reports created a top five list of the most effective insect repellants, which were shown to prevent bites from ticks and at least two types of mosquitoes for at least eight hours.

• Off Deep Woods Sportsmen II (DEET 30%)
• Cutter Backwoods Unscented (DEET 23%)
• Off FamilyCare Smooth and Dry (DEET 15%)
• 3M Ultrathon Insect Repellant 8 (DEET 25%)
• Repel (Plant Based Lemon Eucalyptus)

 
The maximum concentration of DEET recommended for infants and children is 30 percent. DEET products should not be used on children under 2 months of age.

Repellant should be applied over the clothes, and avoid using it on the parts of the hands that might come in contact with your eyes or mouth.

Mosquitoes care what you wear. Avoid bright, floral colors in clothing as well as fragrances in soaps, shampoos and lotions.

Mosquitoes tend to bite between dusk and dawn, and they tend to hang out near water. When it’s hot and humid, expect more pests.

Females lay their eggs in standing water, so be aware of potential breeding areas such as:

• Bird baths
• Outdoor pet dishes
• Flower pot saucers
• Ponds
• Gutters
• Wheelbarrows and buckets
• Wading pools and swimming pools
• Trashcans, recycling bins and trash lids
• Puddles and ditches in your yard or driveway

Five bug repellents scored high marks for preventing bites, and another did pretty well, but four common choices didn’t make the grade in May 2010 testing by Consumer Reports. As a parent and pediatrician, I want a mosquito and tick repellent that is safe, effective, and easy to use. It also helps if it doesn’t smell like bug spray.

Insect and arachnid bites aren’t just annoying; they are also the cause of hundreds of West Nile virus infections, about 1500 cases of malaria, and about 35,000 cases of Lyme disease diagnosed in the US each year – not to mention the million people who die from malaria each year around the world. Even though most mosquito bites are just an itchy nuisance and most tick bites are barely noticed, it’s important to have a reliable way to block bites when needed.

Repellent testing involves daring testers who put their bare arms in mosquito-filled cages and who let ticks crawl on them, while observes record how long it takes the critters to start biting. The top five products prevented bites from ticks and two important species of mosquitoes for at least the full eight hours of the test. In four of these winners, the active ingredient was DEET. The other was a plant-based repellent using oil of lemon eucalyptus:

• Off Deep Woods Sportsmen II (DEET 30%)
• Cutter Backwoods Unscented (DEET 23%)
• Off FamilyCare Smooth and Dry (DEET 15%)
• 3M Ultrathon Insect Repellant 8 (DEET 25%)
• Repel (Plant Based Lemon Eucalyptus)

Another repellant scored almost as well, but the volunteers did start getting mosquito bites after 7 hours:

• Natrapel 8-Hour with Picardin (Picaridin)

All of the above repellents use active ingredients registered with the EPA and included in the CDC recommendations for preventing diseases spread by insect bites.

Other products tested had some benefit, but scored much lower overall:

• Avon Skin-So-Soft Bug Guard Plus IR3535 Expedition SPF 30 (IR3535)
• Bite Blocker Xtreme (Plant Oils)
• Cutter Skinsations Clean Fresh Scent (DEET 7%)
• Burt’s Bees All Natural Herbal (Plant Oils)

These results were similar to what my family found last summer when we tested a number of ‘natural’ insect repellents on a trip to Yosemite.  Repel was the clear winner, preventing all bites.

How safe are the top repellents?

The EPA rates DEET as Category III (slightly toxic) for acute oral or dermal exposures. DEET is irritating to the eyes and mucus membranes. Skin rashes are the most common side effect and are uncommon. Suspected serious adverse reactions are rare, but include seizures and encephalopathy in children. DEET is considered slightly toxic to birds, fish, and aquatic invertebrates. The EPA says that child safety claims on some DEET products are misleading and not allowed because concentrations lower than 30% are not known to be any safer. Because the risks are well understood, DEET is recommended by the CDC and AAP for use on babies down to 2 months old, but is not considered safe for newborns.

Likewise, the EPA considers picaridin Category III (slightly toxic) for acute oral or dermal exposures. In animal studies it caused slight to minimal liver hypertrophy, individual necrotic liver cells, chronic kidney inflammation, and slight kidney degeneration when ongoing large amounts of picaridin were applied to the skin. They found no evidence that it is an endocrine disruptor or carcinogen. It is nontoxic to birds and moderately toxic to fish.

I prefer the plant-based oil of lemon eucalyptus. No adverse effects have been found, other than eye irritation. The EPA considers it Category IV (practically non-toxic), for acute oral or dermal exposures – indeed for any route except being splashed in the eyes (so use lotion or use spray in the palm to apply to face). They’ve determined that it poses minimal or no risk to wildlife and is not harmful to the environment. The EPA assessment concludes that it is not expected to pose health risks to people, including children, pregnant women, or other sensitive populations. Nevertheless, the official recommendation is not to use it on children younger than 3 because testing has not yet been done on young children.

So the moment of truth arrives.  The reality is, a lot of kids really don’t like and resist applying sunscreen.  I know, I have two boys and sometimes it is a frustrating process.  Patience, as with all things, is key.  So is a bit of understanding and good old fashioned ingenuity.  Here’s a bit of mine.

It’s important to remember that most kids are very visual and literal. They learn best through and enjoy multi-sensory experiences. Remember, kids need more time than adults to process information and they will always be more proactive and engaged if they are empowered to make choices on their own.  A few thoughts:

The Gift Of Time:   Don’t rush them through the application process – again, they need more time to process information.

The Sunscreen Place: Find a place in or around your house where clean up is easy or not an issue.  You want to make children a part of the process from an early age, which can get a little messy.  Make sunscreen a fun, actively healthy ritual, not a rushed afterthought.

Start with one body part:  Let them choose it – and give them enough product to make it happen.  It engages them, gives them a task and empowers them to be responsible for taking care of themselves.  It also keeps them busy while you slather the rest of their body.  I also let them “paint” my face or arms with sunscreen; why not? I can use all the help I can get and it keeps them entertained and engaged in the process.

Kids learn by example: Make sure they see you apply your own sunscreen.  Talk about sunburn and sun damage as health risks.  Make the correlation by presenting examples of how the oxidation occurs, show them rusty metal, let them smell a rancid oil and show them pictures of what happens to skin from sun damage – photoaged skin.

The Power of Choice:  If your kids continue to object to sunscreen, give them the choice not to use it – with the choice being that they must stay in the shade. Kids like to make their own choices. If they sit on the sidelines at the beach long enough, they will eventually make their own choice to apply the sunscreen so they can go splash in the water or kick the ball or what have you. Don’t let the battle be about applying the product, make it about staying out of the sun.

I’ve enjoyed this week’s journey with you on the topic of sunscreen.  I got to catch up on the industry buzz as well as listen to some of your biggest concerns in the process. I truly embrace the opportunity to hear your feedback and love to get questions from parents about skincare for babies and kids. You are most welcome to join in our conversation on facebook.  You can also find a library of my skincare articles on our website.