Summer is Here!
The recent heat wave reminded us that summer is already here, and like every year, with all the advantages of the hot season, there are dangers that are worthwhile knowing about and taking into account in order to protect our children and to enjoy a healthy and safe vacation. Dr. Liat Ashkenazi-Hoffnung, Director of the Hospital Day Care Department at Schneider Children's, and a pediatric and infectious diseases specialist, describes typical summer illnesses as well as "winter disease" that was prevalent recently.
Diaharrea and Dehydration:
Various pollutants, viruses and bacteria lead to diarrhea, which is common in summer. The heavy heat causes an increase in the amount of bacteria found in foods at restaurants and kiosks. As a result, many children suffer from diarrhea, vomiting and deydration. Infants and small children are more prone to diarrhea, both due to their tendency to become infected and also due to the danger of dehydration. The percentage of water in their bodies is particularly high: 70% of their body weight compared to 50% in adults. To avoid contamination, meticulous hand hygiene must be maintained following every visit to the toilet, diaper change, and before and after meals.
Similarly, it is worthwhile avoiding foods that have stayed in the sun and heat, and unrefrigerated for a prolonged period. The best way to avoid dehydration is to drink water. In cases of severe diarrhea, regular diets should be continued without any need for changing or diluting formulas. The child can be given an oral rehydration solution which contains certain salts which have proven effective in reducing the need for an intravenous drip.
In cases of frequent bouts of diarrhea (over 8 times a day) or vomiting in infants under the age of 2 months, or children with a significant history of disease, this might be dysentery (high fever, blood in diarrhea) or dehydration (lethargy, absence of urine), and medical attention should be sought.
Children are more prone to suffer from heat injuries than adults. Exposure to the heat is significant especially in the sun-drenched Israeli summer at the beach, pool or outing. Injury occurs when the heat is greater than the ability of the body to cool down. Heatstroke, the highest level of injury from heat, is manifested by headache, weakness, nausea, vomiting and a mild rise in body temperature. Later, the body temperature can rise to over 40º at which point other symptoms appear such as lethargy, rapid and shallow breathing, and even convulsions. To avoid heatstroke in summer, it is necessary to drink a lot of water, avoid outdoor stress exercise particularly during the hottest time of the day when heat is at its peak, and wear a hat and light clothing. Of course, never leave a child in a closed car, even for a short while.
At every stage of heatstroke, medical attention must be sought immediately while the body should be cooled by removing clothing, moving the child into the shade or air conditioning, and throwing cold water on the body. If the child is awake and cooperative, he should drink water.
Forgetting Children in the Car:
Because extreme heat can affect infants and toddlers much more quickly and more severely than adults, it is recommended to take advantage of technology to prevent forgetting children in the car. The temperature within a car standing in 35º heat can reach over 50º after 20 minutes and more than 65º after 40 minutes.
Over and above the potential of heat injury, prolonged exposure to the sun is unhealthy to children's skin since sunburn in childhood raises the risk of contracting skin cancer in adulthood. Therefore, it is preferable not to remain in the sun for long periods, especially around midday when radiation strength is at its peak. If a child does stay in the sun for a long time, his delicate skin must be protected by cream with a Sun Protection Factor of at least 30 or more that should be applied every two hours or after swimming, as well as wearing a sun hat.
Children spend more time outside during summer and wear light clothing. This exposes them to insect bites. Although a mosquito bite does not cause any significant injury, it can be uncomfortable and prone to secondary bacterial infection. To avoid mosquito bites, screens should be placed on all windows at home and anti-insect ointment containing an active substance called Deet or Picardin applied to the skin (except for infants under 2 months of age). Treatment of mosquito bites includes applying a cold pack to the area and soothing ointment such as aloevera or any anti-histamine such as Fenistil that will reduce the itch.
Mediterranean Spotted Fever:
Mediterranean Spotted Fever (MSF) is caused by a bacteria called Rickettsia conorii and transmitted to humans by a brown dog tick Rhipicephalus sanguineus, which is generally considered to be the most common tick in the Mediterranean area. The disease appears mainly in the summer months when ticks and humans are active outdoors. Symptoms include fever, headache and a rash, as well as muscle pain, vomiting and diarrhea. The disease can be fatal if not treated.
When at the beach in summer, children can be stung by a jellyfish which causes pain, blisters and is itchy, and even have numbness in the area of the sting. If a child is stung, the area should be washed with sea water or vinegar (lifeguards usually have some) but not with sweet water. Ice and pain-relieving ointment can be applied.
Danger of Drowning:
Most regrettably, during the bathing season in 2019, there were 228 drownings of which half (110) were youngsters under the age of 20. To prevent drowning, small children must be carefully watched and floaters placed on their arms as well as for older children who are not strong swimmers. An adult should always maintain eye contact with every child, irrespective of age. Infants and toddlers under 4 years are at high risk because their weight is centered in the upper part of the body, so that if they fall in the water, the head falls forward. This is dangerous even in shallow water. In addition, as they are unaware of any danger, their ability to cope is low.
This is also true for children and even adolescents who are at high risk of drowning due to their over-confidence in their ability to swim, incorrect evaluation of the hazards and the tendency for impulsive and dangerous behavior. Therefore, they should not swim at the beach or in the pool without the presence of a lifeguard.
Outer Ear Infections:
Summer is a time to spend at the pool. When water enters the outer ear canal, an outer ear infection can develop which causes extreme sensitivity especially when the ear is pressed. Outer ear infections can also be caused throughout the year by inserting earbuds too deeply. This should be avoided. Treatment includes antibiotic and steroid ear drops which usually bring rapid relief. If infections recur, ear plugs should be inserted before swimming.
Even though summer is here, there is evidence over recent weeks of the appearance of "winter disease" or bronchiolitis, caused by the RSV bacteria. During the period of coronavirus, the RSV bacteria did not proliferate, although now with the reduction in corona incidence, there have been a number of reports about this disease which is significant mainly in children during their first and second years of life. Bronchiolitis involves the airways and can be hazardous to premature infants and children with a history of lung or heart disease. Treatment is mainly supportive including administering fluids - as infants have difficulty nursing/eating - and oxygen to those with low saturation. In the coming weeks, we will know more if the rate of infection is significant as is usual during the winter season or only slightly raised.