June

Time for summer fun!
Read on to find out about topics that may affect your family this month:
Water safety
Scabies
Sun exposure and sun screen
Insect repellants

Water Safety

Contrary to what many people believe, drowning is a quick and silent killer. In the time it takes to …

…cross the room for a towel (10 seconds), a child in the bathtub can become submerged.

…answer the phone (2 minutes), that child can lose consciousness.

…sign for a package at your front door (4 to 6 minutes), a child submerged in the bathtub or pool can sustain permanent brain damage.

Despite a 34 percent decline from 1987 to 1998, drowning is still the second leading cause of unintentional injury-related death to children ages 14 and under, taking more than 1,000 children’s lives each year. For every child who drowns, four more are hospitalized for near-drownings; for every hospital admission, four children are treated in emergency rooms.

But knowledge is a powerful tool for combating these tragedies. Knowing how and where children drown, as well as the concrete steps you can take to avoid danger, may make a life-and-death difference for your family.
Why Kids Are at Risk
Most drownings and near-drownings occur in residential swimming pools. More than half of these drownings take place in the child’s home pool, and one-third occur at the homes of friends, neighbors or relatives. However, it’s important to know that children – especially younger ones – can also drown in as little as 1 inch of water. This puts them at risk of drowning in wading pools, bathtubs, buckets, diaper pails, toilets, spas and hot tubs.
Childhood drownings and near-drownings can happen in a matter of seconds. They typically occur when a child is left unattended or during a brief lapse in supervision.

Other risk factors:

The majority of children who drown in swimming pools were last seen in the home, had been out of sight for less than five minutes, and were in the care of one or both parents at the time of the drowning.

In-ground swimming pools without complete four-sided isolation fencing are 60 percent more likely to be involved in drownings than those with four-sided isolation fencing.

Drownings and near-drownings tend to occur on the weekend (40 percent) and between the months of May and August (66 percent).

Older children are more likely to drown in open water sites, such as lakes, rivers and oceans.

Death rates from drowning are higher in the country than in cities and suburbs, in part due to decreased access to emergency medical care.

Protecting Your Family
A child should never be unsupervised in or near water, even shallow wading pools. Devices (such as bathtub seats or water wings) can not be relied upon to keep them afloat and alive. Remember, children can drown in as little as 1 inch of water — and it can happen in no time at all.

Other steps you can take to protect your children:

Eliminate potential hazards:

Empty all buckets, containers and wading pools immediately after use. Store them upside-down and out of children’s reach.

Keep toilet lids shut and use toilet locks.

Pay attention to open water. Be aware of undercurrents and changing waves and undertows when at the ocean or lake.

Do not let children dive into water unless the child has learned proper diving techniques, an adult is present and the depth of the water is greater than 9 feet.

Plan ahead:

Children should learn to swim. Enroll them in swimming lessons taught by qualified instructors when they are ready, usually after age 4. If you don’t know how to swim, enroll with your kids!

Adults and kids over age 13 should learn infant and child CPR.

Know which of your child’s friends and neighbors have pools. Make sure your child will be supervised by an adult while visiting.

Install four-sided isolation fencing at least 5 feet high, equipped with self-closing and self-latching gates, around home swimming pools.

Keep rescue equipment, a telephone and emergency numbers by the pool.

Pool alarms and pool covers can offer an extra layer of protection. However, do not rely on them to keep your kids safe; they should be used in conjunction with fencing and constant supervision.

Teach safety:

Swimming lessons are an important step, but they do not make a child “drown-proof.” Children need to learn other water safety lessons, as well.

Always wear a U.S. Coast Guard approved personal safety device around oceans, rivers, lakes or when participating in water sports.

Always swim with a buddy. Swimming alone is very dangerous.

Know how to use rescue equipment and where emergency phone numbers are located.

WHAT IS SCABIES?

· Scabies is a highly contagious skin disease caused by a mite too small to see with the naked eye.

· The most common symptom is a rash that itches intensely at night. The rash can be anywhere on your body but is usually on the hands, breasts, armpits, genital area and waistline.

· Scabies can affect men, women and children of all ages. It is easily spread from person to person by close physical contact, such as between family members, sexual partners and children playing at school.

How Do I GET RID OF SCABIES?

· You will need to see your health care provider to prescribe cream that will eliminate the scabies and relieve the itching.

· To apply, thoroughly and gently massage the cream into all skin surfaces from your head to the soles of your feet. Be sure that infants and elderly patients are treated for scabies on the neck, scalp, temple and forehead. The cream should be left on overnight for 8 to 14 hours and removed the next morning by bathing and shampooing.

· It is extremely important to put the cream on every square inch of your body; not just where the rash is. That includes applying it under your fingernails and toenails, around the nail beds, between your fingers and toes, and in the cleft of your buttocks and genital area. If you wash your hands or any other area during the treatment period, new cream must be reapplied immediately.

· Itching, mild burning and/or stinging may occur after application of the cream.

· Everyone affected should be treated at the same time, as directed by your health care provider.

· Be sure to change your clothes and bed linens, and have all the affected articles washed at the same time on a hot cycle or professionally dry cleaned. It is not usually necessary to clean sweaters, jackets, furniture, drapes, or rugs.

· You will not usually be contagious after one treatment if these instructions and your physician's directions have been followed carefully. The scabies mites will be gone in a matter of days; however, the rash and itching may persist up to 4 weeks after treatment. This is rarely a sign of treatment failure and is not necessarily an indication for retreatment. If itching is excessive or if irritation persists, consult your healthcare provider.

· Avoid contact with your eyes. If the cream accidentally gets in your eyes, flush with water immediately.

Sun Sun Exposure:

Guidelines for Parents

The sun is the main cause of skin cancer, the most common form of cancer in the United States. All skin cancers are harmful and some, including malignant melanoma, can be deadly.

Why are children at risk for sun damage?

Virtually everyone is at some risk for sun exposure damage. Infants, children, and adolescents are at a higher risk because of the time they spend outdoors; between 60% to 80% of a person's lifetime exposure happens before he or she turns 18 years old. Research has shown that one or more blistering sunburns in childhood increase the risk of developing skin cancer later in life. A parent's knowledge of sun exposure helps decrease or avoid the chances of run, re skin cancer in their children.

How can I protect my child?

There are several ways to protect children from the sun. Babies under 6 months of age should be kept out of direct sunlight. Children should be clothed in comfortable, lightweight, tight-woven long pants and shirts. Hats should have a brim of at least 3 inches (7.5 cm) all around to cover the face, neck, and ears. Sunglasses are important for all ages. Protective glass on car windows will decrease the damaging ultraviolet ray exposure. Avoid the sun between 10 a.m. and 3 p.m. (11 a.m. to 4 p.m. during daylight saving time) and use sunscreens and sunblocks whenever outdoors.

What about sunscreens and sunblocks?

Sun products that protect against both ultraviolet A (UWA) and ultraviolet B (UV~) rays are best. Look for the words broad spectrum on the label. Sunblocks such as zinc oxide or titanium dioxide, or combination sunscreens such as benzophenones (oxybenzone, dioxybenzone, sulisobenzone), provide protection against both UVA and UVB rays. Always choose a sunblock or sunscreen with an SPF of 15 to 30. Anything over 30 is unnecessary and may actually harm your child due to strong chemicals. Apply 1 ounce (28.35 grams) 15 to 30 minutes before going outdoors to all areas of the body including the lips, ears, nose, neck, shoulders, hands, back, waist, and feet. Reapply sun lotion every 2 to 3 hours and after swimming and sweating. All children, especially adolescents, should avoid artificial light sources such as tanning beds and sunless tanning products.

How should I treat a sunburn?

Signs of sunburn usually appear 6 to 12 hours after exposure, with the greatest discomfort during the first 24 hours. For red skin, tepid baths and cool soaks arc best. Washcloths dipped in water, milk, or cold teas can be applied directly to the skin. Plain yogurt applied several times a day for 10 minutes may offer relief. Have your child drink plenty of fluids including water and juices. Apply moisturizers and aloe to dry skin and use oatmeal baths for itchy skin. Always avoid butter, grease, or powder on any type of burn; these home remedies can actually make the burn worse. For pain, acetaminophen or ibupro-fen may be given as directed. Ask your primary care provider about applying a low-dose over-the-counter cortisone cream to sore and swollen skin. If your child has severe blisters, fever, chills, headache, or a general feeling of illness, call your primary care provider immediately.

parks, public signs can be posted at playgrounds and swimming pools, lifeguards can set good examples, and policies can be created. Parents can make a big difference in the prevention of sun exposure and future skin cancer in today's children. For more information, contact these national resources:

What else can I do?

Setting a good example is the best preventive measure that a parent can initiate. It is a good idea to periodically perform skin assessments on children by looking for the ABCDE's of skin cancer (see chart). Parents can also help by getting involved in the community and schools and encouraging sun-safe activities for children. School teachers and coaches could participate. Trees can be planted along streets and

Although most children's moles are perfectly harmless, it is important to look for changes in size, texture, shape, and color. An easy way to remember what to look for is the "ABCDE" signs of skin cancer:

A= Asymmetric

B= Border irregularity

C= Color variance

D= Diameter greater than 1/4 inc

(6 mm)(or the size of a pencil eraser)

E= Elevation and Enlargement

American Academy of Dermatology

P.O. Box 4014

930 North Meacham Road

Schaumburg, IL 60618-4014

(847) 330-0230

http://www, aad.org

American Academy of Pediatrics

141 Northwest Point Blvd.

P.O. Box 927

Elk Grove Village, IL 60009-0927

(847) 228-5005 http://www, pediatrics.org

American Cancer Society

1599 Clifton Road, NE Atlanta,

GA 30329 1-800-ACS-2345 http://www, cancer, org

National Weather Service Climate Prediction Center

http://nic.fb4.noaa.gov/

Skin Cancer Foundation

P.O. Box 561

Department JDN

New York, NY 10156

(212) 725-5176; E-mail: info@skincancer, org

How to choose and use insect repellents

When the weather turns warm, you may want to use an insect repellent to protect your child from bites by mosquitoes, biting flies, gnats, chiggers, ticks, or other "bugs." In choosing a repellent, you need to keep in mind what insects you want to protect against and which substances are safe and effective.

The best all-purpose insect repellent is a substance called N,N-diethyl-m-toluamide, commonly known as deet. It is the active ingredient in most commercially available repellents. Deet is available in products packaged as sprays, aerosols, gels, liquids, sticks, and impregnated towelettes. Although deet has been used safely for 40 years, it is best not to apply products with a deet concentration of more than 10% to children’s skin. Check the label of the product you are considering for the concentration.

Be sure to apply the deet product to all exposed areas except the hands (particularly of small children) and the skin near the eyes and mouth. Also keep repellent away from cuts or any patches of irritated skin. Deet will remain effective for several hours, but will wash off with water and sweat, so it’s best to reapply it from time to time. The substance also may damage plastics and spandex.

If you prefer a plant-derived product, consider a repellent in which the active ingredient is citronella. Although citronella is effective, it does not protect as long as products containing deet. Soybean oil is another "natural" repellent that works well.

When clothing or other objects rub the skin,some repellent may come off. Evaporation, wind, heat, sweating, and water have the same effect and shorten protection time.

Using an insect repellent with sunscreen. The sun protection factor (SPF) of sunscreens may decrease when an insect repellent containing deet also is applied. Therefore, if you use sunscreen and deet-containing insect repellent on your child at the same time, choose a sunscreen with a higher SPF than you usually use. If you apply one of the new combination sunscreen and insect repellent products, keep in mind that it may not protect as well against sun as the SPF on the label would suggest.

What about Lyme disease?

Many parents worry that their child will be bitten by a tick and get Lyme disease. The best protection against ticks is permethrin, which is available in a spray repellent. Permethrin should not be applied directly to the child’s skin, however, because its safety when used that way has not been firmly established. Spray permethrin repellent on clothing, shoes, tents, netting, sleeping bags, and the like.

It will last for several washings. On the child’s skin, use a deer-containing repellent.

Safety first

Whatever repellent you choose, observe the following guidelines, developed by the Environmental Protection Agency (EPA), for the safe use of insect repellents:
Verify that the repellent has an EPA-approved label
Read the entire repellent label before each use · Use the repellent only as directed by the manufacturer and only for the insects it claims to be effective against · Keep repellents out of the reach of children
Apply only to areas specified by the label
Use enough repellent to cover exposed skin or clothing, but avoid frequent applications
On returning indoors, wash repellent off skin with soap and water
If you suspect a repellent-induced toxic reaction, wash off the repellent and call the poison control center. If you go to a doctor’s office or other facility, take the repellent with you.
For information on the active ingredients in repellents, contact the National Pesticide Telecommunications Network at 800-858-7378.
It is open 24 hours a day, seven days a week.

92 CONTEMPORARY PEDIATRICS Vol. 15, No. 6