A Dose of Dr. Gwenn

The season changes can be a magical time of year with new found colors and a heralding of the next holiday season. But, those amazing colors and falling leaves don’t come without a price. For many people, the more dramatic the season change, the more dramatic the sniffles and sneezes of allergies.

Believe it or not, anyone can develop allergies over the course of their life time. We are all born with a potential for all sorts of medical conditions and our life experiences are what trigger what may occur and when. For allergies, our environmental exposures are the trigger – outside pollens and molds in quantities that overwhelm our immune response causing it to actually over react. It’s this over reaction of our immune response that causes our symptoms.

For many people, young and old, moving from one part of the country or world to another may be the straw that tips the balance. For others, it could be the intensity of a particular season. Here in New England, for example, we have experienced very extreme allergy seasons for the last year so many people who have never had past issues have found themselves reaching for tissues and calling their doctors.

For kids and adults, the typical allergy profile and symptoms tends to include:

1. a family history (but not always)
2. symptoms start when allergy season starts and ends when allergy season ends
3. sniffles, runny nose, and sneezing
4. cough, often worse at night
5. wheezing in susceptible kids (usually asthmatics)

Treatment involves preventing the symptoms and addressing the symptoms. The best preventive medications are antihistamines. We typically start with over the counter Claritin for kids 2 years of age and older. This is a great medication because it is safe and doesn’t make kids sleepy or hyper and comes in a variety of forms, pill and liquid.

To get the most benefit, however, you need to start the Claritin as soon as your recognize your child has allergies and continue through the allergy season. Keep in mind, depending on the allergen count (pollens and molds), your child will have break through days, but those days will be worse without an antihistamine on board. Your pediatrician can help you determine the dose that is right for your child based on your child’s age.

For nasal congestion, saline nose spray used as needed helps most kids free up their clogged nasal passages. If that alone does not help, over the counter Mucinex, an expectorant, may help for kids older than age 2.. Avoid decongenstants such as Pseudofed as they do not work and are not safe in young kids.

For older kids with primarily nasal symptoms, runny nose and sneezing, prescription steroid nose sprays are a great choice because they actually stop the nose from making the mucous. Talk to your pediatrician if this sounds like something that would benefit your child.

If your child is asthmatic, make sure you have all your child’s asthma medications on hand during season changes incase an asthma exacerbation is triggered. Season changes and pollens and molds tend to be reliable triggers for many asthmatics so you’ll want to have these medications close at hand and review your asthma plan with your pediatrician.

Finally, the longer your child is congested, there is the possibility of developing other upper respiratory infections such as ear and sinus infections. Contact your pediatrician if your child develops ear or sinus pain or fever to get an evaluation.

by: Gwenn S. O’Keeffe, MD, FAAP

The time between Thanksgiving and New Year’s Eve are typically filled with all sorts of extra and unique celebrations from school events to family meals. While these are the times that tend to make our most special and unique family memories, for our kids the holidays can be a hectic time and the very aspects that make the holidays so out of this world also carry some health and safety risks we need to be aware of.

The American Academy of Pediatrics has some holiday tips they always circulate this time of year that they encourage us to circulate around. These cover the lion’s share of issues that tend to pop up during the holidays that can turn a magical moment into a nightmare but there are a few others that I’ve thought of that I’ll share with you at the end.

The 2007 American Academy of Pediatrics Tips for Safe Holidays:

Trees
• When purchasing an artificial tree, look for the label "Fire Resistant."
• When purchasing a live tree, check for freshness. A fresh tree is green, needles are hard to pull from branches and when bent between your fingers, needles do not break. The trunk butt of a fresh tree is sticky with resin, and when tapped on the ground, the tree should not lose many needles.
• When setting up a tree at home, place it away from fireplaces, radiators or portable heaters. Place the tree out of the way of traffic and do not block doorways.
• Cut a few inches off the trunk of your tree to expose the fresh wood. This allows for better water absorption and will help to keep your tree from drying out and becoming a fire hazard.
• Be sure to keep the stand filled with water, because heated rooms can dry live trees out rapidly.

Lights
• Never use electric lights on a metallic tree. The tree can become charged with electricity from faulty lights, and a person touching a branch could be electrocuted.
• Before using lights outdoors, check labels to be sure they have been certified for outdoor use. To hold lights in place, string them through hooks or insulated staples, not nails or tacks. Never pull or tug lights to remove them.
• Check all tree lights-even if you've just purchased them-before hanging them on your tree. Make sure all the bulbs work and that there are no frayed wires, broken sockets or loose connections.
• Plug all outdoor electric decorations into circuits with ground fault circuit interrupters to avoid potential shocks.
• Turn off all lights when you go to bed or leave the house. The lights could short out and start a fire.

Decorations
• Use only non-combustible or flame-resistant materials to trim a tree. Choose tinsel or artificial icicles of plastic or nonleaded metals.
• Never use lighted candles on a tree or near other evergreens. Always use non-flammable holders, and place candles where they will not be knocked down.
• In homes with small children, take special care to avoid decorations that are sharp or breakable, keep trimmings with small removable parts out of the reach of children to avoid them from swallowing or inhaling small pieces, and avoid trimmings that resemble candy or food that may tempt a young child to eat them.
• Wear gloves to avoid eye and skin irritation while decorating with spun glass "angel hair." Follow container directions carefully to avoid lung irritation while decorating with artificial snow sprays.
• Remove all wrapping papers, bags, paper, ribbons and bows from tree and fireplace areas after gifts are opened. These items can pose suffocation and choking hazards to a small child or can cause a fire if near flame.

Toy Safety
• Select toys to suit the age, abilities, skills and interest level of the intended child. Toys too advanced may pose safety hazards for younger children.
• Before buying a toy or allowing your child to play with a toy that he has received as a gift, read the instructions carefully.
• To prevent both burns and electrical shocks, don't give young children (under age ten) a toy that must be plugged into an electrical outlet. Instead, buy toys that are battery-operated.
• Children under age three can choke on small parts contained in toys or games. Government regulations specify that toys for children under age three cannot have parts less than 1 1/4 inches in diameter and 2 1/4 inches long.
• Children under age 8 can choke or suffocate on uninflated or broken balloons. Remove strings and ribbons from toys before giving them to young children.
• Watch for pull toys with strings that are more than 12 inches in length. They could be a strangulation hazard for babies.

Food Safety
• Bacteria are often present in raw foods. Fully cook meats and poultry, and thoroughly wash raw vegetables and fruits.
• Be sure to keep hot liquids and foods away from the edges of counters and tables, where they can be easily knocked over by a young child's exploring hands.
• Wash your hands frequently, and make sure your children do the same.
• Never put a spoon used to taste food back into food without washing it.
• Always keep raw foods and cooked foods separate, and use separate utensils when preparing them.
• Always thaw meat in the refrigerator, never on the countertop.
• Foods that require refrigeration should never be left at room temperature for more than two hours.

Happy Visiting
• Clean up immediately after a holiday party. A toddler could rise early and choke on leftover food or come in contact with alcohol or tobacco.
• Remember that the homes you visit may not be childproofed. Keep an eye out for danger spots.
• Keep a laminated list with all of the important phone numbers you or a baby-sitter are likely to need in case of an emergency. Include the police and fire department, your pediatrician and the national Poison Help Line, 1-800-222-1222.
• Traveling, visiting family members, getting presents, shopping, etc., can all increase your child's stress levels. Trying to stick to your child's usual routines, including sleep schedules and timing of naps, can help you and your child enjoy the holidays and reduce stress.

Fireplaces
• Before lighting any fire, remove all greens, boughs, papers, and other decorations from fireplace area. Check to see that the flue is open.
• Use care with "fire salts," which produce colored flames when thrown on wood fires. They contain heavy metals that can cause intense gastrointestinal irritation and vomiting if eaten. Keep them away from children.
• Do not burn wrapping papers in the fireplace. A flash fire may result as wrappings ignite suddenly and burn intensely.

The three issues the AAP’s holiday safety tips do not delve into are toy safety given the recent recall barrage, travel issues, and health concerns.

Toys and Recalls
Do be sure to double check the updated recall lists before you purchase any toys for your kids. And, if you receive any toys as gifts you are unsure about, don’t open the toy. Look into the toy online and on the CPSC recall list.

Travel
Holiday travel can be one of the trickiest moments for a family given most people travel to snowy areas! The key to sanity is planning ahead, being flexible for changes and remembering that kids are not small adults. Bring distraction toys and once through security buy drinks and food since airlines on longer have those on board as readily. The other issue is time. Kids don’t do well harried. Give yourself plenty of time checking in and consider checking your bags to make life easier and more convenient.

Health Concerns
Expect someone to get sick during the holidays. Keep in mind that December is the official start of cold and flu season. Make sure everyone in your family who needs a flu shot receives one. If a member of your family has an illness, consider staying home from an event. This is very important because these events are filled with infants, small kids and older adults whose immune systems are not as robust as ours. And, there may be people in the group battling health issues that weaken their immune systems such as cancers. So, we owe it to the health of others to play it safe if our kids or other adult members are sick. We can’t control what others so but we can control excluding our family members when appropriate. What’s the rule? Fever free for 24 hours or on antibiotics for 24 hours if given one. And, the sick person must be ok to visit – no vomiting, diarrhea, coughing that would make it difficult for the person or those around him or her.

Here’s to a safe, happy and healthy holiday season.

(image) For those of us in New England, we live for season changes, especially winter. However, the last few years have been quite disappointing with very mild temperatures and modest snowfalls creating rather unimpressive ski conditions. We honestly didn’t know what to do when the snow started falling just days into December and the deep freeze came shortly thereafter. Out came all the winter gear, hardly used for the last few years, and high hopes were set for a season filled with much anticipated winter fun: sledding, snow shoeing, skiing, and just basic outdoor snow fun!

But, where cold and snow are concerned, “fun” takes on new challenges if we are not adequately prepared and it is all too easy to get injured from the elements and the activities so unique and special to a snowy winter. Anything can happen in snow from concussions due to sledding accidents to sprained ankles or broken arms from falling on icy sidewalks or getting checked during a hockey game. Even building a snow village can be treacherous with frostbite and frostnip risks and lacerations and contusions occurring from snowballs containing hidden objects such as pieces of trees or ice.

According to SafeKids USA more than a quarter million kids are injured in winter sports each year. They report that more than 49,000 children ages 5 to 14 were taken to emergency rooms in 2005 for winter sports juries. Of these, 29,000 were from skiing and snowboarding, 20,000 from sledding, and 660 from snowmobile accidents. If you add to these numbers the amount of kids injured that were treated at home or by their pediatricians, these numbers go much higher.

Proper equipment is essential in minimizing risk for all sports but especially important for winter sports with the added elements of snow, cold and ice. Make sure the equipment is the proper size for your child and consult and outdoor store if you have any doubt as to the integrity of used equipment. For all winter sports, including sledding, a ski helmet is mandatory for kids and adults and can cut down the risk of traumatic brain injury by over 50%.

Kids often have trouble understanding how dangerous the cold can be because we dress them like Eskimos but fail to explain to them why. It is crucial they understand starting very young that without all those thermal layers, they would be at risk for hypothermia, frostnip and frostbite – even while just walking to and from school or while waiting in line for a ski lift. How do you decide how cold is “too cold”? In general, the further below zero the wind-chill falls, the shorter the time it will take for any of these cold-related injuries to occur. Massachusetts schools all follow very strict guidelines for outdoor recess. Children must have snow suits and boots to play in the snow. And, children are kept indoors during cold weather advisories and when the temperature drops below zero. Encourage your family to follow these same guidelines for home and recreational activities. So, if it's too cold for outdoor recess, than it's too cold to build a snowman or hit the slopes.

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Cold-related injuries can be very serious and early identification and treatment is essential. Hypothermia develops when the body's core temperature drops below normal. The body essentially freezes and major systems stop functioning normally. Symptoms result from the body's attempt to warm up and conserve energy. Early symptoms include shivering, clumsiness, and slurred speech. If you become concerned your child may be developing hypothermia, get your child in a warm environment and seek medical attention right away.

Frostnip and frostbite are two extremes of the same problem and result from direct cooling and freezing of the skin and underlying structures. Early on the skin turns white and becomes numb and is referred to as frostnip. Frostbite is an actual freezing of the skin and outer tissues. Fingers, toes, ears and nose are the most susceptible. They may appear pale, gray or blistered and the child may complain that the skin burns or feels numb. Frostbitten areas need to be warmed up with warm water. Wrap your child in a warm blanket and give hot cocoa to warm up the inside temperature. If the symptoms do not resolve in a few minutes, call your doctor.

I know my family is looking forward to finally having a winter worthy of schlepping all the ski stuff north for! At the same time, I know as a parent I have no hope in getting my kids to dress like an Eskimo if I don’t do the same. So, “all for one, one for all” will be our motto for winter dressing and should be your family’s motto, too. And, that includes on the slopes. Believe it or not, ski helmets do come in adult sizes!!

It is a very scary diagnosis for parents and doctors, meningitis. And, this time of year it seems to make headlines somewhere in the country. Last year some hockey players from New Jersey shared water bottles and contracted meningitis, and this week two Bentley College students in Massachusetts have been hospitalized with meningitis.

Parents often wonder when their children complain of symptoms if those symptoms are "meningitis". Viruses and bacteria can cause meningitis, which is irritation of the lining around the brain. Like all illnesses, there is variation and there can be mild to severe degrees of illness. But, bacterial meningitis, the type that is making news this week, makes people very, very sick and very quickly. This isn't the type of situation where you wonder if your child is sick - you know it. These kids look and act sick. They have fever, often very high. They feel lousy. They are tired and often very sleepy. Some may feel very sick to their stomachs . Some may seem confused to those around them. They have severe headache and their neck becomes so stiff they truly can't bend it without their heads hurting more.

Antibiotics help when begun early but it is a serious illness and, sadly, can claim lives and leave survivors with horrible problems once they recover. For this reason, close contacts are also treated, and a vaccine has been developed for preteens and close contacts. But, what is important to remember is that only close contacts need to be treated because bacterial meningitis can only be spread by sharing saliva - kissing, sharing food utensils or cups. This isn't the type of illness that spreads by casual contact which is actually reassuring. Your kids won't get bacterial meningitis by being in the same room as a person with the illness - there has to be that direct contact with saliva. Breathing air or touching isn't a risk factor.

So, what should you do next time your child has fever, headache and complaints of a sore or stiff neck? Don't play doctor, call your doctor for advice. Keep in mind that true, serious illness like the type bacterial meningitis causes doesn't hide for long so if your child looks well and is acting well that is always reassuring. But, if your child is becoming sick before your eyes, your child needs medical attention right away. In fact, if that is going on, call your doctor on the way to the ER or call 911 if your child is horribly ill to you.

Here are some links for more information:
CHOP Meningitis Information
CDC Meningitis Information

Summer is a wonderful time for outdoor fun with outdoor activities and downtime we don’t get to experience during other times of the year. At the same time, those very features of summer that make it so wonderful, so have some unique safety issues that are important to consider or very quickly a long awaited long weekend could turn into a trip to the emergency room instead.

With the 4th of July approaching and many families opening up summer homes, let me cover two of the hot topics at the moment first: fireworks safety and open water safety. I'll cover some other summer safety tips in a follow-up post soon.

Fireworks Safety

People seem to have a love/hate relationship with fireworks. Many people love them, while some don't. Despite the warnings from professionals about the extra precautions they need to follow to pull off professional shows, too many people attempt to set off fireworks from their backyards or beaches causes all sorts of injuries to themselves or the people around them.

I have seen more than my share of fireworks injuries over the years! There was the teenager who did a number on his leg after some bottle rockets he had in his pocket exploded as he walked by a campfire. My own toddler nephew suffered a nasty burn to his finger by a sparkler because a relative gave him one to hold not realizing those things burn down – and he was too young to let go! And, I witnessed adults setting off fireworks on a beach in Connecticut a few weeks back where kids were sitting around campfires only feet away. I didn’t stick around long enough to see the result – we scrambled to get our own kids to safety!

Your best course of action is to keep the fireworks to the pros and watch from afar! The American Academy of Pediatrics has these tips for you to keep everyone in your family safe from fireworks harm:

"• Fireworks can result in severe burns, scars and disfigurement that can last a lifetime.
• Fireworks that are often thought to be safe, (i.e. sparklers) can reach temperatures above 1000 degrees Fahrenheit, and can burn users and bystanders.
• Families should attend community fireworks displays run by professionals rather than using fireworks at home.
• The AAP recommends prohibiting public sale of all fireworks, including those by mail or the Internet."

More fireworks safety information can be found here.

BOATING and OPEN WATER SWIMMING SAFETY

How many of you will be on the water this weekend? Very common time of year to explore the ocean and lakes in your area either by boat or by swimming. Any water activity carries an element of risk event for the most experienced of boaters and swimmers. The American Academy of Pediatrics has these tips to keep your family safe with your water activities:

Boating

"• Children should wear life jackets at all times when on boats or near bodies of water.
• Make sure the life jacket is the right size for your child. The jacket should not be loose. It should always be worn as instructed with all straps belted.
• Blow-up water wings, toys, rafts and air mattresses should never be used as life jackets or life preservers.
• Adults should wear life jackets for their own protection, and to set a good example.
• Adolescents and adults should be warned of the dangers of boating when under the influence of alcohol, drugs and even some prescription medications."

Open Water Swimming

"• Never swim alone. Even good swimmers need buddies!
• A lifeguard (or another adult who knows about water rescue) needs to be watching children whenever they are in or near the water. Younger children should be closely supervised while in or near the water - use "touch supervision," keeping no more than an arm's length away.
• Make sure your child knows never to dive into water except when permitted by an adult who knows the depth of the water and who has checked for underwater objects.
• Never let your child swim in canals or any fast moving water.
• Ocean swimming should only be allowed when a lifeguard is on duty."

The Bottom Line

While summer affords us all a wonderful opportunity to relax and participate in recreational activities unavailable to us at other times of the year, we have to remember that relaxation and fun is not an excuse to throw caution to the wind and forget basic safety. In fact, following safety rules will make your adventure more fun because no one will need a first aid kit or emergency room by the end of the day – just a shower!

With the summer in full swing, and full bloom, kids are actively out and about participating in all sorts of formal and informal recreational activities. Keeping kids safe each summer can be a challenge because you have to consider not only the special characteristics of the activity the child is participating in but the outdoor elements the activity is occurring in.

Here’s some important tips from the American Academy of Pediatrics (AAP) on all the key activities your kids will be out and about doing this summer: sun, bugs, pools, playgrounds bikes and bugs!
(original tip source: American Academy of Pediatrics Summer Safety I; used with permission)

FUN IN THE SUN

Babies under 6 months:
• Avoiding sun exposure and dressing infants in lightweight long pants, long-sleeved shirts, and brimmed hats that shade the neck are still the top recommendations from the AAP to prevent sunburn. However when adequate clothing and shade are not available, parents can apply a minimal amount of suncreen with at least 15 SPF (sun protection factor) to small areas, such as the infant's face and the back of the hands. If an infant gets sunburn, apply cold compresses to the affected area.

For Young Children:
• Apply sunscreen at least 30 minutes before going outside, and use sunscreen even on cloudy days. The SPF should be at least 15 and protect against UVA and UVB rays.

For Older Children:
• The first, and best, line of defense against the sun is covering up. Wear a hat with a three-inch brim or a bill facing forward, sunglasses (look for sunglasses that block 99-100% of ultraviolet rays), and cotton clothing with a tight weave.
• Stay in the shade whenever possible, and limit sun exposure during the peak intensity hours - between 10 a.m. and 4 p.m.
• Use a sunscreen with an SPF of 15 or greater. Be sure to apply enough sunscreen - about one ounce per sitting for a young adult.
• Reapply sunscreen every two hours, or after swimming or sweating.
• Use extra caution near water, snow, and sand as they reflect UV rays and may result in sunburn more quickly.

HEAT STRESS IN EXERCISING CHILDREN

• The intensity of activities that last 15 minutes or more should be reduced whenever high heat and humidity reach critical levels.
• At the beginning of a strenuous exercise program or after traveling to a warmer climate, the intensity and duration of exercise should be limited initially and then gradually increased during a period of 10 to 14 days to accomplish acclimatization to the heat.
• Before prolonged physical activity, the child should be well-hydrated. During the activity, periodic drinking should be enforced, for example, each 20 minutes, 5 oz of cold tap water or a flavored sports drink for a child weighing 90 lbs, and 9 oz for an adolescent weighing 130 lbs, even if the child does not feel thirsty.
• Clothing should be light-colored and lightweight and limited to one layer of absorbent material to facilitate evaporation of sweat. Sweat-saturated garments should be replaced by dry garments.
• Practices and games played in the heat should be shortened and more frequent water/hydration breaks should be instituted.

POOL SAFETY

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• Install a fence at least four-feet high around all four sides of the pool. The fence should not have openings or protrusions that a young child could use to get over, under, or through.
• Make sure pool gates open out from the pool, and self-close and self-latch at a height children can't reach.
• Never leave children alone in or near the pool, even for a moment.
• Keep rescue equipment (a shepherd's hook - a long pole with a hook on the end - and life preserver) and a portable telephone near the pool. Choose a shepherd's hook and other rescue equipment made of fiberglass or other materials that do not conduct electricity.
• Avoid inflatable swimming aids such as "floaties." They are not a substitute for approved life vests and can give children a false sense of security.
• Children may not be developmentally ready for swim lessons until after their fourth birthday. Swim programs for children under 4 should not be seen as a way to decrease the risk of drowning.
• Whenever infants or toddlers are in or around water, an adult should be within arm's length, providing "touch supervision."

BUG SAFETY
• Don't use scented soaps, perfumes or hair sprays on your child.
• Avoid areas where insects nest or congregate, such as stagnant pools of water, uncovered foods and gardens where flowers are in bloom.
• Avoid dressing your child in clothing with bright colors or flowery prints.
• To remove a visible stinger from skin, gently scrape it off horizontally with a credit card or your fingernail.
• Combination sunscreen/insect repellent products should be avoided because sunscreen needs to be reapplied every two hours, but the insect repellent should not be reapplied.
• Insect repellents containing DEET are most effective against ticks, which can transmit Lyme Disease, and mosquitoes, which can transmit West Nile Virus and other viruses.
• The concentration of DEET in products may range from less than 10 percent to over 30 percent. The benefits of DEET reach a peak at a concentration of 30 percent, the maximum concentration currently recommended for infants and children. DEET should not be used on children under 2 months of age.
• The concentration of DEET varies significantly from product to product, so read the label of any product you purchase.
For more information on DEET, click here.

PLAYGROUND SAFETY

(Source1; Source 2)

• The playground should have safety-tested mats or loose-fill materials (shredded rubber, sand, wood chips, or bark) maintained to a depth of at least 9 inches. The protective surface should be installed at least 6 feet (more for swings and slides) in all directions from the equipment.
• Equipment should be carefully maintained. Open "s" hooks or protruding bolt ends can be hazardous.
• Swing seats should be made of soft materials such as rubber, plastic or canvas.
• Make sure children cannot reach any moving parts that might pinch or trap any body part.
• Never attach-or allow children to attach-ropes, jump ropes, leashes, or similar items to play equipment; children can strangle on these.
• Make sure metal slides are cool to prevent children's legs from getting burned.
• Parents should never purchase a home trampoline or allow children to use home trampolines.
• Parents should supervise children on play equipment to make sure they are safe.

BICYCLE SAFETY

(Source1; Source 2)

• Do not push your child to ride a 2-wheeled bike until he or she is ready, at about age 5 or 6. Consider the child's coordination and desire to learn to ride. Stick with coaster (foot) brakes until your child is older and more experienced for hand brakes.
• Take your child with you when you shop for the bike, so that he or she can try it out. The value of a properly fitting bike far outweighs the value of surprising your child with a new one. For more information on finding the proper fit, go to http://www.aap.org/family/bicycle.htm
• Buy a bike that is the right size, not one your child has to "grow into." Oversized bikes are especially dangerous.
• Your child needs to wear a helmet on every bike ride, no matter how short or how close to home. Many accidents happen in driveways, on sidewalks, and on bike paths, not just on streets. Children learn best by observing you. Whenever you ride, put on your helmet.
• When purchasing a helmet, look for a label or sticker that says the helmet meets the CPSC safety standard.
• A helmet protects your child from serious injury, and should always be worn. And remember, wearing a helmet at all times helps children develop the helmet habit.
• A helmet should be worn so that it is level on the head, not tipped forwards or backwards. The strap should be securely fastened, and you should not be able to move the helmet in any direction. If needed, the helmet's sizing pads can help improve the fit.

SKATEBOARD, SCOOTER, IN-LINE SKATING AND HEELYS SAFETY

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• Children should never ride skateboards or scooters in or near traffic.
• All skateboarders and scooter-riders should wear a helmet and other protective gear; wrist guards are particularly important.
• Communities should continue to develop skateboard parks, which are more likely to be monitored for safety than ramps and jumps constructed by children at home.
• While in-line skating or wearing Heelys, be sure to wear appropriate protective equipment and only skate on designated paths or rinks and not on the street.

BOTTOM LINE

Kids want to be spontaneous and to a degree we want to encourage that this summer. However, we have to be sure they don't get into trouble at the same time. So, before they dart outdoors with their 11th hour plans, make sure they take a few extra seconds to lube up, cover with DEET and grab whatever safety gear the activity of the day needs. Those extra few seconds really is the difference between coming home happy and healthy and coming home needing the first aid kit or your pediatrician!