It's Memorial Day weekend and that means the official start of summer, and pools across the region are opening up to offer a break from the heat. In the summer, fun is number one – but keeping your children safe from accidental injury is a top priority too. Parents and caregivers who emphasize summer safety are rubbing on more than just sunscreen; they are applying a healthy dose of safe habits for kids.

“Children rely on parents and adults to supervise their participation in summer activities, even if those activities are in your own backyard,” said Susan A. Helms, director Injury Prevention and Safe Kids at Le Bonheur Children’s Hospital.

A former director of the intensive care unit at Le Bonheur, Helms shares practical ways for parents to practice active safety habits.

Be a Water Watcher

• The Water Watcher Card is designed to be passed between adults taking turns acting as the designated watcher of children in and around water. 
• The card acts as the active communication link between responsible adults and helps them focus on children. 
• When it comes to protecting children from drowning, nothing works better than good, old-fashioned vigilance. 
• Download and print off your Water Watcher Card at www.safekids.org

At or Near the Water 

• Take Swimming Lessons.
• Always use the Buddy System. 
• Never dive into shallow water. 
• When boating, wear a Life Jacket. 
• Non-swimmers should wear life vests in any body of water. 
• Always check weather conditions.

Spot the Tot

• Spot the Tot encourages drivers, even those without children of their own, to do a safety check to look for children walking or playing around cars.
• Drivers should walk all the way around a parked vehicle to check for kids, toys and pets before entering the car and starting the motor. 
• Spot the Tot should become your mantra this summer, as many children are badly injured and even killed by vehicles backing out of their own driveways. 
• Learn more about Spot the Tot at www.safekids.org

The bottom line: be an active supervisor.

“As parents and caregivers, children are relying on us to show them good, active safety habits," Helms said. “They really are depending on us to keep them safe.”

Summer is a time for kids to be out and about and free. In all that fun, it is quite easy to forget or ignore safety. It’s our job to remind them.

It’s very rewarding when your child makes the right choices. Children want to please their parents – and thrive on positive feedback from their parents. We talked to Thomas Hobson, director of the Child Life Department at Le Bonheur Children’s Hospital about how parents can take advantage of positive reinforcement. Here’s what he had to say.

“Think back to some of the proudest moments in your life.  Did they involve someone telling you that you did a good job?  Perhaps they were proud of you?  Chances are many of those moments involve situations like those. 

The truth is that everyone likes to be told that they’re doing a good job.  To put it in more technical terms, everyone likes positive reinforcement.  When we are rewarded for doing the right thing, trying harder or just generally doing what we’re suppose to do it makes us want to do it more often.  This is true for work, home, friends and our children.

As the parent, we should all remember that our children love when we provide them with positive reinforcement.  It makes them realize that they are doing the right thing and helps to shape expected behaviors. Here are three simple pointers on giving solid positive reinforcement to children:

• Be specific: If your child has done a specific action your compliment should focus on that action.  For instance, “Great job sitting in your seat during dinner.”  This helps your child to know what actions are the ones being praised and the behaviors the parent expects.
• Give more: A professor of mine once said, “if you think you are giving enough positive reinforcement, give 10 percent more.” 
• It’s about the good, not the bad: If you have two children, praise the one doing the right thing, and make sure not to point out that the other one is doing something wrong.  They’ll pick it up on their own.

You will be amazed how well positive reinforcement works with children (and adults).  It’s as simple as focusing on the positive things your child is doing, instead of talking/screaming about the negative things.  If you take this to heart and practice it, you will find you are more relaxed and your children will be happy too. Parenting is a job - you are the supervisor and your child is the employee.”

Every parent has dealt with their child's tantrum. It’s never easy to deal with - most times, you're not sure how. We talked to Thomas Hobson, director of the Child Life Department at Le Bonheur Children’s Hospital. Here’s what he had to say.

“It doesn’t matter where it happens or whether there’s build up to it or not, a child’s temper tantrum is a thing of parents’ nightmares. They can be embarrassing. They can be frustrating. They can (and will) test your patience.

During the big blow out temper tantrums, it is tough to keep your composure and not get sucked into your child’s whirlwind of emotion. You find yourself being pulled in, and before long, the whole situation is a screaming match. Each side continues to escalate until it’s nothing but chaos.

How do I know all of this? Well, my confession is that despite all of my “kid smarts”, I’ve been pulled into these same situations. Then again, haven’t we all been roped into our children’s temper tantrums. Here are a few tips to help keep you cool when your child is losing it:

• Watch with an outsider’s eyes: When you are watching someone else’s child throw a tantrum, do you get mad? No, you usually feel bad for the parent, and that’s about it. Learn to give yourself the leeway and to remember that you’re the one in charge.
• Don't yell: It is a normal gut reaction to want to yell in these situations. However, think about what happens when someone yells at you. Typically, we go on the defensive and get ready to yell back. This will only cause your child to dig their heels in and fight harder.
• Know when to walk away: After watching a tantrum, even if you’re calm, there comes a point when you know you are going to lose it. Learn to watch for your own cues, and walk away until you cool down. Make sure your child is in a safe place, and simply step into the other room.
• Don’t use sarcasm: Young children simply don’t understand sarcasm. It only serves to confuse them. However, they will figure out that you’re making fun of them, and that will be hurtful.
• Break the cycle: Sometimes, children get so wrapped up in their fit that even if they want to stop, they don’t know how to do it. Instead, they just keep going on with it. Introduce something new that they’ll be interested in. Then, when everyone is calm, you can go back and talk about everything. During a recent tantrum, I told my child that I wanted to show them a new game I had on my phone. The tantrum, which had been going on for 30 minutes, stopped immediately. After a few minutes, we came back and talked about it.”
  

Autism affects one in 88 children, according to the Centers for Disease Control and Prevention. And a recently published study suggests one in three autistic adults lack a job or education. As the number of autism spectrum disorder (ASD) diagnoses increase, experts says early intervention and therapy are key.

Dr. Kathryn McVicar, a Le Bonheur neurologist, weighs in on ASDs below.

There are many theories, but no great answers as to why autism spectrum disorder diagnoses have increased.  Here are some of the possible contributors:

• Older maternal and paternal age at conception is thought to play a role.
• Increased awareness and recognition with more individuals who are 'mild' being diagnosed.

Early signs of an autism spectrum disorder (but also of other developmental and psychiatric disorders) include:

• A child who does not point with one finger by the age of 1 year.
• A child who does not recognize his/her own name.
• A child who does not like to be cuddled and becomes upset if shown affection.
• A child who does not look you in the eye.
• Speech delay of any type can be an early sign of an ASD.

There are theories proposed to explain why boys are more likely to have an ASD, but no definite answer.  Some investigators think it might be due to neuroendocrine influences on the developing brain. For example, some scientists believe that an ASD could occur as a result of testosterone acting in vulnerable developing brains or stress during critical times in brain development.

Popular DIY bloggers Sherry and John Petersik of Young House Love recently posed a question about the safety of some sandboxes. Their concerns were over certain types of sand -- commonly found in playgrounds or sandboxes -- that contain crystalline silica and asbestos tremiline-- both known to potentially put children at risk for developing cancer, says Susan Helms, Le Bonheur director of Injury Prevention and Safe Kids Mid-South.

Helms says the kind of play sand that can have both of these carcinogens is made from crushed rock,  so look for river or beach sand for your child’s sandbox.  These can usually be found at landscape or gardening stores.  Though slightly more expensive, Safe Sand sells carcinogen-free sand for sandboxes.

Helms also recommends following these guidelines from the National Health and Safety Performance:

• Sand play areas should be distinct from areas for any other equipment (such as swings, slides).
• All sandboxes should be kept covered when not under active adult supervision.  This area needs to be secured to prevent entry by children or animals, and sufficient to prevent contamination by liquids and solids.
• Sandboxes should be equipped with constant and effective drainage systems and made to present no safety hazards.
• Sterilized sand or very fine pea gravel may be used.
• Sand that becomes contaminated should be replaced.  Treatment of sand with chemicals is not recommended.
• Sand in sandboxes and play areas should be replaced as needed, but at least every two years.
  

The outdoors is exactly where children should be during the long days of summer. Running and playing in open fields and grass is what just about every child loves to do. But, those are also the same places where snakes inhabit, and if a child steps on or startles one, it might bite.

In the event you ever find yourself in a situation where a child has been bitten, Dr. Barry Gilmore, director of Emergency Services at Le Bonheur Children’s Hospital, tells exactly what you should do.

“Most importantly, parents should know that snakes are not usually agressive and won't strike unless startled, stepped on or feel threatened. In most cases, children who are bitten have been playing outdoors, hiking or walking in fields or near water. The most common area bitten are the limbs.

The first thing you should do if a child is bitten is stay calm. Allow the bite area to bleed freely for about 15 to 20 seconds, and then thoroughly cleanse the bite with antibacterial soap and water. Applying Betadine (Povidone – Iodine), an antiseptic, is ideal, however not necessary if you don’t have it on hand.

Keep the limb that has been bitten at or slightly below the heart.If it is elevated too high it could cause the poison to travel faster, and if it is too low it can cause swelling problems. Many times, parents put hot or cold packs on the area. This is not necessary and provides no benefit to the child or to the wound. There are some wives’ tales that say to suck the poison out of the fang marks by mouth or cut an incision on the site so that the poison can drain. Do not do this. Also, using a tourniquet, applying pressure or wrapping the area with bandages offer no benefit either.

After the first three steps of allowing it bleed, cleaning and keeping it at or below the heart, the next most critical thing is to get to an emergency room. The smaller the child, the worse the reaction to the poison can be, so it is very important to seek medical attention. Usually, a life-threatening reaction doesn’t immediately occur in most cases. I also encourage parents not to waste any time killing or catching the snake.It’s more important to have the bite medically assessed.

Snake bites in our area are not uncommon. Iin summer months, we can see about one per week in the Emergency Department. The most common bites come from copperhead or water moccasin snakes. The only treatment is anti-venom, and this would be administered if the complications from the bite became life-threatening.

As we get into the full swing of summer, parents need to be mindful of snakes’ presence. Around boat docks, sheds, in fields and wooded areas are all ideal places for snakes to be. The best advice is to teach your children the importance of being careful and watching for snakes while they play. They also need to understand that the best thing to do if they see one is simply back up and walk away.”

Hospitals around the country have noticed a startling issue: teens drinking ethanol hand sanitizers to get drunk. It is a dangerous trend, and we found some great information worth sharing from the American Association of Poison Control Centers.
Symptoms from alcohol poisoning include confusion, vomiting, slow or irregular breathing, blue-tinged or pale skin, low body temperature or loss of consciousness.

Safe Kids Mid-South supports the following tips for parents:

• Talk to your teens about the dangers of drinking hand sanitizers.
• Explain why alcohol poisoning is not a laughing matter
• Buy hand sanitizers that don’t contain ethanol
• If you think someone has drunk hand sanitizer to get high, call 1-800-222-1222 to reach the experts at your local poison center. Don’t wait for symptoms to develop.
  

As we get closer to summer and outdoor activities, kids will be more likely to experience a tick bite. We talked to Dr. Sandy Arnold, infectious disease specialist at Le Bonheur Children’s Hospital, about what parents need to know. Here’s what she had to say – parents note, this one is definitely worth the read!

What are ticks?
Ticks are arachnids that live in wooded areas and fields.  You can be exposed to ticks by spending time in these areas but ticks can also be found around your home. Tick bites are most common in the summer months but in warm climates it is possible to be bitten year round.

How can I be harmed by a tick?
Different kinds of ticks transmit different diseases.  Ticks acquire and transmit these infections by eating blood from animals and the diseases ticks carry depends on the part of the country in which you live.

What should I do if I am bitten by a tick?
It is very important not to use any home remedies to remove a tick. Things like nail polish, petroleum jelly, heat or flames are not effective.

Use tweezers to grasp the part of the tick that is closest to the skin.  Apply steady upward pressure to pull the tick’s mouthparts from your skin.  If you pull too hard, the mouth parts may break off.  If this happens, you need to use the tweezers to pull out the remaining parts of the tick if possible. 

Once the tick is removed, clean your hands and the area well with soap and water or rubbing alcohol. The saliva from the tick can be irritating and cause some redness and discomfort at the site. However, this does not necessarily mean the site is infected. Some diseases transmitted by ticks will result in a lesion or rash at the site of the tick bite but some do not. If you develop an abnormality of your skin in the area from which you removed the tick, consult your child’s pediatrician.

What illnesses can I get from a tick in this region?
There are several important tick borne illnesses that are relatively common in the Mid-South.

Of note, Lyme disease is not transmitted in this region.  The tick that could carry the disease, (Black Legged tick) is found in this region, but its feeding habits make it unlikely to transmit Lyme disease.  The “bull’s-eye” rash at the site of the tick bite that occurs with Southern Tick Associated Rash Illness (STARI) is very similar to that seen with Lyme disease - these can be easily confused.  This rash may be accompanied by fatigue, headache, fever and muscle pains. The cause of STARI is unknown. As it appears very similar to Lyme Disease, most physicians will treat this infection with antibiotics.

Ehrlichiosis is transmitted by the Lone Star tick in this region.  The symptoms of Ehrlichiosis usually develop within 1-2 weeks after being bitten by an infected tick.  There are many symptoms associated with Ehrlichiosis.  These are similar to symptoms of Rocky Mountain Spotted Fever.  Patients with Ehrlichiosis have fever, chills, headache, malaise, muscle pain, nausea, vomiting, diarrhea, red eyes, confusion and rash (not at the site of the tick bite).
Rocky Mountain Spotted Fever (RMSF), caused by Rickettsia rickettsii, is an infection transmitted by the dog tick.  Symptoms can begin 2 to 14 days after a tick bite and include fever, rash (which appears 2-5 days after onset of illness), headache, nausea, vomiting, abdominal pain, muscle pain, red eyes, confusion and neck pain.

These diseases can be difficult for physicians to diagnose because the symptoms overlap with many common, self-resolving, viral illnesses. It is important to note that not all patients have all symptoms and  some people have very mild or no symptoms.  Unfortunately, there is no test that your doctor can do to easily diagnose these infections so treatment must be started based on suspicion.  The infection may be confirmed by doing a blood test 10-14 days after the diagnosis but this will not influence the decision to treat.

Treatment should never be withheld pending the results of a blood test. Severe Ehrlichiosis or RMSF infection can be fatal if not treated appropriately. Prompt treatment is associated with rapid resolution of symptoms. The appropriate treatment for Ehrlichiosis and RMSF is doxycycline for children of all ages.  This is the drug recommended by both the Centers for Disease Control and the American Academy of Pediatrics. No other drug should be used to treat these infections.

Tularemia is a disease that can be transmitted by both the Lone Star tick and the Dog Tick. This disease is much less common than the others. While tick borne Tularemia can present in many ways, it may be associated with an ulcerated lesion at the site of the tick bite with or without a swollen lymph node nearby. If this occurs, you should see your child’s doctor.

How can I prevent myself from being exposed to these illnesses?
The best prevention for tick infections is the prevention of tick bites. To keep ticks out of your yard, you should remove leaves, tall grasses, brush and trash from the yard.

You can keep ticks off yourself and your family by avoiding wooded areas with tall grasses and staying on trails when hiking. Use insect repellents with DEET (20% or more) on exposed skin and Permethrin on clothing and gear.  Wear long sleeve shirts and long pants tucked into socks to avoid contact of skin with ticks.

You should also do regular tick checks after coming in from outdoors. Particular areas to check include:
• under the arms
• in and around the ears
• inside the belly button
• behind the knees
• between the legs
• around the waist
• and in the hair. 

Also check your gear and pets because ticks can come into the home then attach to you later.

Please consult the CDC website for more information.
http://www.cdc.gov/ticks/index.html