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.”

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

For many families, our pets are an essential part of everyday life. Walks in the parks, playing fetch and napping around the house are a daily occurrence for our beloved friends. Parents need to be informed and take certain precautions to ensure that the entire family unit is living happily - and most importantly, safely - all under the same roof.

Dr. Barry Gilmore, director of Emergency Services at Le Bonheur Children’s Hospital, shares some important information about what parents should know about dog bites.

What is the most common reason for a child to be bitten by a dog?
A toddler or small child usually startles the family pet or approaches an unfamiliar animal. Many times, children will approach an older pet or one who is eating or sleeping causing a negative reaction from the animal.

What are some injuries seen resulting from a dog bite?
Puncture wounds to the skin from the animal’s teeth are usually the most common injury seen. Many times, small tears and scrapes are seen as well from the teeth and claws.

Parents should clean the wound immediately with soap, warm water and hydrogen peroxide. Stopping the bleeding and assessing the severity of the wound needs to happen next. This will then determine whether or not a visit to the emergency department or pediatrician’s office is needed. Injuries to the face or hands and ones that are deep or have persistent bleeding need to be evaluated by a doctor. Parents need to ask the doctor if a tetanus shot should be administered after the child is bitten or scratched.

Where do dogs usually bite a child?
Injuries to the face are most common for small children as they are at eye level with the animal. Older children usually have injuries to their lower legs and arms. Other more severe injuries can occur to the eyes, mouth or neck area.

What can parents do for any pain or swelling?
For injuries not requiring medical attention, cold compresses to the skin will reduce the swelling and help with the pain. Motrin or other pain relievers can be given every 4 to 6 hours for children over the age of six months. For children under six months, Infant’s Tylenol can be given. Parents should watch the wound for infection until it has healed completely.