Summer can be such an exciting and fun time for children and their families. However, the fun that comes with summer activities can often lead to unexpected ED visits.
Dr. Barb Walsh, Emergency Medicine Physician at Boston Medical Center, is here to remind you how to keep your family safe this summer, whether you’re at the beach, in the pool, or in your own backyard.
Barbara (Barb) Walsh, MD
Dr. Barbara Walsh is a pediatric emergency medicine physician at boston medical center. She is board certified in emergency medicine and pediatric medicine. She completed the Boston Combined Residency Program in 1999.
Melanie Cole (Host): Summer can be such an exciting time for children and families, however the fun that comes with summer activities can often lead to unexpected emergency department visits. My guest today is Dr. Barbara Walsh. She's a Pediatric Emergency Medicine physician at Boston Medical Center. Dr. Walsh, let's start with sun safety. Quantify for us a little bit about what you see as an emergency physician as far as burns, and sunburns, and things that might happen in the sun.
Dr. Barbara Walsh, MD (Guest): Absolutely. It's a great question, and it's certainly the perfect time of the year to be discussing this, especially as peak weather has definitely hit. So unfortunately I think even though we have all of this media out there about sun safety, we are still seeing a fair number of children that are brought into the emergency department with burns.
For the most part, they are first degree burns, which means they're a red hot area that burns on the skin. Unfortunately though, especially more in the teenagers, the young adolescents, the older adolescents, when they are sort of in an area where there's more sort of prolonged sun time, they are starting to blister, and that's a second degree burn, and it's a little bit more serious. So there are bubbles that form on the skin, you still get that hot red area, but then the area blisters and the blisters can be large, they can be small. You want to try and leave those intact and not pop them. We will see children in the emergency department for treatment of the pain and discomfort. Simple stuff is always best, Solarcaine spray, some nice soothing aloe vera gel are very simple over-the-counter techniques that can be done from home. Anti-inflammatory medications such as Motrin or Tylenol for pain relief is also another good source of relieving the discomfort.
I will say that any sort of tight clothes on a burn are going to exacerbate the pain, so loose fitting after a burn is always better. And then the final thing is when you do get a second degree burn, sometimes those people end up coming to the emergency department, you try and leave a blister intact, cool soothing water, no ice. Leave the blister intact if you can. If we do see blisters, what we do is we try and put some Bacitracin or some Silvadene ointment over that and just do a- what's called a wet-to-dry dressing. But for the most part, these people could be very, very mindful, especially with the younger children, about really re-applying the sunscreen. That would really be the best bet obviously.
Melanie: Great advice about the blisters. People don't always know that. Now onto water safety. You know, this is a tragic situation I'm sure, that if you were to see something. Tell us what you recommend as far as water safety so that there is no tragedy that happens.
Dr. Walsh: Yeah, another great question. People with pools, or whether you're going to lakes, or certainly out in the ocean, you certainly want to keep an eye on your children. The best advice ever is know where your kids are at all times, make sure someone is keeping a watchful eye, especially someone who is obviously more than just a young teenager who's babysitting because eyes wander, and people get distracted especially in larger crowds.
Really for children, I know people are very excited about sort of those arm floatie things, but if you really have a young child, the best bet truly is wearing a small life jacket; one that fits properly, and they can have the clip that goes underneath in between the legs so that it's secured on and fits snugly. But I would really honestly recommend a life jacket for younger children. People that have pools, obviously the rules are to make sure that the gate is locked at all times. I can't emphasize that enough. Unfortunately we do see kids that somehow wander away, go through the sliding door, and if the pools aren't locked, they go in there and they're found floating in the pool. We certainly don't want to see tragic unnecessary events like that.
Other things to be mindful for at the beach, if there's a strong undertoe, just be really careful about the children going in and how far out they go. That's another thing that I think people don't think about frequently. Sometimes there are going to be warnings about that when the tides are really strong, but not always the case. So I just think being mindful, being aware, and being vigilant is really important, especially at larger places like the beach.
Melanie: Another thing that seems to be popular in the summer is fireworks, not only at the Fourth of July, but kind of all summer long you hear them going off in the neighborhoods. What are you seeing as far as firework issues that come into the emergency room?
Dr. Walsh: Another great question. So I would say right around the Fourth specifically, but yes, you're correct about all summer long we are seeing various fireworks injuries. Younger kids will often get tiny little burns, so more like first degree burns like a sunburn when they're doing things like sparklers.
Typically it's the older- young tween or young adolescent where they're starting to use fireworks that are a little bit more potent like the M-80s, things like that, or even firecrackers, and unfortunately we do see kids that will avulse, meaning rip off a finger, blow up something in their hand, and they'll get extensive soft tissue damage whether it's a deep burn, a laceration, or you're actually losing a digit, we absolutely see that.
Places like New Hampshire, fireworks are legal, anyone can buy them, anyone can use them. People certainly transport them over the border. I really think it's imperative that parents are vigilant with their children who may or may not have purchased them. I really think if that's going to be part of the festivities, an adult who knows what they're doing, who understands fire safety, should really be the person lighting off fireworks- true fireworks. And things can still go amiss. Fireworks can tip over, these fireworks can shoot at you, so you have to be really diligent and careful this time of year, especially using these things.
I personally think we should not let any children handle sparklers, little firecrackers, any of that stuff, because it's just not worth the risk. Kids find a way to get injured, it keeps me in business, they just find a way.
Melanie: They certainly do, and it turns a fun summer time into every parent's nightmare. Now grilling, another fun thing that we do, in just a brief moment tell us about grilling and keeping our kids away from the hot grill.
Dr. Walsh: I wish there was a great answer. I think we should just put a barricade around the grill with high, high walls. Again, a great question. I think that when parents are grilling, they really need to be careful about where their kids are, what they're doing. They can't leave that grill unattended, and I cannot speak to that more significantly. The grill should never be left unattended. If the grill does need to be sort of left for a second or so, you really need to put the top down, you really need to make sure that there's no one in the area. Kids will put their hand on it and get as bad as a second degree, and even further type of burn, which is a third degree, although much less common. Kids can get some flames popping out at them and get sort of more superficial type burns, but it can be really, really dangerous and I think that an adult has to be at that grill 24/7 when they're actually grilling, when it is on, et cetera. And if they need to put food on a plate and the plate has to be delivered, someone should come over and get it. Simple, simple common sense things I think are really what's going to make a difference for kids in the summertime.
Melanie: And even pets need to stay away from the grill. They tend to lick the propane tank.
Dr. Walsh: Oh yeah.
Melanie: So it's certainly something we have to watch out for. Now we want our kids not to play video games all the time, especially in the summer, Dr. Walsh. So then they're out on the playground, bicycle, scooters, that's what we want them to do. But you're an emergency room physician and head injuries, concussion; tell us what you want us to know about keeping kids safe when they do actually play outside.
Dr. Walsh: And I agree with you, I think they should be out playing outside. I think on a gorgeous summer day, a gorgeous spring day, a gorgeous fall day, even in the winter they should be playing outside and avoiding screen time as much as possible. It is 100% imperative that every child wears a helmet. That should go without saying. There is no exception. Bike helmets save brains. There is no question. I have seen plenty of accidents where a bike has crashed into a car, a car has hit a child on a bike, I have seen lots of scooter injuries, skateboard injuries. If you wear your helmet, it will be protective. You may end up with a minor concussion, but you don't have a severe traumatic brain injury.
There are places where people can access them for a much reduced cost. I know Boston Medical Center definitely has different programs with bike helmets and such, and I know that a lot of other places do as well. Every child needs to have a helmet, there's just no question about it.
In terms of scooters, rollerblading, skateboarding, I know this is not the most fashionable approach, but I think wrist guards are really important. Kids that fall on an outstretched hand is one of the biggest injuries I see, and it's not simply just from roller-skating or skateboarding, but in the summertime when kids are out doing that, when they fall on an outstretched hand they often break their ulna, their radius, or both, which is the forearm bones in your arm. That can be a pretty awful accident to happen in the summertime when you're stuck in a cast and you can't go in the water. So wrist guards on the wrist, while maybe they might get made fun of a bit, they really, really prevent broken bones, and I'd rather have a kid maybe be teased a little bit than end up with broken bones, and then have their complete summer ruined. Nobody wants that.
So bike helmets, wrist guards. I would even go so far as to say knee pads for those that are rollerblading and skateboarding, but you see less fractures from that, more contusions and soft tissue injuries.
Melanie: 100% great advice, and now we want to kind of finish with lawnmowers and then bugs. I don't know if as an emergency room physician you see problems from bugs, but speak about lawnmowers first, and then if you see anything with bugs, let us know.
Dr. Walsh: Yeah, no absolutely. So in terms of lawnmowers, do not let you children ride on the lawnmower with you. That's just basic common sense one, because kids again like I said, I'm in business for a reason. Children find a way to get injured. It's just part of their nature. Kids should not be riding on the ride-on lawnmower. Young kids should not be, I think, using a lawnmower because I think that they're too young, there's a skill involved, and accidents do happen.
A lot of what we see are fingers getting caught in the motor or being run over accidentally in the motor. So we're seeing a lot of lacerated hands and foot injuries where there can be tendon and nerve damage, vessel damage, which can be very complex. Your hand is one of the most intricate parts of your body with a lot of moving pieces that are vital to function. So I think that young children should not be anywhere near lawnmowers when they're out, should not be riding on the lawnmowers, and I think people need to be very cautious about how they're stored and kind of access to them. And while we have great surgeons out there that can fix a lot of these injuries, it's best to prevent it than to have to deal with it of course.
In terms of bugs, I mean mosquitoes are everywhere. The weather this season, the more we're seeing. Certainly people worry about West Nile and other types of tick-borne and mosquito-borne bug issues. I think for younger children doing sort of precaution with bug spray. That is not Veet, which I think is a little bit safer, might be a little bit less effective is definitely the way to go. There's different sprays, there's different sort of applications with more like a sponge. I think that any kind of camping, being by a lake, a river, things like that, hiking, I think it's really important because the bugs are pretty, pretty bad.
For the most part, if you get bit by a mosquito, it's not really that big a deal. Not that many people are going to get West Nile or equine encephalitis, but some people do and it's usually the extremes of ages like the young and the old. For the most part, you have to worry about a bunch of bug bites getting infected, that kind of thing. So more of the common stuff like a cellulitis. Ticks are everywhere. Not just in Massachusetts, not just in New England, ticks are everywhere. I think one of the things to think about after being outside with your children is at night, before they get in the bath, be really diligent about doing a head to toe tick check, including the hairline. Ticks find a way to crawl up and get in all sorts of crevices. They like the nooks and crannies. I just think it's really important.
Lyme's Disease is very treatable, but sometimes we can miss it if the rash isn't there, so I think that just being really careful about doing a tick check, and getting the ticks off is very important. And one little sort of trick that I love, a vet store, any veterinarian place, and you can get a dog tick remover. They come in two sizes, and those dog tick removers work great on humans. I use them in my own practice. $0.99 I believe, it's the best thing I've ever purchased, and all you do is scoot it underneath and you just twirl it around and it pulls the tick right out.
Melanie: What a great thing.
Dr. Walsh: Yeah, it's phenomenal.
Dr. Walsh: I know, it's so simple.
Melanie: What a great tip, Dr. Walsh.
Dr. Walsh: I should be doing marketing.
Melanie: You should, that's fantastic. Now wrap it up for us. You know, we don't want to see you, and we don't want you kept in business, but certainly people are going to have things happen in the summer. Best advice for summer safety?
Dr. Walsh: You know, I think the best advice is to really be thoughtful about the activity that you're doing, potential areas where things could go amiss, and just using common sense. I think if we just stop and thought about, "What activity are we planning for the day with the family? What are the things that we need to make sure everybody is in a safe environment?"
And I think it's just that simple. Just pause for a moment. I think we just go too fast and do things too quickly and maybe we forget the suntan lotion, or we forget the bug spray, or, "I forgot my helmet but this is a really important thing." I think if we just take a step back, take a breath, think about what we're doing, and just take a minute to think about summer safety, I think common sense will help us prevent a lot of these injuries this summer.
Melanie: Thank you so much, Dr. Walsh, for being with us today and sharing all of that great information. So important for parents, really and for everybody to hear at this point. Thank you so much again for being with us today. You are listening to Boston Med Talks with Boston Medical Center. For more information you can go to www.BMC.org. That's www.BMC.org. This is Melanie Cole, thanks so much for listening.