Anticipatory Guidance

Summertime Safety


During the summertime months, children enjoy time off from school and participate in outdoor activities. The following guidelines will help ensure a safe and healthy summer.

Sun Protection

Spring and summer means more sun-exposure, but various measures can be taken to help minimize any long-lasting skin damage.  Melanoma is the seventh most frequent cancer in the US and sunburns in childhood increases a person’s risk for developing it. It is estimated that 80% of a person’s lifetime of sun exposure occurs before the age of 18.

Its important for providers to discuss skin cancer prevention at all ages, calling particular attention to those individuals who are at higher risk for skin cancer:

  • Lighter colored skin, hair, or eyes
  • A tendency to burn rather than tan
  • A history of severe sunburns
  • Many moles or some irregular moles
  • Personal or family history of skin cancer

For infants under 6 months of age (and all ages), sun avoidance is best.  Infants are very sensitive to the sun partly because they have less melanin in their skin (which means greater risk of burning) and also because they have a reduced ability to sweat and dissipate heat.  Avoidance, avoidance, avoidance is the key, particularly when it comes to infants.  Stay in the shade, pull down the cover on the stroller, and use lightweight wide brimmed hats.

 It is okay to apply a small amount of sunscreen on infants under 6 months if there is no way to avoid the sun. For older children, apply liberally and remember it takes 15-30 minutes to be effective.  Use an SPF of at least 15 and choose one that says it is broad spectrum which means it provides protection against UVA and UVB rays.  Do not apply it to infant's hands as they can suck on them.  Also, consider choosing a sun-block that is fragrance-free to minimize any contact irritation.  

Higher levels of SPF protection may offer higher protection (SPF 15 blocks 94% of UVB radiation while SPF 30 blocks 97%), however the key to sunscreen is in it's proper application (a liberal amount) & reapplication at least every 2 hours, sooner if there is excessive sweating or contact with water.

Providers should council families to at least avoid being outdoors during the midday (10 am to 4 pm) when sun exposure is the most intense.  Also, remind families that most of the sun’s rays can come through the clouds on an overcast day; so use sun protection even on cloudy days.

Additional protective measures can include covering up with lightweight loose clothing to cover the arms and legs, wearing a brimmed hat, and wearing sunglasses that block UVA and UVB rays.

CLICK BELOW to link to some helpful sun safety resources for parents & providers alike.


Water Safety

In the summertime months, children enjoy playing in and around swimming pools and natural bodies of water. Unfortunately, drowning is a common cause of childhood death and can occur in as little as 2 inches of water.

For adolescents and young adults (ages 15 to 24 years), most drowning incidents occur in natural bodies of water. Parents and clinicians should educate adolescents about water safety and the dangers of drug use & intoxication while in and around water.

Children aged 1 to 4 years are more likely to drown in swimming pools while temporarily unsupervised (usually for less than 5 minutes). Typical incidents involve a child left unattended temporarily or under the supervision of an older sibling. Parents should practice touch supervision, where they are within an arm's length of a swimming child at all times.

Additiona​l safety measures include:

  • Ensuring proper fencing around swimming pools. The fence should enclose all four sides of the swimming pool at a minimum height of 4 feet and have a self-closing latched gate. This type of fencing has been shown to reduce drowning incidents by up to 80%.
  • Life vests are an important preventive intervention for all age groups.
  • Although swimming lessons may improve swimming ability, they have not been shown to reduce drowning incidents.
  • Parents, caregivers and pool owners should all learn how to perform CPR





Head trauma is a major cause of death in children, and a significant proportion results from bicycle-related injuries. Children under 15 years of age account for 75% of bicycle-related head injuries and up to 50% of bicycle-related deaths. Although less common, children can also be injured when using scooters, skateboards, and skates. These injuries include fractures of the wrist, hand, and ankle and facial trauma.

Parents should be counseled on the importance of bicycle helmets and personal protective equipment for children riding bicycles, scooters, skateboards, and skates. Bicycle helmets reduce pediatric head injuries by 85%.

Helmets should be approved by Snell or American National Standards Institute (ANSI) and must be fitted properly - CLICK BELOW to link to helmet fit information.


For inline skaters, wrist guards and elbow pads can reduce injuries to the upper extremities by 90%. Children riding scooters, skateboards, and skates should wear knee and elbow pads.

Heat-related illness

On hot summer days, children are susceptible to heat-related illness, which encompasses a spectrum of conditions ranging from mild (heat exhaustion, heat cramps) to life threatening (heat stroke) (Table 1).

Heat stroke is a medical emergency characterized by a core body temperature of 40°C or greater and central nervous system disturbances. Children who perform strenuous activity in hot and humid environments are at increased risk. Among high school athletes, football players are at a 10-fold increased risk of heat-related illness.




Initial treatment

Mild (heat cramps, heat exhaustion)

Diarrhea, dizziness, headache, irritability, loss of coordination, nausea/vomiting, syncope, weakness

Core temperature <40°C, normal mentation, goose flesh, pallor, tachycardia, hypotension

Move to a cool location, hydration, rest, sodium ingestion

Heat stroke

Confusion, dizziness, hallucination, headache, nausea, vomiting, syncope

Core temperature ≥ 104°F, altered mental status, hot skin with or without perspiration, hypotension, seizure, tachycardia

Initiate on-site cooling, intravenous hydration, transport for emergency care

Table 1: Heat-related illness. Reproduced from Becker et al.

Morbidity is reduced with rapid cooling. The best technique is cold-water immersion, which leads to a survival rate of almost 100%. When cold-water immersion is not available, alternatives include applying ice packs, convection cooling with a fan, and spraying water mist. Intravenous hydration should be initiated as soon as possible to protect the kidneys and vital organs. Delayed or improper treatment can lead to death.

Heat-related illnesses can be prevented by spending time in air-conditioned areas (8). Fans do not provide the same protection. Children should continue to drink water and remain hydreated when spending time outdoors. Parents should be educated about the signs and symptoms of heat-related illnesses and seek immediate medical attention should they arise.

Parents should NEVER leave children in a car unattended during even semi-warm days.  Heat can accumlate exponentially in cars and the body temperature of children rises 3-5 times faster than adults, meaning as a result, children are much more vulnerable to heat stroke. Child deaths from heat stroke have occurred as early as February and with an outside temperature as low as 57 degrees F.  Learn more by CLICKING BELOW:


Information for parents about heat-related illness can be found by CLIKCING ON THE LINK BELOW:


Fire Safety

Summer means barbecues, beach bonfires, and fireworks for many families.  These summert time traditions should be enjoyed, but proper safety precautions should be taken to ensure no one is hurt.

Keep children away from barbecues and any heat sources like fire pits or bonfires.  Take care walking around this area, and have children wear protective footwear particularly when walking around potentialy hot embers.

Coals and ashes from fires extinguished long ago (even over a day) may remain hidden in the sand, so take care not to let children walk around areas that have had a recent fire as well.  Proper extinguishing of a fire that families create is helpful in preventing this occurence as well.

Fireworks should never be handled by anyone other than a capable adult.  Even sparklers can generate temperatures over 1200 degrees. Even better advice is to "leave it to the pros" favoring organized and safe firework demonstrations rather than ones performed at home.  CLICK BELOW for more information on firework & Fourth of July safety.

Insects and Ticks

Bites from insects and ticks most often cause local inflammation but can also lead to dangerous allergic reactions and infectious diseases. Insect and tick bites can be prevented by avoidance:

  • Avoid going outdoors when insects feed, especially at dusk or dawn, after rain, or in brush, tall grass or wooded areas.
  • Avoid areas where insects nest or congregate, such as garbage cans, stagnant pools of water, uncovered foods and sweets, and orchards and gardens where flowers are in bloom.
  • Empy pools of standing water where insects can breed.
  • When you know your child will be exposed to insects, dress appropriately in long pants and a lightweight longsleeved shirt.
  • Avoid dressing your child in clothing with bright colors or flowery prints, because they seem to attract insects.
  • Don’t use perfumed items like scented soaps, perfumes, or hair sprays on your child, because they also are inviting to insects.

If avoidance is not possible, topical insect repellents play a role in protection. Scientific evidence has demonstrated the efficacy of DEET, icaridin, and PMD as repellants. Other repellents, including many plant-based oils, are not as effective.  

Although effective, any of the following repellants should be used sparingly and not for more than once a day.  

  • DEET is the first-line insect repellent. It is considered practically non-toxic for acute inhalation and primary exposure and only slightly toxic for oral, dermal, and eye irritation. It is approved for use in children older than 6 months.
  • Icaridin has a similar efficacy and safety profile as DEET but often requires more frequent application.
  • PMD is a plant-based oil derived from lemon eucalyptus and has equal efficacy and about or slightly less longevity as DEET.  It is approved for use in children over age 3.

Typically, the more of the active ingredient a product contains the longer it will protect from bites.  For example, a product with 23% DEET will provide an average of five hours of protection, but a product with 5% DEET only one and one half hours of protection.

The AAP recommends 30 percent DEET applied once before going outdoors. These repellents are effective in preventing bites by mosquitoes, ticks, fleas, chiggers, and biting flies, but have virtually no effect on stinging insects such as bees, hornets, and wasps

It is important to review generic safety use for families with these products:

  • Use as directed on the product label
  • Apply only to exposed skin or clothing
  • Do not allow children to handle this product, parents should apply to child
  • Do not apply to eyes or mouth, or infant's hands and do not spray directly on face, instead spray a parent's hands first to apply it to the face
  • Wash skin with soap & water upon returning indoors and prior to reapplying
  • Do not apply over open skin
  • Do not use combination repellent/sunscreen products - sunscreen should be applied often and copiously. Use insect repellent only as needed and washed off immediately when out of harm of insects.

Tick bites

Ticks are more prevalent in the warm summer months and can carry diseases. Prevention of tick bites is important for children spending time outdoors, especially in wooded areas. Preventative measures include:

  • Avoiding tick-infested areas (especially places with leaf-litter and high grasses)
  • Wearing protective clothing such as long-sleeved shirts, long trousers, boots or sturdy shoes and a head covering. Consider taping the area where pants and socks meet so ticks cannot crawl under clothing.
  • Walk in the center of trails so weeds do not brush against you.
  • Avoid sitting on the ground or disturbing leaf litter on the forest floor.
  • Bathe/shower as soon as possible after coming indoors with soap & water.
  • Wash and tumble dry clothing used outdoors.
  • Check pets for ticks.
  • At home, clean up items that attract rodents which can carry ticks, such as spilled birdseed, and hiding places like old wood piles.

Repellants containing DEET can also be used on on exposed skin and clothes. Parents should apply these products to their children according to the manufacturer’s instructions, avoiding the hands, eyes, and mouth.

After spending time outdoors, children should be checked for ticks. A full-body check should be performed, including 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.

If a tick is found, it should be removed gently using tweezers from the head, pulling upward with steady, even pressure. Don’t remove ticks with matches, lighted cigarettes, or nail polish remover.  If in doubt, parents should seek medical advice on how to remove a tick.  After tick removal, the bite area and hands should be washed thoroughly with soap and water and apply an antiseptic to the bite site.   

Ticks can be safely disposed of by placing them in a container of soapy water or alcohol, sticking them to tape or flushing them down the toilet. If you want to have the tick identified, put it into a leak-proof container with rubbing alcohol along with the date and location where the tick was encountered and contact your local health department for assistance:

  • Illinois Department of Public Health, Division of Environmental Health, 525 W. Jefferson St., Springfield, IL 62761; 217-782-5830, TTY (hearing impaired use only) 800-547-0466.

The concern over ticks is due to the numerous tick-borne illnesses. Most cause fever, chills, headache, fatigue, muscle pain, and rash. Unique features of different tick-borne illnesses are listed in Table 2. The diagnosis and treatment of tick-borne illnesses depends on the particular disease, consult the AAP Red Book for further information.


Causative Organism

Tick Vector


Unique Symptoms


Anaplasma phagocytophilum

Ixodes scapularis, Ixodes pacificus

Northeast USA, Pacific coast USA



Babesia microti

Ixodes scapularis

Northeast USA, Upper Midwest USA



Anaplasma phagocytophilum, Ehrlichia ewingii, Ehrlichia chaffeensis, Ehrlichia canis, Neorickettsia sennetsu

Ambylomma americanum

South Central USA, East USA

Maculopapular or petechial rash

Lyme Disease

Borrelia burgdorferi

Ixodes scapularis, Ixodes pacificus

Northeast USA, Upper Midwest USA, Pacific coast USA

Joint pain, erythema migrans


Rickettsia parkeri

Amblyomma maculatum

Gulf Coast USA


Rocky Mountain Spotted Fever

Rickettsia rickettsii

Dermacentor variabilis, Dermacentor andersoni, Rhipicephalus sangunineus

USA, Central America, South America

Rash (macular followed by petechial)

Southern Tick-Associated Rash Illness


Ambylomma americanum

Southeast USA, East USA

Rash similar to erythema migrans

Tickborne Relapsing Fever

Borrelia hermsii, Borrelia turicata

Soft ticks




Francisella tularensis

Dermacentor variabilis, Dermacentor andersoni, Amblyomma americanum


Ulcer at site of tick bite, lymphadenopathy

Table 2: Tick-borne illnesses. Information compiled from the CDC.


CLICK BELOW or call 217-782-2016 to obtain fact sheets and information about symptoms and treatment of tickborne diseases:


Insect Stings and Allergic Reactions

Approximately 1% of children have systemic allergic reactions to insect stings. The insects most frequently responsible are bees, yellow jackets, hornets, wasps, and fire ants. Systemic reactions are IgE mediated and may cause anaphylaxis.

Signs and symptoms include generalized urticaria, angioedema, throat tightness, dyspnea, dizziness, and hypotensive shock. The majority of systemic reactions include only urticaria and angioedema; however, children may develop anaphylaxis.

Children that do develop anaphylaxis require emergency medical attention with observation for 3–6 hours. The best treatment for anaphylaxis is intramuscular epinephrine. Children should be discharged with a self-injectable epinephrine device (EpiPen or EpiPen Jr.) and a referral for an allergy consultation. Parents and caregivers must be informed that self-injectable epinephrine does not substitute for emergency medical attention.

Proper EpiPen education & use is critical, and often not reviewed with families. CLICK BELOW to access a very informative video for parents on how to administer the drug if needed.



Clinical information on recognition and management of anaphylaxis can be found by CLICKING HERE:



  1. Moore SJ et al. Insect Bite Prevention. Infectious Disease Clinics of North America. 2012;26(3): 655-673.
  2. CDC. Accessed March 23, 2013.
  3. Graham J et al. Tick-Borne Illnesses: A CME Update. Pediatric Emergency Care. 2011; 27(2):141-147.
  4. Golden DBK. Stinging insect allergy. Am Fam Physician. 2003 Jun 15;67(12):2541-2546.
  5. Judy K. Unintentional injuries in pediatrics. Pediatrics in review. 2011;32(10):431-439.
  6. Schunk JE and Schutzman SA. Pediatric head injury. Pediatrics in review. 2012; 33(9):398-411.
  7. Okun A. Safety on bicycles, skateboards, scooters, and skates. Pediatrics in review. 2008;29(10):366-367.
  8. Becker JA et al. Heat-related illness. Am Fam Physician. 2011;83(11):1325-1330.