Your Summer Safety Checklist for Kids

Children need constant supervision, but what can parents or caregivers do when trouble finds the kiddos? Spencer Pruitt, M.D., Texas Tech Physicians pediatrician, answers our questions about potentially emergency situations such as animal bites or stings, drownings, handling a wild animal or being bitten by one. Dr. Pruitt also answers our questions about children and dehydration and food poisoning and when we should take our child to the emergency room or primary care provider. 

Additional notes:

Previous child safety episode: Keeping Kids Safe: A Guide to Burn Prevention

Transcript

Melissa Whitfield  00:00
Hello and welcome back to Texas Tech Health Check from Texas Tech University Health Sciences Center. I'm your host. Melissa Whitfield. We want you to get healthy and stay healthy with help from evidence based advice from our physicians, health care providers and researchers. A few months ago, we did an episode on how to prevent children's burns, but we realized that kids can get into trouble any time of the year. Dr Spencer Pruitt, Texas Tech physicians, pediatrician in Amarillo is our expert for this episode, and he talks to us about what to do in emergency situations such as animal bites or stings drownings or handling a wild animal or being bitten by one. He also talks to us about other potentially dangerous situations like dehydration and food poisoning, and he also explains when we should take a child to the emergency room or see the primary care provider,

Melissa Whitfield  01:06
Dr. Pruitt, Welcome to our podcast.

Spencer Pruitt, M.D.  01:09
Thank you for having me.

Melissa Whitfield  01:10
Can you tell us a little bit about yourself, your expertise and what you do at Texas Tech Physicians and the Health Science Center?

Spencer Pruitt, M.D.  01:20
Yeah, I'd love to I am a pediatric critical care physician at Texas Tech University Health Science Center in Amarillo. I work as both the Medical Director of the pediatric ICU at Northwest Texas Children's Hospital, as well as chief of pediatrics for Northwest Hospital. In addition, in my somewhat free time, I am president of Pediatric Critical Care Specialists, a company that helps provide education and pediatric critical care services around the country to many different children's hospitals as well as volunteering in the community. I'm very active in the Boy Scout troops, I guess it's now scouting America as I grew up as an Eagle Scout, and I'm active in a local troop as well. And I'm a happy father of three, and so I have both personal experience with pediatrics, as well as being a physician.

Melissa Whitfield  02:25
Well again, welcome to our podcast. We're very happy that you could join us, especially from all the way from Amarillo.

Spencer Pruitt, M.D.  02:31
Thank you. Thanks for having me

Melissa Whitfield  02:33
So children can get into sorts of mischief during any time of the year, but summer feels like there are extra hazards out there. For example, what can a parent or caregiver do if a child is bitten by a snake or other venomous animals, particularly in our area, or maybe even spider scorpions or other insects?

Spencer Pruitt, M.D.  02:57
The Texas Panhandle is a beautiful area to live and seems to also be home to lots of dangerous or deadly animals. Snake bites are a relatively common occurrence in the Texas Panhandle. We probably see one or two rattlesnake bites per month during the summer months in the Amarillo area, and it is vitally important that people remain vigilant for those, those snakes. I would say that rattlesnakes are the most common problem snake that people have to worry about. There are a lot of different snakes in the area and really throughout the United States, but rattlesnakes, both are iconic because of their rattle, but also when they strike, the venom has the ability to cause the leg or arm, whatever your bit, to really swell up and get very painful and bruise and look really black and blue. And so people who see the snake bite often come away with this sense of fear and shock. The benefit to a rattlesnake bite, if there is any, is that we have an anti venom for it. So some things that we can do, if we are worried about rattlesnake bites is, first, don't try to pick up the snake. You might laugh, but this is a very common occurrence that people feel like they need to bring the snake into the emergency room with them. You don't. If you can take a picture of it, great. But obviously the first thing we want you to do is get out of the way where you're safe, take your child to where they're safe, and that they can lay down in what we call kind of a neutral position, to keep their arms and their legs at the same level as their heart. And once you're there and there's not a risk of being bitten again, then sure, if you can take a picture of that snake, go for it. Do it. Bring in that picture on your phone so that we know exactly what you're dealing with. If you can't, don't worry about it. The second thing really is to make sure that you remove all rings, bracelets, anything that's going to be constricting off of the limb that was bitten. Your leg or your arm, your child's leg or arm will swell up, and often, will swell up two or three times to the normal size that it is. And so we want to make sure that anything that can constrict that limb is off. Otherwise it could cut blood flow to that limb and cause it another problem that we don't really want to deal with. And then, thirdly, you want to just get to the emergency room as quick as possible. Once you're in the emergency room, a physician there can see you, they can recognize what type of bite it is after talking to you and getting that history, and if it is a rattlesnake bite, we can start with an anti venom. You'll get multiple doses of anti venom, usually in the pediatric ICU, where I worked, and you probably will be in the hospital for multiple days. But it's very key to get that going early and quickly in terms of prevention, snakes, like a lot of humans, want to just go about their own business. They don't really want to be messed with. They're not there to bite you. They're really just there to kind of do their thing. And so the best thing that you can do is, if you see a snake, leave it alone, and if you can do simple things like keep your yard clear, mow your lawn regularly, get rid of things where that might look to a snake as a very enticing place to kind of stay and get out of the heat and make its own home. If you can do that and keep things clear, then you minimize the chance of running into any snake, but especially a rattlesnake. And then one of the nice things about being in Texas is wear your boots. It's a great thing to have boots. And boots were made for a reason, and part of that reason is if you get those high boots and they go up about your your calf or up towards your knee. You know most rattlesnake bites are going to happen on the foot and the ankle, because they're down there at that level and you're walking and you just don't see. The final thing about rattlesnake bites, I think is worth noting is that even if you aren't sure what the snake is, if you can give an approximate size, say, "Oh, this snake was really small," or "This snake was really large." That actually helps a little bit, because contrary to popular belief, young rattlesnakes are more dangerous than older rattlesnakes. An older rattlesnake has learned. They've figured out how to dose their venom, and they actually won't use very much venom, just enough to kind of get whoever's messing with them to go away. But a young rattlesnake, especially a teenage rattlesnake, they're very impetuous, and they don't know what they're doing yet. One bite may have no venom at all. That person's gonna get lucky, but the next bite might have a ton of venom, and you'll get really, really sick. So the sickest rattlesnake bites we actually see come from the youngest rattlesnakes.

Melissa Whitfield  08:41
Well, it's not anything that I ever thought about the age of a snake.

Spencer Pruitt, M.D.  08:45
Yep. You asked about other things that we can think about in the Texas panhandle. Well, some things that we see throughout the Texas panhandle are scorpions. Also, as you go on vacation, maybe you head over into New Mexico or other parts of the Southwest, where scorpions are very common, and as your kids may head off to summer camp, that might be something that you got to think about. Just like with rattlesnakes, prevention is key. Scorpions love to find little places to hide and checking your shoes each morning is the best way to prevent a scorpion sting. If you're out camping, scorpions love to find your shoes and burrow into them. And then you get up in the morning and you put your foot in. Ding! They're going to get you right there. So you know, kicking your shoes, knocking them over make sure that nothing crawls out of them before you put them on is a simple way to prevent from scorpion stings. Scorpion stings are typically worse with smaller kids, because they're going to give the same amount of venom with each sting, regardless of the size of the patient. And so as little kids come in, they're going to get essentially a higher dose, because they have less less weight on them, but they're getting the same amount of venom. Whereas an adult is a much bigger person, it'll typically be very painful. You'll have swelling. You can have some bruising, but the real key you got to watch out for severe symptoms. Severe symptoms are going to feel like your heart is racing. Your kid might have nausea, vomiting. They might have some breathing difficulties. You might see them sweat a lot more than normal, or have increased saliva production. These type of things are the go to the ER immediately signs.Most scorpion stings are just going to hurt and they're going to swell, and they use a little bit of ibuprofen and some ice packs, and you're going to get through it just fine. But again, if you see the severe symptoms, you want to go to the ER immediately. And again, those severe symptoms are heart racing, nausea, vomiting, difficulty, breathing, sweating a lot, salivating a lot. Those type of things show that this venom is really strong and going all over the body.

Melissa Whitfield  11:27
One of my favorite activities during the summer is to watch the bats fly at sunset, and bats are the most commonly reported animals to have rabies. It's not something we hear in the news a lot, but rabies could be another potential danger for children. What should parents or caregivers do if their child has any contact with a bat or with a straight animal?

Spencer Pruitt, M.D.  11:50
I grew up in Houston, Texas, and when I was younger and even into college, one of the things that we would do is head up towards Austin. And Austin is famous for their bats. You can go and you'd see them come out from under the bridge over the river there, and they would fly up in just droves. There's so many of them, and it really is a pretty fascinating sight. Bats are assumed to always have rabies. Never touch a bat. It may be fun to look at, but you don't want to get close to one. The most common way that you're going to interact with a bat is actually when your child is asleep. You're going to come into the room in the morning and you're going to see a bat on the ground dead in your child's room because it got in through an open window. That is the number one way that children are associated with bats. And if that happens, you have to assume that a bite occurred, even though the child may not know it. It is unfortunate. I guess that children don't do a very good job of reporting when they're bit. And so as a health care provider, we have to assume that a child is bit if there is a dead bat around. Now, it might be a little different if you're watching a bat and you physically see the bat land on a tree branch in front of you, or the railing of a fence, then you're actively seeing it. But if you come upon a dead bat in a room with a child and you have no clue what's happened, you have to assume the child's been bit, and then what do you do? Well, you want to go to the emergency room, because rabies is an incredibly deadly disease. In fact, it's nearly 100% fatal. Rabies is a virus that infects the brain of the whoever has been bitten, whether that's an animal or your child, and the only way to prevent death if you've been bitten by a rabid animal is you go to the emergency room and they will give you what's called rabies immunoglobulin that is essentially concentrated pooled cells from somebody who's been infected that's fighting off the virus, and then they'll give them to you so that you can immediately start fighting off the virus that's in you from being bit or your child, and then the next thing they're going to do is they're going to give you a rabies vaccine. And that vaccine is four different shots that will happen on various times over the next two weeks. So you're going to have to return to the emergency room multiple times over the next two weeks to get those shots so that you can prevent this rabies, because, again, when it's 99 to 100% fatal, you just don't want to take any chance with it. Other animals can carry rabies. You know, we always think about dogs in the movies. You think about that dog that's snarling at you and and has maybe foaming at the mouth. But dogs are actually not very common rabid animals throughout the United States and definitely in the Texas Panhandle. The most common carrier is a bat, but the second most common cause and carrier is a raccoon. Raccoons are everywhere. We love them. They look they look cuddly and cute, right? We give them nicknames, like trash pandas, you know. One time, one time, I was even traveling home from Baton Rouge to Houston, and we stopped at a truck stop let the kids use the restroom, and there was a state police officer there, and he had a huge jumbo pack of puffy Cheetos, and he is feeding the puffy Cheetos to a raccoon who is standing on its hind legs, grabbing the puffy Cheetos with both of its front paws and eating them. And of course, my son. He's like, four or five years old, first thing he wants to do is go feed the puffy Cheetos to the raccoon. And all I can think of is rabies, dude. Rabies like, Don't feed the raccoons. They're so cute and cuddly. Everyone wants to mess with them, but raccoons are a common cause of rabies. So some things that you can think about again to minimize your risk is this animal doing a normal thing that it's supposed to do. Raccoons are nocturnal animals. They are awake at night. You shouldn't see one during the day. My wife and my kids and I, we were, we were at a state park, and we were walking through the forest, and all of a sudden we saw a raccoon come up, and it was the middle of the day, and it also looked drunk. It was walking, but it wasn't walking in a straight line. It was kind of drifting right and drifting left. And so what did we do? We all took a step back, made sure that we gave it six to 10 feet where it wasn't near us. And we took pictures, because they're like, hey, it's a raccoon, but then you let it go on because that raccoon most likely had rabies. It was awake when it wasn't supposed to be it was acting like it's drunk. And again, rabies infects the brain. So rabies is going to make them want to bite. It's going to make them not like bright lights, but they're going to act funny in that they're going to be awake when they're not supposed to be, and they're going to look like they're doing things they're not supposed to be, really. You think of Count Dracula, okay. The vampire myths and legends that we have Count Dracula that we see in all the movies and and on our cereal boxes, right? That all stems from a rabies outbreak in the Middle Ages, where you had bats and wolves. You had people that were afraid of the sunlight. You had things that wanted to bite you. All of those things that we now associate with vampires actually are right associated with rabies. And so if you see somebody or something really doing those types of things, just avoid, avoid altogether, and then you don't have to worry about that bite.

Melissa Whitfield  18:21
That's very interesting. Some families might be traveling to go swimming or some water hole, some beach or resort. Drowning could also be a potential danger for children, especially for children with autism or epilepsy. What can parents or caregivers to keep their child safe, and what can they do in case of a drowning? And do you recommend defibrillators for children?

Spencer Pruitt, M.D.  18:50
Oh, drowning is a serious topic. Every summer, I see multiple kids drown every year, and it is an incredibly sad thing. First thing I guess we should probably say about drowning is we should probably set some terminology. In the medical world we call drownings a submersion injury, because you're going underneath the water, and it can be fatal or non fatal. What we don't say is wet drowning or dry drowning or near drowning. All of those terminology are misnomers. They confuse people, and they lead to urban legends, urban myths, things like that. So really, there's only drowning that's fatal, drowning that's non fatal, and it's pretty common. There's about 5500 kids that will die every year from drowning. Another 38, to 40,000 will show up in the emergency room with severe symptoms, and they'll survive, but they will probably have significant neurologic injury afterwards, and spend weeks or months in a pediatric ICU. So the number one thing that we can do, as always, is to try to prevent, instead of reacting to drowning. If we look at who drowns, the most likely person to drown is a child between the age of one and four. In fact, after birth defects, drowning is the number one cause of death in children aged one to four. And the most common reason is that they're not watched properly around swimming pools and bathtubs. I have an axiom that I live by, and that axiom, which I teach to all of my parents that come into the ICU is, the more adults there are, the less anyone is watching your child. I'll say that again: the more adults there are, the less anyone is watching your child. Often, what happens is, you go to the pool party in the summer. It's July 4 coming on up or, you know, it's the it's summertime, and you want to go to the pool. And when you do, there's a ton of people there. There might be 10, 15, kids in the backyard, at the swimming pool. You have parents with everybody. And what happens? Everyone starts to assume that somebody else is watching their child. And you're sitting there and you're talking and you're laughing, maybe you're having a drink, maybe you're eating some barbecue, and all of a sudden, you look over and somebody says, "Where's Jimmy?" I'll give you another example. Kids will move quickly. I was learning to be a pediatrician at the time. This was many years ago, in Baton Rouge, and my wife and I went to a pool party held by one of the pediatricians that was one of my teachers, one of my bosses, there in Baton Rouge, and we were just getting ready to leave. I had two children at the time. One of them was young, and so we got to the front door, and we put her into the the kind of car seat for the car. And my my son, who's my eldest, is about three or four years old. And we looked at each other and we realized that we had forgotten one of our towels, and my son being the good little boy that he is, he says, "Oh, don't worry, Dad. I'll go get it." And he starts sprinting with his little legs back towards the back of the house. Now, luckily, I decided to follow him. Now I'm walking. I've got bigger legs. So he's running; I'm walking. And he gets to that back door before I do and opens it up. And in his little three or four year old brain, he sees the pool, and the idea of getting the towel is absolutely gone out of his mind, and he thinks, I want to go swimming again. One, two, boom, he is in the water, and it is about two steps later that I reach that back door and I see him in the pool, head under the water. At the same time that some of my other pediatric colleagues are standing up. One of them is yelling, "Hey, that's Spencer's kid in the water." And I take two more steps, reach down with one hand and just grab his shoulder and rip him out of the water. He's coughing and sputtering. He ends up being okay. But how close was that? If somebody wasn't looking, if I hadn't chosen to follow him to the back door, he could have drowned. And it wasn't. but the very next day that I am working in the pediatric ICU as a as a pediatric resident, and in comes a child the same age: a three year old boy who had drowned in a swimming pool that day, and man, did that hit me hard. Oh, it hurt so bad, tears in my eyes, because I had seen my own son in that same situation, not more than 24 hours earlier. It happens like that. So when you put a child in a swimming pool or a bathtub, you have to have a designated watcher. Okay, if you're in a swimming pool, and there's a lot of parents around, make someone designated. Say you are the designated watcher for the next 15 minutes. You don't get to drink your beer, you're not chatting with people. You're playing lifeguard for 15 minutes. And just switch out every 15 minutes so everyone gets to enjoy the company, but then somebody is always watching the kids. If you don't have a designated watcher, you got to watch your own kids, because if you're not watching them, nobody is. If you put somebody in your bathtub, it only takes about two inches of water for a toddler to drown in a bathtub. Nobody is safe in a bathtub. If they are under about two to three years of age, cannot be doesn't matter if they walk and they talk. They are not safe. And so many times I have to tell parents, "I'm sorry your child is dead" because they put their kid in the bathtub and then they left for just five minutes because they needed to go and they had to get something, maybe the laundry dinged and they need to change it from the washer to the dryer, or another kid starts crying and they want to go see what's going on, and they come back five minutes later and their kid is unresponsive. So if your child, if your toddler, is in a bathtub, you cannot leave them unattended. You need to stay within arm's reach of any child that's in a bathtub. That's really the best rule of thumb. Stay within arm's reach of any child in a bathtub. Now, what happens if accidents do happen and your child has drowned? Well, the first thing you want to do is you want to try to get oxygen in, get the water out, and that starts CPR. Okay, in this case, rescue breaths are the most important thing you can do, so you want to tilt your head back, pinch the nose, give two good breaths. And if you don't feel a pulse, start chest compressions, and then call 911, and get that child to an emergency room as soon as possible. The number one way that we can see good outcomes of a patient is, do they come to the emergency room quickly? Are we able to get their heart started again quickly? That is the number one predictor of them doing well if they have been submerged for a long time, or if they still need CPR by the time they get to the emergency room, those are poor predictors. And so we really want CPR to start quick and you get to the ER as quick as possible. Another thing for prevention is fences. If you have a pool, the number one thing you can do to prevent drowning is to have a fence around your pool. The American Academy of Pediatrics has done research and found that 80% of drownings can be prevented if you have a fence at least four feet high that has a self latching, self closing gate. So any type of pool, whether it's an above ground pool or an in ground pool, you really need a four foot high fence with a self, latching self, closing gate around that pool, you will you will save many lives you will never know you save because of that.

Spencer Pruitt, M.D.  28:20
Another thing is, you asked about defibrillators. So a defibrillator is also sometimes called an AED, for automatic external defibrillator. So we'll call it an AED. And those are essentially the shock pads that you see on TV in the movies, but they're made in a small, self contained box so that you and I and anybody who is not a medical professional can use them. They're excellent and they definitely should be used in children. When you have a defibrillator, it will come with sticky pads in two sizes. You'll have adult size and you'll have a child size. If you don't see a child size, it is okay to still use the adult size. So no matter what, if you have an AED, you're going to follow the rules, the instructions, that are going to be there in the box. You're going to slap your pads on the child and you're going to turn it on. And the nice thing about these AEDs is that they'll talk to you, and they will you'll hear this electronic voice, kind of like Siri, and they'll say hello, connect the pads, and they'll tell you what to do, so you don't have to know what you're doing. And that takes so much pressure off of you as a parent. If your child is ill or drowned and you want to restart the heart, what it does is you'll put the pads on and you'll hit a button, and it will analyze the heart rhythm of your child to see if the heart is beating or not beating. Okay? And if it's not beating it'll determine whether or not to give a shock or not, just like you see in the movies. And so yes, I recommend that everyone should have one. Definitely every major public place should have them. But really, if you are, let's say you have a cabin, you're out and away, you really would do a great service to make sure that all those places also have AEDs, you know, for kicks and giggles. I looked online for them yesterday, and they're not cheap, but they're a lot less expensive than you might think, and you can get a decent AED for between $200 to $500. That is an investment. It really is. And for a lot of people, they are not going to have 250, 300 bucks around to do it. But when you think about the health of your child, how much is that worth? Then making sure that there is an AED wherever you go and swim, or if you're going off to the cabin, you're going to swim in the lakes, you know, saving up your money so that you can really buy one to have around for you is really key. It will be worth every penny.

Melissa Whitfield  31:18
There aren't any beaches near here, where we are, but one of my worst childhood memories is getting stung by jellyfish out in Mustang Island, and then we went back a couple of years later, and I was stung again. Most of us are familiar with that friend's episode where Monica is stung. What do you recommend for a child who has been stung by a jellyfish.

Spencer Pruitt, M.D.  31:43
Yeah, well, if you're at a beach with jellyfish, you're not in Texas and or you're not in the Texas Panhandle, let's put it that way. And lucky you. That means you're on vacation. I will trade places with you. But yes, jellyfish stings are common occurrence, especially if you are kind of here in the Florida area and kind of the Southern Gulf Coast, there's a lot of jellyfish blooms that are that are happening over the last couple of years. Jellyfish are 95% water, which is fun to think about, but they have that big dome, that dome you can touch all you want. It's the tentacles that string down. Those things have little barbs in them, and so when they are touched, the pressure of that causes these tentacles to kind of open up and shoot their little barbs in. And that's what gives that stinging sensation that we get if a jellyfish stings? Now, what do you do for it? The old wives tale is that you know, you urinate on it. Unfortunately, that's or fortunately, depending on how you look at it, that's not really a good way of treating a jellyfish sting. Urine is pretty sterile liquid, so it's not going to hurt, except it might embarrass whoever you're urinating on, your child. But most likely, the best way to help is actually to wash the sting with more salt water. If you use fresh water, it actually causes more barbs to come out of the tentacles and can worsen the sting. But salt water does not. So you want to use some tools, some gloves, to pull the stinger off of the child's leg or arm, wherever the sting happened. Then you want to pour salt water on it to help wash away any of those barbs, and ideally actually, like to heat some water up. So if you can warm some water up, because the hot water actually inactivates the venom. Now you have to be very careful with this. We don't want boiling water because that's going to cause a totally different problem. If you're putting boiling water on your child and now you've got burns, but heating the water up to about the level that you would in a hot shower actually inactivates the venom that comes from the stingers, and will help decrease that sting and the feeling of pain and swelling that happens from it. And so those are really the common things you should do: Hot water to about the level that you would in a hot shower and salt water after you've gotten rid of the jellyfish sting. If you're at all concerned, it's okay to bring your child to local urgent care or peds emergency room when you're down there in an Orange Beach, you know, or down in Miami or something, and having a fun time compared to all of us that's stuck here in the Texas Panhandle.

Melissa Whitfield  35:03
Well, I wish my parents had known, because wow, that that. I mean, it was so painful, I can't forget it.

Spencer Pruitt, M.D.  35:11
Yeah, it's, it is impressive how painful some of these things are. We don't think about that.

Melissa Whitfield  35:17
Yeah, very painful indeed. Yep, when my son was little, he would sweat a lot, but from like his head, and it just never occurred to me that he might become dehydrated. Do kids get dehydrated from sweating, and how much water should they drink a day? And if a child is sick or has symptoms of diarrhea or is vomiting. What can we do for that?

Spencer Pruitt, M.D.  35:43
Yeah, kids do get dehydrated, and they should sweat. They won't sweat as much as adults, and so sometimes we have the misunderstanding that children don't sweat, but they do, especially if they're playing outside in the heat, because that is the natural way that the body cools off. For children, we really need to think about dehydration when they're playing in the sun and the heat, especially in a place like the Texas Panhandle, where our summer months are going to flirt with the 90s and 100s degrees Fahrenheit, and it's going to be very hot out. We really should think about this topic based on age group. Babies, actually, they can get dehydrated. They don't need extra water, so babies will get all of the water that they need in the breast milk or the formula that they're drinking. If you're like me, you probably became a young parent, and you had grandma and grandpa say, hey, you know when, when we were parents, you know, we'd give little Mikey an extra spoonful of water or a little bit of water, kind of mix it in, give a little bit extra water. That's an old wives tale, and as well intentioned as Grandma and Grandpa are, we actually don't want to give extra water to babies that are drinking breast milk or formula, because it actually increases their chance of having seizures. So if you're out in the hot sun and they're sweating, go ahead and give them an extra bottle, sure, extra bottle of breast milk and extra bottle formula, but don't give them straight water. Now, for older children, that's different. Older kids are running around and they're playing and they're going to be maybe playing soccer or baseball. Those kids, they're going to be eating and drinking normal table food and drinking normal drinks, like you and I, and they should make sure that they have appropriate amount of water. There's a rule of thumb that I coined for water with children, and it says five after five and eight after eight. For kindergarten and older kids that are about five years old or older, but under eight years old, they should have about five glasses of water a day. That's an eight ounce glass of water. If you're eight years old or older, then you need eight glasses of water a day. So five after five, eight after eight. If you're running and you're more athletic, you're going to need to drink more and that's okay, right? So if your son is on the soccer team, that's his thing, or maybe your daughter's in high school and she's doing two a days with band, they are going to need to drink more water. So for that, I would think of two things. Number one, if they are not sweating, that's actually a bad sign, because sweating is how your body cools off, and it uses water to do that. And if you are not sweating, you probably don't have enough water, and so you aren't cooling properly, and you can get heat stroke and dehydration. So as an old Scout, growing up an Eagle Scout, the old adage was, drink until your urine is clear. Is actually generally a pretty good idea. If your urine, or your child's urine, is really dark yellow, they probably need to drink a little bit more. Now some other things I think we need to think about when we talk about dehydration and water, especially during the summer, two things: Number one, watch your children in the car. You don't ever want to leave a child in the car unattended anytime, but especially in the summer. Temperatures in a car in the summer can get up way over 100 degrees, and children can get very ill, sick or even die if they are left in a car. So make sure, especially during these hot summer months, that you always check your back seat before you get out of the car. New cars sometimes sometimes will have reminder alarms. If you've got something sitting on the back seat, it'll ding and it'll say, hey, check the back seat. But if you don't have that, think of what will help you. Maybe it's putting a post it note on your dashboard so you'll see that every time you get out of your car, right? Maybe it's, you know, putting the proverbial bow around, you know, around your finger so that you can remind yourself that there's something you need to remember. Whatever it is, make sure that you look in the back so you don't leave your child in the car. And secondly, it's not okay to leave them in the car with a window cracked, even if it's a short time. During the summer months with it so hot, even with the window cracked, the heat inside that car can still get up way too high that cause injury, illness or death to your child. As much as it's difficult, if you're running into the mailbox at the post office, maybe you got to go to UPS, or maybe you just need to run in to the supermarket for one item. That's all you need is that one item. With the heat, what it is gotta get little, you know, little Junior, out of the car. Take him with you. The last thing about dehydration, really, is Palo Duro Canyon here in Amarillo. It's a pride and joy. But really, through the Texas Panhandle, Palo Duro Canyon is the second largest canyon in the United States, behind the Grand Canyon. It is a fascinating place to visit. It's beautiful. It's gorgeous, and for someone who loves the outdoors, we are so so lucky to have it in our backyard. However, every year I have one or two children that come to my ICU because they became dehydrated and got heat stroke. Being in Palo Duro Canyon, when you are outside in the Texas panhandle, all the brown rock and things that we have that reflects that sunlight and that heat right back up to you, and when you're down in a canyon, it's reflecting off of all sides of that canyon. So if it is 90 degrees up above outside the canyon, you can expect that it'll be 20 or 30 degrees Fahrenheit higher down in the canyon. For that, I would recommend that if you think you're going to go hiking in the canyon, especially if you're going to go multiple miles in start very early in the morning or go later in the evening, but avoid the middle of the day, because that's really when things are super hot, and that's when the problems happen. Now if you do go early in the morning or late in the evening, things will be a little more gray, little darker. You got to watch out for the rattlesnakes that we talked about earlier, but you really need to go at those times. Start early, start at 6 a.m., 7 a.m., and make sure that you're going for a set time and you're coming back. Make sure you've told somebody that you're going down and when you expect to be back, because cell service down in Palo Duro Canyon is very poor, if you have any at all, and make sure you bring lots of water. The general rule of thumb is that if you are outside, hiking, anywhere, doing athletic activity, definitely in Palo Duro Canyon, you really should drink about a gallon of water per person per day. So that's a lot more water than you might think. And most people go out and they start hiking around Palo Duro, and they just got a little 20 ounce bottle, maybe a couple 20 ounces, that's all they got. Really need a gallon of water per person per day. Tell somebody when you're going to be back, because if you don't meet by that time, they can go looking for you because you won't have cell service. And avoid, avoid, avoid the middle of the day when it gets so hot. It can hit 120 degrees down there in the Palo Duro Canyon.

Melissa Whitfield  43:55
So when should a parent take their child to the emergency room or their primary care provider if they're dehydrated or have nausea or are vomiting?

Spencer Pruitt, M.D.  44:05
So the first rule of thumb I have talking to all parents about when to bring their child to a pediatrician or going to the emergency room is, if you're worried, just go. I don't want anyone to ever make the mistake that they felt like they were going and they didn't need to be there or this or that, and then they wish that things could have changed because their child got injured or was seriously hurt or died because of that mistake. It is always better to go than not go if you are at all in any way, shape or form, worried or concerned and you just don't know what to do. As a pediatrician and a pediatric ICU doctor, I tell my my nurses all the time: "Hey, call me. Call me overnight with anything that you are concerned about, even if you think it's minor, because I would rather you call for something that's minor than to not call me and have it actually be major." And that same thing is the advice that I give a parent here in the Texas Panhandle with regards to vomiting and diarrhea and being outside. The things to really remember is that if a child is really sleepy and not responsive, that is a number one key to go to an emergency room. Children love to play. Okay, they will play and play and play, even when they're sick. And we've all seen it. We've seen that kid that's rolling the car back and forth with one hand, and then with the second hand, he's wiping snot off his nose, right? We've seen kids that, oh, man, you feel them, and they are just burning up. Their fever is high, and they look tired under their eyes, and yet, still they want to play with their Legos. That is a beautiful thing about children, right? They just have that zest for life and they love and they want to go if a child is so sick that they're sleepy, they're not really responsive to you, that's that's a red flag. Now you need to be calling your pediatrician or going to the emergency room because that kid isn't doing what they're supposed to. A sick kid still should be interactive and working and doing what they want to do with vomiting. Specifically, the real key with vomiting is, can they keep any fluid down? Sometimes a kid will vomit, but then you can give them a bottle or you give them a glass of water, they'll keep it down, and they'll be fine. And they still will urinate. They'll still wet their diapers. They'll still be able to go and use the restroom. Those kids are okay. You can continue to work with them at home, generally, but if they're vomiting so much that they just cannot keep anything down, you give them a little bit of fluid, and immediately they vomit it back up. Or if their number of wet diapers that they make per day starts to decrease, or they stop going to the restroom, or, heaven forbid, they're they don't make any wet diapers or go to the restroom at all for 24 hours. Those are kids that most likely are quite dehydrated, and they need to be seen, either with their pediatrician or probably in the emergency room so they can get some IV fluids at that point in time, because now they haven't made any urine right. As we spoke above, when you drink, you want to make sure that your urine is relatively clear. It shouldn't be dark yellow. And so if Little Sarah is six months old, and she makes six to eight wet diapers a day, and now all of a sudden, she makes two, that's concerning, and call your pediatrician for that, because she's clearly not making as much urine because she's not getting as much fluid in. The other thing I think about, in addition to the vomiting and dehydration, side of things, is parents always worry about fever. When is too high? What do I need to do about fever? I would say that generally, most parents have what I call fever phobia. They're afraid of the fever more than the fever is actually concerning and doing something. If that child is still playful and active and acting okay when you give some acetaminophen or ibuprofen, then that's okay. I really don't care very much what the actual number of the temperature is. What I do care about is if you've got a fever and you give acetaminophen or ibuprofen, and the kid still just lays around and they're sleepy and they're not really responsive. Okay, just as we talked about right before those are the kids that are sick, because a kid should want to play. And if a kid has a fever of 102 or 103 and you give some Tylenol and it goes down and it's 98 fine, great. If it goes down and it's still 101, but the kid is active and playful, I that's actually less concerning. But if the kid is sleepy, that's really concerning. So if you have a temperature of maybe 105 or higher, and that child doesn't look active and playful after you give acetaminophen or ibuprofen, that would be a child that I would be calling the pediatrician or considering about bringing to the emergency room. And then another thing would be, if you see any abnormal bruising or bleeding, there's a variety of different illnesses that can happen during childhood that can cause abnormal bruising and bleeding. And so if you don't understand exactly why that bruise happened, then it's worth calling your pediatrician and I'll give an example. My middle daughter, when she was very young, she was probably around two years old, maybe a little less. I came home from work and my wife said, "Hey, Spencer, can you take a look at our daughter? She has all these bruises on her shins." And I said, "She's a toddler. That's okay. They're supposed to have bruises." They go around, they, you know, they they play, they bump into things, and she goes, "No, this looks like a lot of bruises." And I walk in, and she's there, and she's playing with her brother, and I was like, "Hey, come here." And she stands up, and yes, there were bruises all over her legs. I thought, What in the world is going on? What happened to her? Well, I call up her pediatrician, and he said, bring her on in. Bring her in immediately, and let us do some blood work on her and make sure that everything's okay. And we did. And by the time I had gotten back from getting the blood work done, Dr. Funes had called me and he said, "Hey, Spencer, your daughter's platelet count is very low." What happened is that she got a virus, and that virus essentially made her bone marrow, which makes your blood, kind of dumb, and it really hasn't made any platelets. And platelets are what the body uses to stop bleeding, and so we had to bring her into the hospital, and she got some transfusions. And then we had to watch her for the next year or two to make sure that it didn't recur. But she got really sick and had a lot of bruising and bleeding from a simple virus that we didn't even think much about. She had some sniffles for a few days. It went away. She was fine from that. And then it was a few days later, all of a sudden, she got all those bruises, and she needed to be watched. So if you ever see any abnormal bruising or bleeding, and you're like, you don't know really where that came from, that's worth going and getting checked out.

Melissa Whitfield  52:17
So this obviously isn't a complete list of potential dangers. Is there anything that you'd like to add that we haven't covered, or that you would want to stress again, that you think is particularly important?

Spencer Pruitt, M.D.  52:31
Yes, I think that one of the most wonderful things about the summertime is getting together with family and friends. People will get together at the park. They'll go to people's houses, barbecues. And it is this time of year that we can see a few illnesses that are worth watching for. If that potato salad is left out a little too long, we can get infected with a bacteria called Campylobacter, and if that hamburger is not cooked quite well enough, we can get E coli. It's another bacteria. These bacteria generally will cause symptoms that we think of with food poisoning, nausea, vomiting, diarrhea, stomach aches, but with each of them, they have the possibility of causing further illnesses. There is a type of E coli that can cause bloody diarrhea and really cause very sick symptoms that may land you in the emergency room or the hospital. Then with the Campylobacter specifically, there is a illness called Guillain Barre. Guillain Barre is a neurologic illness. You get infected with this bacteria, and even though the bacteria itself will get treated and go away in the meantime, it infects you and it causes paralysis. That paralysis will start in your legs and start working upwards until it becomes hard to breathe. And so if you noticed at all that your child was having difficulty walking or running, and they didn't have that before, and they're feeling really weak in their legs. that's a child that needs to come to the emergency room immediately, because they could very well need to stay in the pediatric ICU for days, weeks, or even months, as we try to get through that illness. So my recommendation and my reminder to everybody is to make sure that as you get together and have great fun with your family and friends throughout the summer season, that you don't leave out the potato salad and other side dishes. Once you're done using them, please put them away. And number two, you. Make sure that those hamburgers are cooked well done. I love a good medium rare or rare steak. Hey, anyone in the Texas Panhandle loves their steak. Medium rare and rare steak is one thing, but a hamburger, hamburger is different. Want to make sure that you actually cook that hamburger well done. Outside of that, it's probably good to just kind of remind everybody again, few things. When you're at the pool or in the bathtub, watch your kid. The more people that are around, the less people that are watching your child. And then kids can get dehydrated. So five after five, eight, after eight, and just use your breast milk and formula for the babies you don't need to give extra water. And then, when thinking about critters, because we got a lot of them in the area, don't touch if they're acting funny, if they are awake when they're not supposed to be keep a healthy distance and know that if they're acting funny, they're probably sick and you don't want to get close

Melissa Whitfield  56:08
Well. Dr Pruitt, thank you so much for all this great information, these wonderful tips, and thank you for sharing your personal stories and for reminding us that no matter how cute the trash can pandas are not they should not be approached.

Spencer Pruitt, M.D.  56:23
That's right. Thank you for having me. This has been a great pleasure, and I hope everyone has a wonderful, safe, happy and fun summer.

Melissa Whitfield  56:33
Thank you so much, and we hope to have you again sometime soon.

Spencer Pruitt, M.D.  56:36
Oh, definitely. Thank you.

Melissa Whitfield  56:40
Thanks for listening to Texas Tech Health Check. Make sure to subscribe or follow wherever you listen to podcasts. This information is not intended to be a substitute for professional medical advice. Always seek immediate medical advice from your physician or your healthcare provider for questions regarding your health or medical condition. Texas Tech Health Check is brought to you by Texas Tech University Health Sciences Center and produced by T.R. Castillo, Suzanna Cisneros, Mark Hendricks, Kay Williams, Krystal Meazell and me, Melissa Whitfield.