Evo Terra (Host): This is Children's Health Checkup where we answer parents' most common questions about raising healthy and happy kids. I'm your host, Evo Terra. And today, our conversation is focused on common summer illnesses in kids and how to prevent them. Our expert, Dr. Kelley Smith, pediatrician at Children's Health, joins me to cover issues like dehydration, sunburn, and other illnesses and viruses that are more prevalent in the summer. Dr. Smith, thank you for joining me.

Kelley Smith, MD: Good to join you.

Host: So, let's talk about some common illnesses. What do you see in your practice during the summer months?

Kelley Smith, MD: Okay. So, I know summer's not typically known as a time for thinking about things like cold and flu. But unfortunately, they can be year-round illnesses. And the last five years have kind of taught us that some of our previous patterns of viruses out in the community have kind of changed a little bit. So, I go over with the, "Yeah, we're technically out of flu season, but here we are, end of May and I'm still having flu B cases walking into the office." So unfortunately, all that stuff is still with us.

I also like to say every season is strep throat season. Now, usually, not seeing as much of it because the kids aren't congregating together as much, so not sharing as many of the germs. But all the stuff that you think of when you're thinking fall still can show up in the summer.

Host: Isn't that great? Then, plus all the fun of summer, right? And the accidents and the other kind of challenges. Yeah, you'll be busy I am sure for the remainder of this summertime.

Kelley Smith, MD: And I always remind folks that summer is still also the season for all your lovely vomiting and diarrhea illnesses, so yeah.

Host: Gosh, you're just a barrel of laughs today. So yeah, this is going to be a great time. Well, let's talk about something that is specific to the summer, and that is the heat. At least from my perspective, it's getting hotter and hotter every single year. I can spend much less time outside than I used to be able to. But obviously, summer heat's going to affect children's health as well. So, what should we as parents or grandparents, in my particular case, what should we keep in mind to protect our kids when they're playing outdoors this summer?

Kelley Smith, MD: Okay. So, first, I start off, "Hey, if it's at all an option, try to be out in the morning, try to be out later in the evening. Try not to be out when the sun is at its highest and most intense." Now, in my part of North Texas, it's nothing for us to start the day off in the 80s. So, I won't say it's exactly straight to cool. But certainly, it is a little better in the morning and then often towards the evening time as the sun is going down. So, timing of activities is important.

Next part, I will say, hey, you will probably want to be taking breaks, making sure that people are having a chance to hydrate. Now, I go over with all of my athletes, yes, hydration is water, but also we are losing salt. You need to replace those electrolytes too. So especially, if you've got somebody who's say out playing baseball, you need to make sure you're doing something to replace that, and whether that's a commercially prepared drink like Gatorade or Powerade or even chomping on some pretzels or crackers and then drinking some water, anything that gets some salt in is helpful.

Host: Yeah. I try to keep my kid when she comes over-- well, my kid, my granddaughter, when she is over. So yes, she loves her flavored water because we just put a little, you know, electrolyte solution in her drink as well, because, yeah, she wants to be out in the pool the whole time. I assume also you would highly recommend sunscreen, yes?

Kelley Smith, MD: Oh, absolutely. I am kind of the sunscreen police in my office. I remind folks that, yes, you want to wear it and you want to reapply it. Now, depending where you're going to be, there seems to be at least a question of a concern about do some of the chemical sunscreens pose a problem if you're like in the lake or the ocean. So, if you want to go a little bit more environmentally friendly, you can use one of the zinc oxide or titanium oxide-based ones. If you're just like, again, at a baseball or softball game and just wanting to protect the skin, you can use anything. The key is keep reapplying it. You're going to need to reapply depending on your skin tone, at least every two hours. And if you're on the lighter side, you might need to think about doing that more often.

Host: Yeah, especially, I've seen some of the reports talking about how intense the UV rays are getting this summer for certain areas of the country. So, it is important that we all-- not just kids-- talking to us parents and grandparents too.

Kelley Smith, MD: And then, one more sunscreen pro tip. I always remind kids, hey, it's your hair. You can wear it however you want to wear it. But if you've put a part in it, like if you braided it or if you decided to shave it, it is possible to burn your head. Protect the head. You might need sunscreen on the head. They do make special hair-based sunscreens or throw in a hat. Do what you prefer to do, but don't forget that part either.

Host: Good point. Good point to take. Yeah. You brought up lakes and oceans and things like that. Look, summer fun is a part of that. This next weekend, we are taking our granddaughter out to the lake to go kayaking and standup paddleboarding. She's going to have a blast because she loves doing that. But, you know, there's also issues with pools and lakes and splash pads and things like that. What should families know about keeping their kids nice and healthy when they do these activities?

Kelley Smith, MD: So, let's talk treated water. Your splash pad, your pool, that sort of thing, versus natural water. Okay. If you've had the appropriate treatment to the place, the chlorine should be killing a lot of germs. That's why they're using it. However, if it's a public place, you don't really have control over was someone sick when they got there, that sort of thing. So, I would say in the calculated risk. Please go have fun in the water, but also make sure you're washing your hands, especially before you're eating or drinking something. And if you take a potty break, hey, yeah, all the more opportunity to wash your hands.

If we're in a natural body of water, if it is a body that is moving fairly regularly, like, lakes that get a lot of current to them or rivers, that sort of thing, it's harder for certain rarer organisms to have a chance to grow and cause problems. If you've got one that's a little bit more placid, you're at a little bit higher risk of some of those other things, which again, really the big thing is not the greatest idea to drink the water. If you can swim with your mouth closed when you're in the water, just try not to ingest anything while you're enjoying that. But if you are practicing water safety and wearing a life jacket, you won't get as much water in your mouth anyway. So, there we are.

Host: Yeah, that makes sense. I definitely understand. Stay out of the pond, people. And stay out of that runoff stream behind your house that's probably not really a stream. Okay. You brought up colds at the beginning of this and the flus, right? And yes, the flu virus and the cold viruses are still out there and active. But there are other viruses that spread in the summertime. What should people be looking out for?

Kelley Smith, MD: So usually, in the summertime, i'm also thinking, as I kind of mentioned, the vomiting and diarrhea illnesses, we tend to see a little bit more of things like Giardia and sometimes some of the other stomach bugs. With some of those, it's back to your good hand washing.

Since we are in summer cookout season, food safety is important. From my inheritance in my family, I like to say that we will feed you for all events and there will be at least one potato product, usually both hot and cold. So, let's use potato salad. I mean, it's tasty, but it is not meant for being out in the heat for a long time. So, make sure that you are keeping it chilled. You know, put it up when the gathering is done. Be on top of your food safety. And it'll be another tip for keeping from bringing home extra leftover from your event.

Host: Yeah, we don't want that. Hey, here's something I haven't thought about in a while. Ticks and the Lyme disease and other things that ticks carry. What should parents do about that?

Kelley Smith, MD: First, we're going to start off that North Texas is not an area that is naturally home to Lyme disease. Now, we are home to other tick-borne illnesses, so don't ignore the tick. But that's not one that we usually have a problem with. However, families go on vacation, you can be through all parts of the country.

If you've been out playing, the recommendation is at night before everybody goes to bed, go ahead and do a head-to-toe check. Are there any ticks? And if they are, go ahead and remove them. You want to make sure that you remove both the body of the tick and the jaws. If you think a tick has been there for longer than 24 hours, then you should reach out to your pediatrician and say, "Hey, we were camping in the Piney Woods. There was this tick. What do we need to watch out for?"

Host: Got it. Same things they told us when we were kids. Very similar. You can't take that away. Oh, this is really good information. So, speaking in general, you mentioned we were taking trips and doing vacations, whatnot. Overall thoughts on keeping kids healthy as we are doing all the travel and summer things? Just kind of a general overall scene. What do you think we should be keeping in mind?

Kelley Smith, MD: I'd start with, hey, if anybody in the family's running fever, we really need to hold off on activities for 24 hours fever-free. I mean, that sounds like a very common sense thing to say, but you know, if you can't go to school, we really probably shouldn't be going to whatever adventure was planned. Sorry about that vacation.

Second part, if someone is having vomiting or diarrhea. Again, we usually like you to be at least 24 hours before you're around other people just to be on the safe side, so we're not spreading those germs to other folks. Now, cough and runny nose. I mean, I live in a highly allergenic part of the country. So if we kept everybody home who was sneezing, we wouldn't go anywhere in the spring or the fall. Talk to your kids about covering your cough, blowing your nose. And then, can I say one more time-- hand wash? Because if we've learned nothing in the last five years, I think we've learned we should all be washing our hands.

Now, special consideration that we haven't yet touched on, swimmer's ear. It's an anytime of year problem, but it's particularly a summertime problem. Swimmer's ear, also known as otitis externa because it's an infection of the outer part of your ear. Specifically, you're getting swelling and inflammation in the ear canal. So, that's the space between the outside that you can see-- and if you like piercings-- pierced all the way down to the eardrum. If water gets in there and has a chance to let bacteria grow, then this can be very, very painful. You'll have a kid that does not want you touching that ear, does not want to lay on that ear, may not want to pull over clothes over that ear because it just hurts to move that ear. So if you've got something like that going on, your probably going to need the help of a pediatrician.

But to prevent swimmer's ear in the first place, there are some commercially prepared products that you can put in after swimming. Yes, there is actually a role for white vinegar. It is not an old wives' tale. It is a weak antibacterial. Now, this is really a, "Hey, things really haven't had a chance to cause a problem." If you've got the kid that is already telling you, "Don't even come near this ear, that's not going to cut it," you're going to need prescription-strength help.

Host: And you are bringing back a bunch of painful memories from 50 years ago, so thank you. Literally painful memories. I had the worst swimmers ear ever.

Kelley Smith, MD: I will tell parents that I'm pretty convinced that the outer ear infections seem to hurt the kids more than the middle ear infections that they may have been used to when they were infants and toddlers.

Host: Yeah. Well, I know. All I know is it hurts, That's for sure. Okay. As we wrap these things up, you mentioned it a moment ago when talking about the swimmer's ear. But in general, when should a parent or caregiver be really concerned about that summer illness? And when is it the time to call a doctor like yourself?

Kelley Smith, MD: First of all, I always like to say to my patients, tongue in cheek, Captain Obvious, if you're ever worried about your child's breathing, please seek medical attention. In a less traumatic role, if you've got a kid that has been running fever for like two to four days and just doesn't seem to be getting over this, if they're complaining that their throat is really hurting, if they've got loss of appetite, if they just can't seem to hold anything down, these are all signs that, hey, we probably need to be getting in touch with our pediatrician if not for medical advice, then possibly also for an in-person appointment.

I would also say that if you've got somebody who symptoms just have been lingering, like, yes, you can be sick up to seven to ten days with a cold. But if you've got somebody who's really not seeming like they're doing any better, there are some other things that could be happening. It could have risen to the level of actually being a bacteria at this point and needs some antibiotics, hard to say.

So, I'd go with are they getting better? Are they breathing okay? Are they holding things down? And are we now hitting the two-week mark with just no signs of really shaking this off?

Host: And if their legs bent backwards, no big deal. No, kidding. Obviously, if you have anything that's broken or any serious injury of bleeding, yes, definitely do that.

Kelley Smith, MD: I like to say if the whole playground knows the arm is broken, you need the emergency department.

Host: That's an excellent way to wrap this conversation up. Anything else you wanted to add that I didn't get to?

Kelley Smith, MD: We've kind of danced around the heat when we were talking about sun protection. there are certainly some heat-related illnesses. I do preach that the best treatment for heat exhaustion, heat stroke is preventing it in the first place. So, kind of like we talked at the top of this. "Hey, make sure your kids are taking breaks. Make sure that they are getting their hydration in. You may have to cut short practice."

Thinking some of my older patients, smart watches have heart rate monitors in them. You can allow your middle schooler and high schooler to kind of keep track of what's going on with their heart rate. And if it's getting above a certain amount, that may be your sign that, Hey, we need to reign in this exercise for today.

Host: Can you go back in time 40 years ago and tell my football coach that two-a-days are a bad idea in the summer? That would be great.

Kelley Smith, MD: Would you believe that we have actually learned in Texas, and they're still practicing in August. However, they're really on top of making sure that every student, not only survives practice, but doesn't just barely survive practice. So, some will even weigh to make sure you didn't lose too much weight because you sweat it out. So, I mean, when I say we have actually learned, we have actually learned.

Host: Good, good. Well, I'm glad I could be a cautionary tale that let all of that stuff happen. Oh, Dr. Smith, great conversation as always. Thanks for joining me today

Kelley Smith, MD: Thank you so much for having me.

Host: For more summer safety tips, visit children.com/summersafety. And if you're in North Texas, Children's Health Pediatric Primary Care offers trusted care close to home. From newborn checkups to care for common illnesses and more, find a location near you at childrens.com/primarycare. Thanks for listening to Children's Health Checkup. If you found this episode helpful, please follow and share it with a friend.