Welcome back to Prisma Health On Call, our Q+A series that connects you, our readers, to the healthcare professionals at Prisma Health.

With summer in full swing, Prisma Health’s pediatricians are here to answer your questions about child health + safety during summer activities. Think: swimming tips, sunscreen, bug bites + more. (Hint: Keep this bookmarked for your next Saturday on Lake Murray.) 🏖️

See the full Q+A below. And big thanks to Kathryn Stephenson, MD, Sara Lindsey, MD, Madison Merritt, MD, and Jeff Stoeber, MD, for their knowledge + expertise.

Q: How can I ensure my children stay cool on walks or when playing outside?

A: When spending time outdoors this summer, it is important to stay mindful of the heat. Stay out of direct sunlight and avoid prolonged exposure during midday when temperatures are often at their highest. Dress children and infants in lightweight materials, taking care to avoid extra layers. Keep children hydrated — we recommend four cups of water or milk for children ages 1–3. This increases to five cups for kids 4–8 and seven to eight cups for older kids. Infants are also at risk for dehydration when the weather is hot, so keep them hydrated with breast milk and formula only. Note that water can potentially be dangerous for newborns and young infants.

Q. As someone who has seen or experienced near-drownings, I’m amazed how quickly a swimming accident can happen. How do I keep my kids safe in the water?

A: You’ve hit upon the biggest danger with swimming accidents – they can happen in the blink of an eye. Here are seven water safety recommendations to keep the pools and beaches fun + safe this summer:

If swimming in a pool, the pool should have four sides of fencing. There should be a child-proof gate and no ability for a small child to leave a house and get straight into the pool.
Swim lessons are a great, safe way to prepare kids for the summer swim months. The American Academy of Pediatrics recommends starting as early as age 1, and definitely by age 4, as this can prepare a child — but it should not be your only layer of protection.
There should always be someone keeping an eye on swimmers, and everyone should know who that is. If they need to step away, someone else should take over and shouldn’t have other jobs or distractions. If at a public pool or beach, don’t assume a lifeguard is watching your child — they’re responsible to scan the entire pool, so know where your kids are at all times.
If your kids are young or not great swimmers yet, swim in the water with them. They’ll love it and you’ll always be an arm’s length away if something happens.
Life jackets are imperative for any natural bodies of water — as well as for weaker swimmers in pools.
Another good safety rule is don’t become complacent, even if your children have taken swim lessons. And know that baths, baby pools, and above ground pools can also be sites of accidents. One study found the majority of drownings under age five were of children whose families were not expecting them to be in the water at that time.
Accidents do happen, so we recommend parents be prepared by taking infant and child CPR classes. Having these skills in an emergency could save the life of your child or someone else’s.

Q. Both of my children have tubes in their ears. What are the risks of ear infections from the lake or ocean? I know that pools are safer because of the chlorinated water.

A: There is a higher risk of possible ear infections for kids with tubes when swimming in lakes or oceans compared to pools. That’s because the chlorinated/treated water helps get rid of bacteria, and lakes and oceans inherently have a variety of bacteria as part of their natural state.

In general, the older the child, the more likely they are to swim deeper underwater (greater than five feet), and it’s that pressure increase that increases the likelihood of water getting into the tube and allowing bacteria to grow there. The benefit of having the tubes, however, is that we have a direct, localized way of treating these infections with ear drops and can avoid oral antibiotics in most cases.

For children swimming in treated pools and mostly staying at or right below surface level, there is usually no need for ear plugs during swimming unless recommended by your doctor. For children swimming deeper or in more natural bodies of water, we do recommend ear plugs, water resistant headbands, and/or swim caps.

Q: What are signs of my baby overheating?

A: Infants can become easily overheated in hot weather. Watch for the following signs that your infant is getting too hot:

Red, flushed skin
Excessive fussiness or crying
Skin that is warm to the touch or unexplained fever
Vomiting
Extreme sleepiness or lethargy

If concerned, seek a cooler area and contact your physician if symptoms do not improve.

Q: When can I start putting sunscreen on my baby? Any brand recommendations?

A: The American Academy of Pediatrics recommends keeping newborns and infants younger than 6 months out of direct sunlight. If needed, sunscreen should be applied only to small, exposed areas and infants should wear protective clothing, including a hat. For older infants, choose a broad spectrum sunscreen with SPF 30 or higher. Look for sunscreens containing Zinc oxide or Titanium dioxide as they don’t need to be absorbed to work and may be an option for sensitive skin.

Q: How do you treat insect bites and when should you see a doctor?

Almost any bite or sting will result in an almost immediate area of redness and swelling, and eventually result in either pain or itching, depending on the offending insect. Most reactions are localized, meaning the area of redness is confined to the immediate area around the bite. Here are a few common types of bug bites, and what you should do:

Bug bites

Most bug bites result in redness and swelling that can increase over the first 24 hours and can be quite impressive depending on the child’s sensitivity. Areas with very good blood supply and loose soft tissue, such as faces, can swell significantly. The amount of localized swelling is generally not a concern. This can persist for up to 72 hours, and then will usually decline over the next few days. Most bites result in the local release of histamine into the skin, which is the cause of the redness, swelling and itching.

Stinging insects

In the case of stinging insects, the symptoms are compounded by the injection of a small amount of venom into the skin, resulting in pain. In any case, the skin reaction that remains near the site of the bite is not usually a cause for concern. Place a cool compress on the area to relieve some of the discomfort.

In the case of a bee sting, carefully examine to see if a stinger is still at the site and gently remove by scraping perpendicular to the skin. Avoid grasping the stinger with a tweezer as this can inject additional venom into the skin. Cleanse the skin gently with soap and water. Over the next 48–72 hours, symptomatic relief can be provided by giving an oral over-the-counter antihistamine and applying a small amount of 1% hydrocortisone cream to the bite or sting.

Allergic reactions

On rare occasions, a severe allergic reaction to bee stings or fire ant bites can occur. These reactions usually occur within 20 minutes of exposure and can be marked by:

Swelling that is distant from the sting (lips, tongue, mucous membranes)
Shortness of breath
Difficulty swallowing
Nausea
Vomiting
Feeling faint
Passing out

This is a serious reaction and requires emergency medical attention. Call 911 and, if the child is known to have a history of anaphylaxis and has an EpiPen, a dose of epinephrine should be administered immediately. If the child is alert and responsive, a dose of oral antihistamine may also be given. However, do not assume that the dose of antihistamine alone will adequately treat the reaction – still seek prompt medical attention.

When in doubt…

Fortunately, most encounters with biting or stinging insects result in mild, self-limited symptoms that do not require medical attention. When in doubt, it is always wise to consult your pediatrician to discuss your concerns. However, it is also important to know the signs of a severe reaction and seek help immediately when necessary.

Looking for pediatric care for your family? Learn more about Prisma Health's Pediatric Primary Care.*