Do I need a fence for the inflatable above-ground pool? Pediatric Emergency Notes

Do I need a fence for our above ground pool? Drowning prevention,We don’t have a built-in pool at our home, but we often use a little splash pool which got me to thinking about the safety of above-ground pools — you know, the sort that just go up for the summer, whether rigid sides or inflatable, and come down when school is back in session.

As a pediatric emergency department nurse I’ve seen my fill of child drowning victims and so I tend to be hypervigilant around pools. The absolutely crushing part about drownings is that they are nearly always preventable.

I asked Jessica Mitchell, Safe Kids Pima County coordinator, what the rules are regarding fencing and general safety practices around temporary above-ground pool structures.

“The law…oh the law on pools! It can be so confusing. Pretty much, if you have a pool that is taller than 18 inches and wider than 8 feet intended for swimming, it requires a fence/barrier that is at least 5 feet tall with a self-closing or self-latching gate. The entire law for pools can be found on the Arizona government pages“ Jessica shares.

“Mesh fencing is a great option for those with above-ground temporary pools because when the pool comes down, the mesh fence can also come down. There is one exception to having to put up a pool fence, and that is if everyone in the household is 6 years or older, no safety measures need to be in place. This doesn’t mean this is the safest option. Not everyone over the age of 6 can swim, and even swimmers can get into difficulty in a pool.

“If you decide to get a temporary above-ground pool make sure you have a fence at least 5 feet tall with a self-latching gate. Make sure your child cannot use a chair or other item to climb over the barrier or to unlatch the gate. And emphasize to all kids and adults that the gate is not to be propped open.”

Also, we worry most about pool mishaps in the summer, but be vigilant all year for drowing hazards. Empty the cooler of melted ice water; dispose of the bucket of mop water; drain the bathtub (and never leave your toddler or pre-schooler in the tub unsupervised). Unfortunately, we see all these drowning scenarios in the emergency department.

Whether it’s in the pool, the ocean or the bathtub, you will not hear a child drowing. Drowning is silent … keep your eyes on your child.

This summer we’re going to follow all the advice above as well as the ABCs of pool safety whether it’s a splash pool or a regular pool:

“A” is for Adult Supervision

Always have an adult watching the pool, not reading, not looking at their phone, not taking an afternoon siesta – just watching the kids in the pool. Go ahead and take turns if it’s a social gathering, but make sure that the designated adult knows the rules. Better yet, consider hiring a trained lifeguard. While it seems like the more adults who around, the better. But the reality is that it seems to be the opposite – everyone thinks someone else is wathcing. Make hiring a lifeguard a part of your pool-party budget.

Jessica also wanted to remind folks that floaties are toys and not safety devices. If you have a life vest, they need to be the right size, and they are not a substitute for adult supervision.

“B” is for Barrier

Yes, even with an above-ground temporary pool that you picked up for $75 you want a barrier. It can be mesh; it just has to be at least 5 feet tall and have a self-latching gate. Even if your kids are over the age of 6, what about the neighbors or the grandkids? Make sure the barrier isn’t compromised – there aren’t any chairs or trash cans that can be dragged over to act as a ladder, and that nobody props open the gate.

“C” is for Classes

Tucson has lots of great options for swim classes including Vest it Up!  TMC for Children and Credit Unions for Kids offer FREE year-round swim lessons at dates, times and locations that meet the needs of busy families. These free lessons are at local YMCA locations and include a free personal flatation device, or PFD. This U.S. Coast Guard-approved life vest for kids is provided to kids completing swim classes. The free classes are available to the first 400 kids each year between 4-17 years old.  Register here for Vest it Up!

I have a few additional thoughts:

Having a party? Hire a lifeguard.

It seems like the more adults are around to watch the better right? But in reality it seems to work in the opposite way. Everyone thinks someone else is watching. Make hiring a lifeguard part of your pool party budget.

It’s not just pools and it’s not just summer time

We worry especially in the summer when kids are in the pool, but be vigilant all year. Empty the cooler of melted ice water, dispose of the bucket of mop water, drain the bathtub (and never leave your baby, toddler or preschooler in the bathtub unsupervised.) Unfortunately, we see all these drowning scenarios in the emergency department.

Eyes peeled

Whether it is in the pool, the ocean or the bathtub you will not hear your child drowning. Drowning is a silent affair…keep your eyes on your child.

Hope your summer is splashing good fun.

Stay safe,
Melissa

P.S. Did you know that the Drowning Prevention Coalition of Arizona provides pool safety checks? Request one here 

Melissa HodgesPediatric Emergency Notes from Melissa
Melissa Hodges is a pediatric emergency room RN and mom to two young boys. Melissa has been at Tucson Medical Center for 10 years. She is a knitting ninja apprentice who makes a mean chili and enjoys spending time with her family and friends in beautiful Tucson, Arizona.

Dehydration and kids – what you need to know

Dehydration and kids what you need to knowWhile standing on the sidelines cheering my eldest on at his soccer game is enough to get me reaching for my water bottle, my kindergartener with the flushed face needs a little reminding to hydrate. As temperatures soar it becomes especially important to make sure our children are hydrated – dehydration and heat stroke are all too common in the region and in the emergency department. And children are more prone to dehydration and heat stroke than adults.

Your kids are more susceptible to heat than you are!

As kids have a smaller mass-to-surface-area ratio, they can lose fluid more quickly than adults and become dehydrated more rapidly. Children also have a higher metabolic rate, so their bodies use more water, too. Add to that their kidneys do not conserve water as well as an adult’s and kids often may not drink or eat when they are not feeling well, and you have a recipe for a dehydration disaster! Luckily dehydration is easily preventable. Given the average temperatures here in the desert, we need to be aware year round and teach our children how to prevent dehydration.

To encourage my 5 year old to make a habit of hydrating, I follow two pieces of advice:

    1. Encourage constant sipping over infrequent large gulps
    2. Let him pick out an insulated water bottle that would keep the water cool

Remember: be a good role model -drink sips of water often. Throw a slice of fruit in your child’s water, or a silly straw, or perhaps fun colored ice cube shapes – anything that will encourage constant sipping.

The advice below is not a substitute for seeing a physician.

Is my child dehydrated?

  • Does the child seem sluggish?
  • When crying are there few or no tears?
  • Are there complaints about a dry mouth?
  • Is the child more cranky, irritable or fussy than usual?
  • Is urine darker than usual?
  • If child is an infant, is urination less frequent (fewer than six wet diapers a day)?
  • Is the child constipated?*
  • Is the child’s skin particularly dry and lacking its normal elasticity? Maybe even wrinkled?
  • Do the eyes appear sunken?
  • If your child is an infant is the soft spots (fontanel) sunken?

*Sometimes your child may be dehydrated due to diarrhea. Don’t forget to treat the dehydration.

“Yes” to any of the above may indicate that your child is dehydrated. If it is fairly mild you may be able to address this at home, but check with your physician if you have any questions.

What should I do if my child seems dehydrated?

For children older than 1 and less than 11:

  • If your child is dehydrated use an oral rehydration solution, such as Pedialyte. If your child is eating food, plain water may be used to replace lost fluids. But if the child isn’t eating, plain water doesn’t provide essential electrolytes, so an oral rehydration solution is needed. Avoid sodas, caffeinated beverages or gelatins, which don’t relieve dehydration and may make symptoms worse.
  • Make sure your child is drinking small amounts, frequently.
  • Rehydration may take a few hours, so keep your child in a cool, shaded area and sipping fluids frequently
  • Allow your child to drink as much fluid as he or she wants. Encourage your child to drink extra fluids or suck on flavored ice pops, such as Popsicles. Children ages 4 to 10 should drink at least six to 10 glasses of liquids to replace lost fluids.
  • Call your doctor if symptoms do not improve or if they worsen

How can I prevent my child my child getting dehydrated?

  1. Hydrate, hydrate, hydrate.

Insist on your children taking plenty of breaks to drink fluids while playing outside, especially if playing sports or engaged in vigorous physical activity. Perhaps set up a timer as a reminder. Also, hydrate before, during and after time in the heat.

  1. Stay indoors

We’re all about getting kids out and physically active, BUT when the heat is high, avoid spending time outdoors. In Tucson summers this means stay indoors any time after 9 a.m. into early evening.

Our suggestion: wake early to play outside, take a siesta in the afternoon and then venture out in the evening.

  1. Never leave a child in a parked car at ANY TIME, NOT EVEN FOR A MINUTE

Even if the windows are open, temperatures can rise to shocking temperatures in minutes.

  1. Keep it light and wear a hat

Have children wear light, loose-fitting clothes when they’re outside. Breathable fabrics like cotton are best.

Stay cool this summer,

Melissa

Melissa HodgesMelissa Hodges is a pediatric emergency room RN and mom to two young boys. Melissa has been at Tucson Medical Center for ten years. She is a knitting ninja apprentice, who makes a mean chili and enjoys spending time with her family and friends in beautiful Tucson, Arizona.

This advice does not substitute for that of a medical professional. If you are concerned that you or your children may have heat stroke or moderate to severe dehydration please seek in person medical advice.

Flu season is here – when to bring your child to the emergency room

Over the past few weeks our pediatric and adult emergency rooms have swelled with patients with flu-like symptoms looking for relief.

While it is critical that some seek emergency help, the majority of patients with the flu do not need emergency medical care.

In the Pediatric Emergency Department we are seeing a lot of children with flu-like symptoms who have high fevers (103F-105F). As a mom to a toddler and a preschooler I know how worrying those high fevers and respiratory symptoms can be, and I have to remind myself that a fever is actually a sign of the body taking care of itself. So when should you bring your child to the emergency room and what can you do at home to relieve symptoms?

This information is meant as a guide, but should not be used in place of medical advice from your health care provider.

When to bring your child with fever and flu symptoms to the emergency room

  1. Your child is struggling to breathe.
    If your child’s skin has a blueish tinge, is breathing fast or is struggling to breath
  2. Is not waking up
    It is normal when we’re sick to sleep or rest, but if you can’t get your child to wake during the day or the child is not interacting go to the emergency room.
  3. If your child has a high-risk condition, such as heart, lung or kidney disease, or an immune-system disease and is spiking a high fever (103F-105F) seek medical help.
  4. If your usually affectionate child is so irritable he or she doesn’t want to be held
  5. Has a fever AND rash
  6. If your infant has no tears when crying or has significantly fewer wet diapers for 8 to 10 hours.
  7. Any infant less than 2 months old who has a fever over 100.4F.

My child seems to be coming down with flu-like symptoms, but none of the above apply.

The kid is miserable and so am I should we come in?

If your child is at high risk of flu complications because of another condition, call your health care provider, otherwise you can probably avoid the emergency room. Try to make children as comfortable as possible at home.

  1. Let them rest
  2. Make sure that they are getting lots of fluids to avoid dehydration
  3. Let the fever do its job. However, if your child is uncomfortable try lowering the body temperature with a lukewarm bath (do not use ice packs or alcohol bath) or giving acetaminophen or ibuprofen. Make sure you give the right dose! Talk to your pediatrician or pharmacists for help in finding the right dose. Do not over bundle them.

What if my child has a fever over 103, should I bring them in?

My child’s temperature recently soared to 105.6 Fahrenheit, and he was uncomfortable so we brought the fever down by alternating doses of ibuprofen and acetaminophen, talk to your pediatrician before trying a combination approach. DO NOT GIVE THEM ASPIRIN – there has been an association with Reye’s syndrome. The medications won’t get rid of the flu, but they may help you and your child ride out the flu with less suffering. If the fever persists for more than three days or if your child develops any of the symptoms above contact your pediatrician.

What we can and can’t do in the emergency room

Make my kid better please!

There is nothing we would like more than to make your child feel better. It’s what we’ve dedicated our lives to. When it comes to the flu we are limited in what we can do. Because the flu is a virus, antibiotics like amoxicillin are USELESS. In fact, they are worse than useless and can be harmful if used when not needed.

FIND OUT MORE ABOUT ANTIBIOTIC MISUSE AND DRUG-RESISTANCE HERE.

While there are antiviral drugs like Tamiflu, there is a very small window at the beginning of the flu where they have limited effectiveness. Usually, by the time your child is exhibiting symptoms, it’s too late. What we can do in the emergency room is help if your child is dehydrated or struggling to breathe.

How can we stop the rest of the family from getting sick?

  1. Teach your children to cough into their elbows and model the behavior to help reduce the amount of germs flying through the air.
  2. Make sure everyone in the family practices good hand-washing technique and washes their hands frequently–after going to the bathroom, before eating or touching their face, etc.
  3. Use masks! Stop the droplets.
  4. Get the flu vaccine. I know, I know, this year’s flu vaccine isn’t as effective as usual, but it is stopping some of the flu variants, AND it may help reduce the length of time you’re affected.
  5. Eat well, get plenty of sleep and exercise.

Healthy wishes,
Melissa Hodges RN

Melissa Hodges is a pediatric emergency room RN and mom to two young boys. Melissa has been at Tucson Medical Center for ten years. She is a knitting ninja apprentice, who makes a mean chili and enjoys spending time with her family and friends in beautiful Tucson, Arizona.


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