Kids, Athletics, Fitness and Summertime

Written by Jesse Hackell MD FAAP

It has finally warmed up, even in the more northerly reaches of our land, and school is out. Our children will—we hope—be spending much greater amounts of time outdoors—at the beach, lake or pool, playing sports, both organized and pick up, in camp or in neighborhood parks. They will be doing what children do so well—playing and expending energy, freed from the constraints of classes and short daylight hours of the winter.

As much as pediatricians encourage this activity—and we do, strongly, extol the benefits to kids, and our nation as a whole, of vigorous physical activity—this support is extended hand-in-hand with a number of cautions and warnings. We want our children to play and to exercise, but most importantly we want them to do so safely. Prevention of injury goes right along with participation in activities.


Bicycles are a great means to keep active during the summer months. And bicycle safety is something which must be taught to children from the moment they get their first set of wheels. Helmets are a mandatory and non-negotiable element of this safety education. Many states and communities have laws requiring helmets for all cyclists; even in those areas which do not have such laws, it is imperative that parents and pediatricians insist that all riders, no matter their age or the distance they will be riding, wear helmets for every ride. Nor should we forget about scooters and skateboards and rollerblades—a fall from any of those wheeled vehicles can lead to a head injury just as serious as a fall from a bicycle. Get them out there moving on their wheels—but make sure that their heads are protected.


Water safety should be a given, since every year, emergency rooms see drownings and near-drownings of toddlers and children left alone and unsupervised “for just a moment.” Whether they can swim or not, children must be supervised or have a capable buddy with them at all times when in, or even near, water bodies. Remember that falls and head injuries which occur at the edge of a pool can still lead to an unconscious child falling into the water and being incapable of self-rescue.


And don’t forget about sunscreen and protection of a child’s delicate skin from both the acute and long-term dangers of excessive UV ray exposure. A sunburn is painful, as we all know; a child’s skin is thinner, with a thinner outer layer, and even more susceptible to a painful or blistering burn than that of an adult. In addition, unprotected sun exposure will start a child down the long-term road to wrinkles, leathery, sun-damaged skin as well as melanoma and other skin cancers.

Protect your children from the sun’s damaging rays every day. There are new labeling requirements which will be showing up on sun protection products over the coming months. In summary, the key points of sun protection are as follows:

  1. Use enough product to be effective—an average adult needs to use a full ounce of sunscreen to adequately protect the body; an average child may require half an ounce, while adolescents should be treated as adult-sized bodies.
  2. Use it often enough—most sunscreen protection needs to be re-applied every two hours or so, and more often if the child is spending a lot of time in the water. Sunscreens are NOT waterproof, and they lose their effectiveness due to swimming and sweating. So re-apply it frequently.
  3. Use the right product. An SPF greater than 30 confers little additional protection, at greater cost. Additionally, SPF protection only refers to UVA protection, so it is important to make sure that all sunscreen products specifically state that they protect against both UVA and UVB rays, in order to protect against all forms of skin-damaging UV rays.


Organized team sports and fitness activities are great ways for kids to get in shape and stay in shape through the summer months (and year round, in fact). But especially in the heat of the summer, heat stress is a major factor in exercise-related injury to children. Because of their large body surface area relative to their weight, as well as their relatively thinner skin, children have a greater tendency to lose water by perspiration than do adults.

In addition, the volume of fluids that they can consume at one time is less than an adult. So the risk of dehydration is always present for kids who are active and playing vigorously, especially in the heat of the day. Fortunately, the days of trying to “toughen” up a child athlete by restricting water intake during practices and games are long past, and most coaches and trainers allow and encourage free access to water at all times.

But for our younger children, who may not be supervised at all times of their play by an adult, ensuring adequate fluid intake becomes even more urgent. When kids play out in the hot sun for an entire day, frequent water breaks and rest periods out of the direct sun are needed, and need to be enforced by parents. While it is not possible to specify a fixed amount of water needed by a child, a good rule of thumb is to check the color of your child’s urine at the end of each day.

Clear or very pale yellow urine indicates adequate hydration; dark yellow urine is a sign that the child has not had enough fluid intake that day, and need to “top off the tank” before another day outside in the heat.

We want our kids to have fun and active summers, doing the sorts of activities that kids love to do and do so well. By taking care and paying attention to some very basic safety rules, we as parents and pediatricians can assure that a fun summer will also be a healthy one.

Dr. Hackell is a founding member of Pomona Pediatrics PC, a division of Children’s and Women’s Physicians of Westchester. He practices in the lower Hudson River Valley just north of New York City.