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Summer Safety Statements: True or False?

It’s hard to believe that Summer 2020 is here. With all of the uncertainty in our world with COVID-19 as well as rising racial and political tensions, Summer has snuck up on us. And, while summertime in NC means sunny days, sand, swimming, picnics and outdoor fun, we mustn’t forget that a truly happy summer is a healthy one. Here, I will share a few common summer health topics—but are they True or False?

You can’t experience heat exhaustion if you are well hydrated.


To begin, let’s first discuss the symptoms of heat cramps, heat exhaustion and heat stroke.

Heat Cramps:

  • Heat cramp symptoms can include: severe cramps that typically begin suddenly in the hands, calves, or feet, and hard, tense muscles.

Heat Exhaustion:

  • Heat exhaustion symptoms can include:
    • fatigue
    • nausea
    • headache
    • excessive thirst
    • muscle aches and cramps
    • weakness
    • confusion or anxiety
    • drenching sweats, often with cold, clammy skin or “prickly skin”
    • slowed heartbeat
    • dizziness
  • In heat exhaustion, symptoms temperature is usually <104 deg F and brain function is not impaired.
  • Heat exhaustion requires immediate attention.
  • Treatment involves rest in a cool environment with oral rehydration, and then transporting to an emergency department if these methods are unsuccessful in resolving the symptoms.

Heat Stroke:

  • Heat stroke symptoms can include many of the symptoms of heat exhaustion but with the following:
    • hot, flushed, dry skin
    • rapid heart rate
    • shortness of breath
    • decreased urination
    • increased body temperature to 104-106 deg F
    • confusion or loss of consciousness and convulsions
  • Heat stroke can occur suddenly, without any symptoms of heat exhaustion.

Heat illness can only occur when the ambient temperature is above a specific number.


The environmental temperature certainly plays a big role, but so does the type of activity a person is doing, its duration, how acclimatized the person is to that type of activity, the person’s hydration level, their nutrition, their sleep, and more.

Even when one person experiences heat illness, others in the same environmental conditions do not, so there is clearly more involved than just the temperature.

You can suffer heat illness even if you’re properly hydrated.


Of course, being well hydrated is a good thing, but acclimatization, the environmental conditions, the intensity of activity and duration of activity are all major factors when it comes to heat stroke and other heat illnesses.

Salt tablets replace the electrolytes lost in sweat.


The average athlete with normal kidneys needs water. Supplements such as sports drinks can be used in situations during and following strenuous workouts, but should be in addition to, not in place of plain water.

The sodium in our body fluids is closely regulated by the kidneys. In most situations, it is water that is lost in perspiration and breathing. To correct or prevent these losses, usually all that is needed is to take in more water. The small amount of sodium loss is easily replaced from a normal diet.

In a situation when we become dehydrated, the sodium concentration in the body is already elevated. Adding salt (sodium) only aggravates the condition by forcing the kidneys to excrete more water in order to eliminate the extra salt and could stress the body further. Only in extreme circumstances such as intense exertion in hot and dry weather, severe vomiting, and diarrhea, and other illnesses, are special electrolyte solutions (not just sodium) required.

SPF refers to protection from all types of UV rays.


Sun protection Factor, or SPF, actually only rates how much a product protects your skin from UVB rays only.

There are two types of ultraviolet light: UVB, which causes sunburn, and UVA, which penetrates the skin more deeply and can cause wrinkles. The idea here is simple: The higher the number, the better the coverage. “Broad spectrum” covers both UVA and UVB rays, the two basic types of ultraviolet rays that can contribute to skin cancer. The Food and Drug Administration (FDA) recommends “broad-spectrum” sunscreens with a sun protection factor (SPF) of 15-30 or higher. SPF currently goes all the way up to 50+.

I can still get a sunburn on a cloudy day.


Just because you can’t feel the intense burn of the sun’s rays doesn’t mean they aren’t there. UV rays can still be powerful on a cloudy or even overcast day.

In fact, on an average cloudy day, only about 50% of UVB rays may be blocked.

Depending on how overcast the day, the protection from clouds could be more or less than this. So, beware. The sun doesn’t need to be shining brightly to give a scorching.

For additional sun protection, UV rays may also be partially blocked in a shady spot created by tree leaves or a beach umbrella. But UV rays frequently bounce off reflective surfaces like grass, sand, sidewalks, water and, don’t forget, snow to hit your skin. So, keep the sunscreen close by– even in the shade, you’re still exposed.

Having darker skin protects me from sunburn.


It’s a common myth that the burden of sun damage is carried by the pale or most-freckled among us. While fair-skinned people are likely to absorb more solar energy than dark-skinned people under the same conditions, people with darker skin still experience sun damage, even if it doesn’t show as the recognizable pink burn.

In fact, survival rates for certain types of melanoma are actually much lower for non-white people due to a lack of awareness about the sun’s risks on darker skin.

Those with darker skin can also experience wrinkles and early skin aging from too much sun. In addition, “pre-tanning” in a tanning bed before a sunny vacation does not prevent sunburn. This type of tanning is exposure to mostly UVA light, which just furthers sun damage of skin.

Again, according to the American Academy of Dermatology, you should look for a sunscreen that has an SPF of 30 or higher that provides broad-spectrum coverage against both UVA and UVB light.

There is no such thing as waterproof sunscreen.


Some sunscreens that are thicker may stay on better or be water resistant, but there is no waterproof sunscreen.

The key to sunscreen protection is to apply often especially with sweating and water exposure, as frequently as every 2 hours.

Frequently forgotten spots to apply sunscreen include the ears, nose, lips, back of neck, hands, tops of feet, along the hairline and areas of the head exposed by balding or thinning hair. So, don’t forget that wearing a hat, sunglasses and lip balm with SPF are also important items that go hand-in-hand with your sunscreen.

All types of sunscreens are equally safe to use on children, as long as it says “For Kids” or “For Babies” on the label.


Sunscreens are not recommended for infants.

The FDA recommends that infants be kept out of the sun during the hours of 10 a.m. and 2 p.m., and to use protective clothing if they have to be in the sun. Infants are at greater risk than adults of sunscreen side effects, such as a rash. The best protection for infants is to keep them out of the sun entirely. Ask a doctor before applying sunscreen to children under six months of age.

For children over the age of six months, the FDA recommends using sunscreen.

Follow the directions on the package for using a sunscreen product on babies less than 6 months old. All products do not have the same ingredients; if your or your child’s skin reacts badly to one product, try another one or call a doctor. Keep in mind, sunscreen is not meant to allow kids to spend more time in the sun than they would otherwise. Try combining sunscreen with other options to prevent UV damage.

Although the protective action of sunscreen products takes place on the surface of the skin, there is evidence that at least some sunscreen active ingredients may be absorbed through the skin and enter the body. If possible, avoid the sunscreen ingredient oxybenzone because of concerns about mild hormonal properties. Remember, though, that it’s important to take steps to prevent sunburn, so using any sunscreen is better than not using sunscreen at all.

For sensitive areas of the body, such as the nose, cheeks, tops of the ears, and shoulders, choose a sunscreen with zinc oxide or titanium dioxide. These products may stay visible on the skin even after you rub them in, and some come in fun colors that children enjoy. Put sunscreen on 15 to 30 minutes before going outdoors. It needs time to absorb into the skin.

DEET is safe for children 2 months and older.


Let’s review why insect repellent is important. Insect repellents are used to repel mosquitoes, ticks, flies, and other biting insects. Mosquitoes can transmit diseases such as Zika, Malaria, and West Nile virus. Ticks can transmit Lyme disease, Rocky Mountain Spotted Fever, and other diseases.

Repellents are not meant to kill insects, but to keep them away to prevent bites and the spread of disease. DEET and picardin are the two most common, Environmental Protection Agency (EPA) approved, effective insect repellent chemicals in bug sprays.

Mosquitoes are attracted to carbon dioxide as well as the warmth and humidity your body is giving off. In addition, they are also attracted to certain chemicals in your sweat.

Per the EPA, DEET is very safe when used according to label directions, and it’s not classified as a carcinogen (cancer-causing agent). The label directions on DEET products will say you should apply it only once a day to exposed skin and outerwear – not under clothing. Under clothes, it can absorb into the skin more readily, and possibly cause irritation. DEET can also irritate the eyes.

Repellents with less than 10% of an active ingredient may only offer protection for short periods of time (1-2 hours). Sweat, water contact, and rubbing from clothing can affect how long a repellent may be effective. Water resistant repellents are available. If you choose to use a DEET product, the CDC recommends products with DEET concentrations of 20-50%. Consider using a variety of methods to prevent bites. You may cover exposed skin with clothing or alter the landscaping in your yard to make it less mosquito or tick friendly.

The American Academy of Pediatrics (AAP) does not recommend insect repellents for children younger than two months. The CDC recommends that DEET can be used on children older than two months. The AAP recommends that products applied to children should not have more than 30% DEET. Oil of lemon eucalyptus products which are natural and shown to be effective DEET alternatives should only be used on children older than three years.

Applying Insect Repellent on Children

Other special considerations for children: When possible, clothing or netting should cover exposed skin. Children may be more likely to mishandle a bottle or lick treated skin, increasing their risks. Young children should not be allowed to apply the insect repellent themselves.

To apply repellent to a child’s face, first spray it on your hands and carefully rub it on their face, applying lightly around the ears, avoiding the eyes and mouth. Check the product label to see if there is a minimum age for use. If no age limit is on the label, the EPA has not put age restrictions on the product. The insect repellent should be washed off when a child returns indoors.

In pregnancy, according to the CDC and the American College of Obstetrics and Gynecology, DEET and other approved repellents may be used during pregnancy. This may reduce risk to mom and baby from insect-related diseases and is especially recommended in areas with risk of Zika. The use of approved insect repellents while breastfeeding is generally considered low risk.

It is not safe to swim alone even if you are a competent swimmer.


Generally, swimming alone should not be recommended. Swim where there’s a lifeguard whenever possible, and swim with a buddy — never alone.

It may go without saying but drinking alcohol should be avoided if swimming, boating, or enjoying other water sports. In addition, if swimming outdoors, one should heed local weather conditions and warnings and avoid dangerous conditions like thunderstorms or strong currents.

Before swimming, you should also consider investigating water quality testing at your local beach. You’ll want to swim where the water usually tests clean, where the water is tested frequently, and where officials close the beach whenever contamination is present.

Avoid swimming for at least 24 to 48 hours after heavy rains, which are known to wash harmful bacteria from land and sewers into water. In addition, no swimming should be allowed if a child is having diarrhea. Parents should confirm that all pools are properly maintained, inspected, covered and secured.

Children are the highest risk age group for drowning and should NEVER be allowed to swim alone or unattended. It only takes 5 minutes underwater to result in death or serious brain injury. Being proactive with preventing water-related accidents is vital. The risk of drowning is decreased by nearly 90% when children aged one to four years participate in formal swimming lessons.

Even still, you should never assume a child is water-safe, regardless of swimming lessons or experience. Infants and toddlers need to be within an arm’s reach away. You should talk with your children about pool and water safety. Never allow a child to play in a way that would permit hair to come near a drain cover in a pool or stick fingers, toes, or body parts into drains. They should not play the “hold your breath underwater” game.

Make sure children know how to recognize when others in the pool may be experiencing distress. Please also require good behavior from your kids at the pool, including no running or pushing near the pool and no toys like tricycles near the water.

Foods containing mayonnaise are more likely to cause food poisoning.


Mayonnaise does not cause food poisoning; bacteria do.

If you have food poisoning, there’s nothing you can do but wait for it to pass.


Even though it may need to “run its course,” you can reduce the effects of food borne illness with rest and by taking extra fluids and electrolytes to replace losses from vomiting and diarrhea.

Symptoms are not always the same with each episode of food related or food borne illness. The most common symptoms are nausea, vomiting and diarrhea. It can take up to 7 days to start feeling symptoms from the time of exposure.

Sometimes more than one person can eat the same food but not everyone will get sick, or one person will get sicker than another. Also, “foodborne illnesses” could refer to several different situations. Certain bacteria or parasites can cause infection by contaminating food or water, but sometimes bacteria, viruses or parasites can be transmitted by the person who prepared the food to the person eating it. Most of the time, it is too hard to tell.

How can we prevent food borne illnesses then?

#1 – Wash your hands.

Anyone handling food should wash their hands frequently, for at least 20-30 seconds, with soap and water, while scrubbing under nails and between fingers.

#2 – Keep food prep and handling to a minimum when possible.

The less food prep and handling, the less potential spread of bacteria from person to food. In addition, keep those food thermometers handy!  Bacteria grow best on foods that contain protein and are at temperatures between 40-140 degrees F.

#3 – Be mindful of food that has been left out.

Food left at room temperature for more than two hours should be discarded. When the temperature outside is 90 degrees F or hotter, food should be discarded after just one hour. Remember, food borne illnesses are not always from bad food.

I’ve taken life-saving and CPR, so I can rescue my child.


CPR and life-saving don’t replace adult supervision, life vests, swimming skills and water safety awareness. It only takes five minutes under water to have brain damage, a cardiac arrest, or even to die.

Once children learn to swim, they don’t need life vests.


At swimming pools and supervised swimming areas, an older child who swims well may not need to wear a life vest. However, around natural waterways, steep banks, rivers or docks, where the water is swift, dark and cold, the drowning risk increases and rescue becomes much harder. With those factors working against us, we need to use more caution.

When boating, rafting or inner-tubing, or while swimming in open water like a lake or a river, adults and children should always wear properly fitted life vests. Water conditions change, boats capsize, and cold water makes life-saving and swimming skills difficult. Life vests improve chances of survival and rescue. But they only work if they are worn. You need to wear life vests, too, so you are prepared to help a child or yourself.

“My kids won’t wear life vests so I shouldn’t fight them.”


They’ll wear them if your expectation is clear and consistent. It helps to start young. Make life vests a part of all water activities, just like bringing sunscreen if you’re going to be in the sun. Life vests come in many shapes, sizes and colors. Let your children pick their favorite, as long as it fits properly. As children grow older, keep insisting on life vest use. Check their life vests each year for fit, wear and tear, and style.

Drowning is noisy. I’ll hear my child splashing and struggling in time to help.


Maybe in the movies, but not in real life. Children don’t have the ability to figure out what to do, such as right themselves or stand up, even in a few inches of water. As a result, they just “slip away” in silence.

Again, toddlers and preschoolers need constant adult supervision and life vests that fit each time they play near or in the water or on a dock.

Most drownings happen during a brief lapse in supervision, when a parent becomes distracted or involved in some other activity. A life vest is no substitute for supervision, but it can buy time.

I don’t live or vacation near the water, so I don’t need to worry about water safety.


There are water hazards in and around every home. Toddlers have drowned in five-gallon buckets, garden ponds and toilet bowls. Keep young children out of the bathroom except when directly supervised and don’t leave buckets or barrels where they can gather water. Children can drown in just a few inches of liquid.

Fresh fruits with a thick peel are always safe to eat.


Produce with a thick peel, like bananas, may not need to be washed unless you are cutting into them with a knife. But, for fruits like melons, bacteria on the peel can be transferred to the interior with a knife.

No matter how thick the peel, always try to wash produce using cold streaming water (no soap or bleach) and where possible, use a soft scrub brush or in the case of greens, submerge it in a water bath to properly clean and reduce residuals and potential bacteria.


About Rhoda Chang, MD

Dr. Rhoda Chang is a board-certified primary care physician with clinical interests in preventative care and wellness, school-aged and adolescent pediatrics, women’s health and management of chronic diseases such as diabetes and hypertension. With dual certifications in internal medicine and pediatrics, she sees patients of every age group.

Request an appointment with Dr. Chang today.