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Summer Camp Health Guidelines

June 7, 2005
In just a few weeks, 10 million American kids will head off to summer camp. But before they go, health experts are issuing strong new advice to both parents and camp directors, and recommending new precautions to protect campers' health.

Parents should make sure to ask camp officials now what kinds of health services, including emergency response, their child's camp has in place, the experts advise.

Campers should provide, and camps should require, a full health exam and list of any medications that campers use -- and let children have immediate access to emergency drugs for asthma and allergies. And parents shouldn't see camp as a time to give kids a "holiday" from drugs for behavior issues or mental health issues.

Even homesickness, a common psychological malady for campers, can be prevented with a little effort by parents and doctors in the weeks before camp.

The new guideline, published in the June issue of the journal Pediatrics, was written by a team led by a University of Michigan Health System physician who specializes in camp health. Edward Walton, M.D., FAAP, FACEP, is lead author of the paper, which is an official policy statement of the American Academy of Pediatrics (AAP) and was produced in conjunction with the American Camp Association.

"Summer camp, whether it's day camp or sleep-away, can be a great experience for children -- but it's crucial that parents, camp officials and medical professionals work together to make it as safe and problem-free as possible for children," says Walton, a clinical assistant professor of pediatrics and emergency medicine in the U-M Medical School who has studied camp health for 18 years. "We hope this new guideline can help with that process."

Walton and U-M colleagues recently published a study in the journal Wilderness & Environmental Medicine showing that almost half of camp health officers reported caring for children with significant medical needs, including diabetes, asthma, attention deficit disorder and epilepsy.

But 44 percent of the camp health officers had medical training at the paramedic level or less, and 40 percent said it would take an ambulance more than 10 minutes to get to their camp. More than 70 percent said the hospital that would receive an injured or ill camper was small or rural.

In light of these statistics, Walton advises parents and camp officials to communicate openly, early and often about any health problems a child has or might face at camp, how the camp would respond, and how parents can be reached in an emergency.

The new policy statement for the first time advises parents to thoroughly assess whether a camp is right for their child's mental, emotional and physical well-being, as well as their interests and skills.

That means, Walton says, that camps should provide parents with a complete picture of what their programs involve, whether it's strenuous sports, rough wilderness camping, horseback riding -- or intense music or computer practice. If an activity raises risk for kids with certain medical conditions, for instance scuba diving and asthma, camps should tell parents about those risks ahead of time.

Homesickness prevention, the authors write, should start weeks before a child goes off to camp, and can be led by parents with the help of the doctor or other health care provider who performs the child's pre-camp health assessment.

"If parents discuss camp positively, avoid expressing doubts about a child's ability to avoid homesickness, involve the child in preparations for camp, and arrange brief trips or sleep-overs away from home, children will be better prepared to go to camp," says Walton. "Parents should also avoid making pre-arranged plans with their children about picking them up if they get homesick."

With the new guideline, the AAP also recommends that its members -- the pediatricians who treat many of America's children -- get involved with camps in their local area to make sure that health policies and standing orders are up-to-date.

They can also act as medical backups to the nurses and paramedic-trained camp health officers on site at camps -- instead of the local emergency room or urgent care center, which Walton's study found was the case 75 percent of the time.

Preparing for rapid and effective response to emergencies is a major part of camp health, Walton explains, because of all the injuries and acute illnesses that can strike campers while they're pursuing new physical activities and interacting with new environments.

While the AAP policy statement does not recommend that all camps purchase an automatic external defibrillator (AED) to re-start stopped hearts, it does say that camps that choose to purchase the devices should make sure camp staff are trained to use them in accordance with local regulations.

The AAP does recommend that all camps have staff who can administer first aid and CPR (cardiopulmonary resuscitation), and that waterfront supervisors be certified in CPR.

The increasing numbers of children who have asthma and allergies also bring new challenges for camps. The new guideline recommends that parents teach their children how to use rescue inhalers or EpiPens (allergy-calming epinephrine injection devices) long before the kids go to camp, and to work with camp officials to specify what situations might require children to use the devices. And camp officials are advised to allow children who know how to use such devices to carry them or have them nearby at all times.

"The delay that can occur when another camper or counselor has to run to the camp nurse's office to grab an inhaler for a child who is having an asthma attack or an EpiPen for a child who has been stung by a bee can have real health consequences," says Walton.

The new guideline does not give detailed recommendations for camps that serve only children with special medical circumstances, such as cancer, physical disabilities, blindness, deafness or diabetes. But it recommends that camps work with local pediatricians and health professionals to assess children's fitness to take part in such camps, and establish programs specific to them.

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