The risk of sun damage is cumulative throughout a lifetime—we recommend protecting your child from excessive sun exposure in infancy and making it a habit they will be able to carry with them as they grow.

Babies less than 6 months old

• Ideally, avoid sunscreen before 6 months old.
• Keep sun exposure low by staying out of direct sunlight, especially between 10am and 2pm. Find shade under a tree or umbrella.
• Dress your baby in lightweight clothing, covering as much skin as possible. Use a sunhat with a wide brim and sunglasses with UV protection.
• Watch for overheating and encourage extra fluids if it is warm.
• Sunscreen may be applied to small areas of skin that are not covered by clothing. Use a mineral based sunscreen such as zinc oxide or titanium dioxide.
• If your baby is excessively fussy or has any areas of red skin, take her inside.

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Babies older than 6 months and toddlers

• Keep sun exposure low by staying out of direct sunlight, especially between 10am and 2pm. Find shade under a tree or umbrella.
• Dress your baby in lightweight clothing, covering as much skin as possible. Use a sunhat with a wide brim and sunglasses with UV protection.
• Watch for overheating and encourage extra fluids if it is warm.
• Apply a broad-spectrum, water-resistant sunscreen with an SPF of 30 or greater to all exposed skin 15-30 minutes prior to going outside and reapply every 2 hours. Use a mineral-based sunscreen such as zinc oxide or titanium dioxide.
• If your child is excessively fussy or has any areas of red skin, take her inside.

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School-aged children, adolescents and adults

• Keep sun exposure low by staying out of direct sunlight, especially between 10am and 2pm. Remember: if your shadow is shorter than you, seek shade!
• Dress in lightweight clothing, covering as much skin as possible. Use a sunhat with a wide brim and sunglasses with UV protection.
• Stay hydrated by drinking plenty of fluids.
• Apply a generous amount of a broad-spectrum, water-resistant sunscreen with an SPF of 30 or greater to all exposed skin 15-30 minutes prior to going outside. Reapply every 2 hours and after swimming and sweating.
• If possible, avoid sunscreens with oxybenzone, parabens and phthalates as there are some concerns about these chemicals affecting hormone levels. An alternative to oxybenzone is to use a mineral-based sunscreen such as zinc oxide or titanium dioxide. However, when there are no other options, using any sunscreen is better than getting burned.

Insect bites can be uncomfortable and in some cases, can spread disease. In cases where you may choose to use insect repellent on your child, keep these tips in mind:

• Do not use insect repellent on infants under 2 months old. Instead, cover strollers with mosquito netting.
• Minimize exposed skin by dressing in long sleeves and pants, to reduce the area that needs to be covered with repellent.
• DEET is safe and effective to use on children. Use no more than 30% DEET on children and only apply once per day. A 30% DEET repellent should last about 5 hours.
• Apply to exposed skin and clothing, never under clothes. Avoid the eyes, mouth, cuts and irritated skin.
• Choose sticks, lotion and unpressurized sprays to avoid inhaling the repellent or getting it in the eyes. Have your child close their eyes and mouth during application if using any type of spray.
• Avoid applying repellent to the hands of young children who may put their hands in their mouths and eyes.

Remove the tick as soon as possible

• Use tweezers and grasp the tick as close to the skin as possible
• Pull straight up with even pressure. Do not twist or rock it from side to side
• Do not use petroleum jelly or a hot match to remove the tick.
• Small parts of the tick may remain in the skin but will eventually come out on their own. Avoid digging into the skin to remove small pieces.
• Wash your hands and the bite site with soap and water.
• Dispose of the tick by flushing it down the toilet. Testing the tick for Lyme disease is available but is not useful or recommended.

Risk of Lyme disease is low if the tick has been attached for less than 36 hours.

Preventative antibiotics are not recommended for children less than 8 years old and generally not necessary for older children.

Call us if your child develops any of the following symptoms in the next 30 days

• Rash (especially a bull’s eye rash at the site of the bite or multiple red rings on the body)
• Signs of infection at the bite area (increasing pain, redness, swelling, oozing or pus)
• Joint pain/swelling
• Fever, fatigue, or flu-like symptoms
• Severe headache or stiff neck

It can take weeks after a tick bite for the blood test for Lyme disease to turn positive so if you have any concerns about Lyme disease, your child’s symptoms or any of the above information, make an appointment to come in and discuss it further.

Car seats are an important—and proven—way to protect your child in case of a car accident, from the day you first bring them home until they can make their own macaroni and cheese (your mileage may vary). We hope this information helps you navigate the regulations and requirements that will best protect them until they can safely travel without one.

Rear Facing Car Seat — Until at least age 2 (but as long as possible!)

Children should be in a rear facing car seat in the back seat until at least age 2—but preferably as long as possible. (The rear facing height/weight limits allow many children to remain rear facing up to around age 4.) When a child exceeds the height/weight limits of an infant car seat, switch to a convertible car seat with a higher rear facing limit and continue to rear face as long as possible. Even if their legs appear cramped, it is much safer for them to remain rear facing.

Infant car seats are meant to be used semi-reclined (45 degrees) when rear facing. It is not safe to allow infants to sleep in car seats when not clicked into an appropriate car or stroller base because this position could obstruct their airway. Also, never put a rear-facing child in front of an active airbag.

Forward Facing Car Seat with Harness — Until at least age 5 and 40 pounds

Children who have outgrown their rear facing seat should use a forward facing seat with a harness in the back seat until at least age 5 and 40 pounds. Remember to keep rear-facing until at least age 2 before turning forward. Use a car seat with a 5 point harness and tether until age 5, or until they reach the upper height and weight limits for the 5 point harness. Maximum forward facing harness seat weight limits vary from 40-85 pounds, depending on the model. Make sure the child is within the weight limits of their seat and their head is at least 1 inch below the top of the seat.

Booster Seat — Until 4’9” and 80 pounds and the seat belt fits

Children who are at least 5 years old, 40 pounds and who have outgrown their forward facing seat with 5 point harness can switch to a booster seat in the back seat. They should continue to use the booster seat until 4’9 and 80 pounds (typically between ages 8-12).

In order to graduate from a booster seat, you should be able to answer yes to all 5 of the following:

1. Child can sit with their back and hips against the car seat back.
2. Child can bend their knees easily over the front edge of the seat and place feet flat on the floor.
3. Lap belt fits low and snug across the hips, not on the belly.
4. Shoulder belt fits across mid-chest and shoulder.
5. Child can sit without slouching or playing with the seat belt and can remain in this position and awake for the entire ride.

High back booster seats should be used in cars without head restraints or with low seat backs. Backless boosters can be used in cars with high seat backs and head restraints. Lap belts and shoulder belts are required for use with a booster seat. All children under age 13 should sit in the back seat.

No Booster (and back seat until age 13)

Children who are at least 4’9 and 80 pounds can ride in the back seat with an adult seat belt. In order to come out of the booster seat, you should be able to answer yes to all 5 of the following:

1. Child can sit with their back and hips against the car seat back.
2. Child can bend their knees easily over the front edge of the seat and place their feet flat on the floor.
3. Lap belt fits low and snug across the hips, not on the belly.
4. Shoulder belt fits across mid-chest and shoulder.
5. Child can sit without slouching or playing with the seat belt and can remain in this position and awake for the entire ride.

Both the lap and the shoulder belt are needed for optimal protection. Make sure your child does not tuck the shoulder belt under his arm or behind her back. All children should sit in the back seat until age 13.