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Measles in Children

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The rise in measles cases recently has many people, parents included, very concerned, and with good reason. Measles is a viral illness that can be very dangerous especially for infants, children under age 5 years, pregnant women, and those with immune system problems. As of 2/26/25, there have been 165 cases in 10 states, including Washington, and sadly one child has died. Although the number of infected people does not sound very high, measles is one of the most infectious viruses known, so numbers are likely to grow. Measles infects 90% of those exposed if they are not vaccinated.

Measles starts with a fever (as high as 104), runny nose, cough, and red watery eyes. These symptoms usually start 7-14 days after exposure though it can take as long as 21 days to show signs. Two- three days later, small white spots inside the cheeks (Koplik spots) may show up. The typical measles rash starts on the face at the hairline about 3-5 days after symptoms begin. This rash consists of red, usually flat, spots that spread head to toe and may join together. Fever may spike to 104 when the rash appears. Diarrhea can also occur.

Complications are common with measles, especially in infants, children under age 5 years, pregnant women, adults over age 20 and those who have immune system deficits. Ear infections occur in 1 out of 10 kids with measles and pneumonia happens in 5% of all people infected. Brain inflammation (encephalitis) afflicts 1 out of 1,000 infected children and can cause brain damage, deafness, seizures, and death.  Nearly 3 in 1,000 kids with measles die, most commonly due to pneumonia or encephalitis. Pregnant women are at increased risk of delivering early and having a low-birth-weight baby.

There is a very rare complication that can occur 7-10 years after measles infection called Subacute Sclerosing Panencephalitis (SSPE). It is a brain disorder related to the earlier measles for which there is no treatment and results in death within 3 years of diagnosis without exception.

The good news is that the measles vaccine (either as MMR [measles, mumps, and rubella vaccines] or MMRV (as above plus varicella [chickenpox] vaccine) is safe and effective. For kids it is a 2-dose series, given at ages 12-15 months and 4-6 years; adults who are unvaccinated may only need one dose. One dose of a measles vaccine is 93% effective at preventing infection, and 2 doses gives 97% protection. Common side effects include muscle soreness at the injection site, low grade fever, and a mild rash. Rarely there can be a brief harmless seizure due to fever, occurring in less than 8 kids per 10,000 vaccinated.

The Health and Human Services Secretary Robert F. Kennedy, Jr, issued a statement on March 3, 2025, with the subheading “MMR vaccine is crucial to avoiding potentially deadly disease” and then noted “Vaccines not only protect individual children from measles, but also contribute to community immunity, protecting those who are unable to be vaccinated due to medical reasons.”

Earlier concerns about MMR vaccine and autism have been strongly disproved in multiple studies. The doctor who made those claims was found to have fabricated his ‘results’ and lost his medical license. Autism is often diagnosed at around the same age as when kids receive MMR vaccine, but the vaccine does not cause autism.

During a local measles outbreak, students who are unvaccinated are excluded from school for 21 days from the last measles rash identified in the community. If they are given the first dose of the MMR or MMRV series, they may return to school. If an unvaccinated child is exposed to measles, they should be immunized as soon as possible to decrease the risk of infection.

If you have questions about measles vaccination, contact your child’s health care provider. Measles is a very dangerous virus that is unfortunately also extremely contagious. Our best way of protecting our kids and our community is vaccination.

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Dr. Elise Herman

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Dr. Herman is passionate about community health outreach, school programs, and child/family health and wellness. She has more than 31 years of experience as a pediatrician in Ellensburg, Washington, the last 3 with KVH Pediatrics. In 2022 Dr. Herman mostly retired from practice and continues to contribute blog posts and remain a visible advocate for kids in the community.

Preventing Hearing Loss in Kids

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Excellent hearing is crucial to a child’s health and development. Poor hearing, even if mild, can cause problems in communication, learning, speech, and social skills. There are multiple reasons a child may develop hearing loss, including chronic ear infections, trauma, certain medications, and vaccine-preventable serious brain infections like meningitis.

In 2023 the American Academy of Pediatrics released a policy statement concerning one of the most preventable causes of hearing loss—excessive noise exposure, calling this a “largely unrecognized … serious public health hazard”. This type of hearing loss can be temporary or permanent. Over 12% of kids aged 6-19 years and 17% of adults under age 70 have permanent hearing damage from loud noise exposure.

Because children have smaller ear canals, higher frequency sounds are more intense and potentially more damaging. Think of noise as ‘dose-related’; the longer the exposure, the more risk even if just slightly louder than what is considered safe. Sounds over 75 dB for older children and adults can cause damage, depending on length of exposure. Noises we consider routine like city traffic, TV, and lawnmowers can harm children’s hearing. Concern has also been raised about infant sound machines used to help babies fall asleep. Since infants can have damage beginning at 60 dB, it is recommended to keep a noise level at 50 dB or lower, but sound machines may exceed this.

Depending on your child’s age, hearing loss can present differently. They may not meet developmental milestones. A 3-month-old should alert to a sound and babble back and forth. By 6 months, you should hear some consonants (“mamamama”, “dadada”, etc.). A 1-year-old will follow simple directions like, “Look at Mommy!”. Toddlers and older kids with hearing loss may have unclear speech, say “Huh?” a lot, and want the volume of TV or music turned up. Acute loud noise exposure can also cause ear pain and ringing in the ears (“tinnitus”).

Personal listening devices (PLDs) such as iPods, smartphones with earbuds, and headphones for watching TV can magnify the risk. The World Health Organization estimates 1.5 billion people worldwide are risking hearing damage from ‘unsafe listening practices’.

We can start early to protect our child’s hearing. Checking decibels in your child’s environment is helpful although decibel apps on phones are not 100% accurate. Anything over 85 dB can harm an adult’s hearing, and over 70 dB can impact a child. The louder the noise, the faster it can cause damage. 

Infant sound machines should be at least 7 feet away from a baby and at 50 dB max. Consider avoiding loud noise exposure (concerts, fireworks, etc.) but if unavoidable, younger children can wear sound protecting earmuffs (plastic cups connected with a headband) over their ears. Ear plugs are safe for older kids and there are different types; ‘musician earplugs’ dampen volume yet preserve audio quality better than foam earplugs from the drugstore.

Be a good role model by setting good rules for hearing protection and wear ear plugs yourself when appropriate. Set clear expectations for protecting every family member’s hearing. Loud background noise can also be distracting, worsen a child’s mood, and disrupt learning, so routinely having a quiet home at times can be a benefit. If you have concerns, talk to your child’s health care provider about getting a formal hearing evaluation by an audiologist.

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Dr. Elise Herman

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Dr. Herman is passionate about community health outreach, school programs, and child/family health and wellness. She has more than 31 years of experience as a pediatrician in Ellensburg, Washington, the last 3 with KVH Pediatrics. In 2022 Dr. Herman mostly retired from practice and continues to contribute blog posts and remain a visible advocate for kids in the community.

Mealtime without Screens

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Contributor Dr. Elise Herman

Mealtime should be a time to connect with our kids and enjoy healthy food in a stress-free environment. This idealized version is not always the case, and for many reasons, kids may end up eating in front of the TV, laptop, iPad, or smartphone. There are multiple problems with this—for both adults and kids.

Obesity:  In general, kids eat more in front of a screen. Some parents are happy to see their child (especially if they are a picky eater) eating more but being distracted while eating means eating mindlessly. This can lead to overeating in the long run since kids don’t pay attention to feeling full and therefore overeat. Research has shown that children who watch a screen during meals are more likely to be overweight.

Digestion: Digestion is aided by really noticing the aromas, the preparation and the sight of food. If attention is more on the screen than the food, digestion can suffer.

Missed social opportunities: When eating alone and watching a screen, kids miss out on connection with others over a meal, learning to make conversation and basic etiquette (taking small bites, not talking with your mouth full, etc.). Mealtime is a chance to slow down, enjoy our food, and socialize. You can model all of this to your child if you eat together, undistracted—powerful stuff!

Exposure to commercials: Commercials during kids’ programming are often for fast food or processed foods high in sugar and calories and aimed specifically at children. Not surprisingly, screen time during meals is associated with increased junk food consumption.

So how to change this behavior in your house? Anticipate that it may not be easy (for either of you) to break this habit, but keep in mind how important this is and stay with it. Here are some suggestions:

Make change gradual: Target one meal at a time, either eliminating screens altogether for that meal or decreasing the time. Substitute music, conversation, or reading books to your child (not having an app read a book). Starting with a no-screen snack is an easy way to begin.

Adults adopt the change, too: No screens for adults as well at mealtimes, not even to text. You can tell your child this is hard for you, too, but you know how important it is for everyone to make this change. Explain your plan to other adults who may provide meals (childcare, sitters, grandparents) so they are also on board with this—consistency is vital for success.

Follow a schedule: Eliminate screens at one meal or snack every 1-2 weeks and you will accomplish the overall goal within 1-2 months. Talk about how different mealtimes are now that you are connecting and eating more mindfully.

Be firm: Don’t give in to tantrums or your child eating less. This behavior will be short-lived, so don’t let it throw you off track. You can however have some occasional exceptions such as snacks while watching sports, but these should be infrequent.

Children age 8-12 in the US look at screens for 5 ½ hours daily and teens spend an average of 8 hours a day on their devices—pretty stunning statistics. Kids who watch a screen during mealtime spend more time on devices overall. Changing this behavior is a good place to start to take control of the excessive screen use in most of our lives.

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Dr. Elise Herman

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Dr. Herman is passionate about community health outreach, school programs, and child/family health and wellness. She has more than 31 years of experience as a pediatrician in Ellensburg, Washington, the last 3 with KVH Pediatrics. In 2022 Dr. Herman mostly retired from practice and continues to contribute blog posts and remain a visible advocate for kids in the community.

Measles Cases Rising 2024

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Contributor Dr. Elise Herman

Measles cases are on the rise, and although numbers in the US are small right now, there is cause for concern. Measles is one the most contagious human viruses, with a 90% chance of someone who is not immune getting infected if they are near someone with measles. People with measles can infect others for 4 days before they have any signs of being sick, and for 4 days after the rash appears. The virus stays in the air and is infectious for 2 hours after the infected person has left. There is no treatment for the measles virus, however there is life-long immunity (protection) after vaccination as well as infection.

This recent rise in measles in the US is in part due to a mild drop in kids’ vaccination rates, often related to children missing routine health care visits during the pandemic. Although the current rate of kindergarteners fully vaccinated against measles is good at 92%, the previous rate of 95% was better particularly because that level gives ‘herd immunity’, meaning protection of those that were not or could not be vaccinated (due to young age, cancer treatment, or other immune system problems) by those who are vaccinated.

The number of measles infections world-wide has increased dramatically, up almost 80% in the last year to 306,000 cases. As people travel more, they can bring the infection home if they are not immune, potentially exposing many people before they know they are sick.

Measles spreads easily through airborne secretions from coughing or sneezing. Infection is also caused by direct contact with droplets from the mouth, nose, or throat. Symptoms develop 7-14 days later and start with profuse runny nose, cough, and red, swollen, watery eyes. Fever is often up to 104 degrees. The rash develops 3-5 days after cold symptoms begin and starts as flat red spots on the forehead, spreading downwards to the trunk and extremities. Some spots may become raised and join to from larger blotches. It is not usually itchy.

Measles itself is miserable, but the biggest concern is regarding complications. Serious complications include pneumonia in 1 out of 20 of those infected, encephalitis (brain inflammation and swelling) in 1 out of 1000 infected, and rarely, temporary or permanent blindness (more common in developing countries). One out of 5 unvaccinated people in the US with measles will be hospitalized, and 1-3 out of 1000 will die. Children under 5 and adults over 20 are most at risk of serious complications. Also at increased risk are pregnant women and those with immune system problems.

Measles vaccination is safe and effective and gives life-long immunity. Prior concern of a connection between the MMR (measles, mumps, and rubella) vaccine and possible autism was based on fake ‘research’ and has been disproven by multiple studies by the American Academy of Pediatrics, the World Health Organization, and the Institute of Medicine.

There has been a 99% decrease in measles cases since the vaccine came out in 1963. Prior to the vaccine, there were 3-4 million cases annually in the US and about 48,000 people hospitalized, most of which were children. Add approximately 500 deaths and 1,000 cases of encephalitis each year, and it is easy to see how miraculous vaccination has been.

The best way to protect ourselves, as well as the approximately 9 million people in the US who cannot get the vaccine due to an immune system problem, is to be vaccinated. Measles vaccine is recommended for kids aged 12 months and again between 4 and 6 years. It is also approved for adults who did not receive it as children. There are 2 types of measles vaccines- the MMR (as above) and the MMRV (also protects against varicella/chickenpox). Your child’s health care provider can provide additional information on measles vaccination.

Recursos en español

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Dr. Elise Herman

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Dr. Herman is passionate about community health outreach, school programs, and child/family health and wellness. She has more than 31 years of experience as a pediatrician in Ellensburg, Washington, the last 3 with KVH Pediatrics. In 2022 Dr. Herman mostly retired from practice and continues to contribute blog posts and remain a visible advocate for kids in the community.

Preventing Respiratory Syncytial Virus Infections

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Contributor Dr. Elise Herman

As the winter weather approaches, so does the ‘sick season’, including illness due to RSV (Respiratory Syncytial Virus). RSV typically starts in fall, peaks in winter, and causes cold symptoms including runny nose, cough, and fever in children and adults. Most kids have had RSV by age 2. Although usually mild, RSV can cause more serious problems like wheezing, pneumonia, and trouble breathing. These problems are more likely in premature babies or in kids with heart disease, lung issues like asthma, and immune system problems. Between 58,000 and 80,000 kids under age 5 are hospitalized due to RSV each year. Adults aged 60 and above are also at higher risk of more severe RSV illness. Reinfections with RSV are common.

Like other colds viruses, RSV spreads by the droplets released by coughing or sneezing. You can also get it by direct contact (for example kissing) or touching a contaminated surface like a counter or cup and then touching your eyes, nose, or mouth.

There is no effective treatment for RSV and since it is a virus, antibiotics do not help. There are, however, two new good ways to prevent RSV—vaccines for adults and antibody treatment for young children. Vaccines stimulate the formation of antibodies to help fight infection (active immunity). Antibody treatments give antibodies directly to the body (passive immunity).

RSV vaccines are available for those 32-36 weeks pregnant during RSV season and if given at least 2 weeks before delivery, will help protect the baby from severe RSV. RSV vaccine is also recommended for those 60 years and older.

Antibody therapy (Nirsevimab) is approved for babies less than 8 months during RSV season (if mom did not get vaccine at least 2 weeks before delivery). Nirsevimab is also appropriate for some infants aged 8-19 months with severe health issues including extreme prematurity, immune system problems, cystic fibrosis, and heart disease. Nirsevimab is an injection and lasts 5 months, so helps protect for the entire RSV season. There is another antibody treatment called Palivizumab that has been used for years, but this is only approved for very high-risk children under age 2 and requires a monthly injection.

Side effects of Nirsevimab are uncommon and include temporary discomfort, redness or mild swelling at the injection site, and a rash. Nirsevimab can be given with routine childhood vaccines and may be given if a child has mild cold symptoms. Children who have had RSV should still receive the antibody therapy due to the risk of getting infected again later in the sick season.

There may be some difficulty having enough Nirsevimab for all kids who are eligible this year; contact your child’s provider about this. Supplies of RSV vaccine for those who are pregnant or 60 and over seem adequate; check with your provider or local pharmacy.

Remember the routine ways we can all help prevent the spread of RSV and other viruses, such as frequent hand-washing, avoiding touching one’s face, staying home if sick, and wearing a mask when appropriate. Also, cover sneezes and coughs, do not share cups or utensils, and keep countertops and other frequently touched surfaces clean. Don’t forget your child’s other important vaccines including Influenza and COVID vaccines as these are also important to help keep your child healthy this winter season.

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Dr. Elise Herman

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Dr. Herman is passionate about community health outreach, school programs, and child/family health and wellness. She has more than 31 years of experience as a pediatrician in Ellensburg, Washington, the last 3 with KVH Pediatrics. In 2022 Dr. Herman mostly retired from practice and continues to contribute blog posts and remain a visible advocate for kids in the community.

Vegetarian and Vegan Diets in Teens

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Contributor Dr. Elise Herman

Although still a minority, more people are exploring plant-based diets, including teens. If your teen has expressed interest in this, you may wonder if being a vegetarian or vegan is nutritionally sound and how to handle this change at home. In some families, a diet different than the rest of the household can be a source of conflict, but it need not be so.

Understanding the reason behind a change in diet is important. Some choose vegetarianism or veganism for health reasons (in adults, these diets are associated with lower risk of some diseases including heart disease, high blood pressure, Type 2 diabetes, and some cancers). The American Academy of Nutrition and Dietetics along with the American Academy of Pediatrics have stated that vegan and vegetarian diets can be “nutritionally adequate during infancy, childhood and adolescence”, but emphasize the need to make sure kids are getting enough nutrition to maintain good health and grow properly. Other reasons for choosing to be vegetarian or vegan may have to do with the larger carbon footprint of animal-based foods and animal cruelty concerns. If your teen is doing this to lose weight, make sure there is not an underlying eating disorder, and touch base with your provider if this is a concern.

There are different types of plant-based diets. Lacto-ovo vegetarians eat no meat but do eat dairy and eggs. Lacto-vegetarians eat no meat or eggs but do consume dairy products. Pescatarians don’t eat meat but do eat fish (and usually dairy and eggs). Vegans eat no food products that come from animals including dairy, eggs and for some, honey.

Vegetarianism and veganism are not just about what is not eaten, but also about what is eaten to be fully healthy. It is important to be mindful of certain key nutrients that may be harder for vegetarians and vegans to get enough of:

  • Vitamin B12: important for brain and heart function; found in animal sources (meat, fish, dairy, eggs) and some plants (bananas, potatoes, etc.) but hard to get adequately from plants alone. Supplemental sources include fortified soy milk, cereals.
  • Calcium: creates strong bones and teeth; naturally found in dairy products. Vegans should eat lots of dark green veggies and look for foods fortified with calcium (juices, cereals, soy milk). Tofu is an excellent source of calcium.
  • Iron: essential for preventing anemia and keeping the immune system strong; found in meat and fish. Plant based sources include beans, peas, dark leafy veggies, and dried fruit. It is harder to absorb iron from plant-based foods, so one needs to eat more of these to avoid having low iron.
  • Protein: builds muscle and is found throughout the body. Protein is in meat, fish, eggs, and dairy. Vegans need to eat adequate plant-based protein sources like nuts, soy, whole grains, and legumes (lentils, peas, and peanuts).
  • Omega 3 fatty acids: very important for cognitive development and assuring adequate energy; most easily found in fish, but also canola oil, soy products and walnuts.

In general, those following a vegetarian or vegan diet should take a multivitamin that has B vitamins, calcium, vitamin D, zinc, and other nutrients. Look for foods that are fortified with vitamin B-12, calcium, omega-3 fatty acids, iron, and vitamin D. Discussing healthy nutrition with your teen is important regardless of their preferences, but especially if they are interested in following a vegetarian or vegan diet. And since plant-based foods are important for all of us, this could be an opportunity for the whole family to learn more about healthy eating.

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Dr. Elise Herman

Blog Posts
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Dr. Herman is passionate about community health outreach, school programs, and child/family health and wellness. She has more than 31 years of experience as a pediatrician in Ellensburg, Washington, the last 3 with KVH Pediatrics. In 2022 Dr. Herman mostly retired from practice and continues to contribute blog posts and remain a visible advocate for kids in the community.

The Benefits of Awe-Inspiring Experiences for Kids

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Contributor Dr. Elise Herman

We have all known the sensation of wonder and amazement when we experience something “awesome” like a spectacular rainbow. It turns out that ‘awe’- the overwhelming feeling of respect and amazement, often created by something vast and mysterious- is an important emotion with lots of benefits. Sources of awe might be nature, art, music, spirituality, or a demonstration of courage.

Experiencing awe has been well studied in kids and adults and has been shown to increase creativity and curiosity, which fuel learning. Awe increases positive feelings, decreases negative feelings, and helps with emotional regulation and the ability to handle stress. Awe inspiring moments give children stronger feelings of connection and cooperation, especially if shared with others. Family bonds are strengthened by family members witnessing something ‘awesome’ together.  Prosocial behavior (behavior that benefits others) has been shown to be more likely after experiencing awe.

In the face of something vast like a starry sky or beautiful ocean, we may feel more humble, understanding how small we really are in the world. This feeling of humility can put our own issues and struggles in perspective and encourage us to think beyond ourselves. This is particularly important now given social media use with its constant attention on us as individuals and how we appear to others.

When nature is the source of wonder, kids tend to feel more comfortable and confident in the outdoors. Nature-inspired awe also can decrease PTSD and overall stress. Feeling awe after doing something brave or challenging can increase a child’s resiliency and ‘grit’.  

The benefits of awe have a biologic basis.  Research shows that feelings of awe decrease cytokines, chemicals in the body which are related to inflammation, illness, and depression. Awe can also cause the release of oxytocin, a hormone associated with love and empathy.

There are relatively simple ways to encourage more awe, terrific for both our kids and ourselves:

  • Slow down and take time to notice the little things such as birds in flight, changing leaves, or a butterfly
  • Have more unstructured time, less rushed time and put away the phones and devices
  • Expose your child to art (such as galleries and museums), dance, and music; there are many local opportunities for this
  • Look for science activities that inspire wonder, such as going to a planetarium or a science museum
  • Get out in nature more, taking the time to comment on and express curiosity about what you see and hear
  • Notice and discuss courageous and kind behavior
  • Read books about brave and pioneering individuals
  • Create experiences at unusual times such as an early walk at sunrise or stargazing late at night (yes, after bedtime!); these can be very impactful
  • Consider doing journaling or artwork about awe-inspiring experiences
  • Although in-person is best, watching nature documentaries can also create feelings of awe
  • Express awe yourself- get excited about wondrous things and share those feelings with your child

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Dr. Elise Herman

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Dr. Herman is passionate about community health outreach, school programs, and child/family health and wellness. She has more than 31 years of experience as a pediatrician in Ellensburg, Washington, the last 3 with KVH Pediatrics. In 2022 Dr. Herman mostly retired from practice and continues to contribute blog posts and remain a visible advocate for kids in the community.

Pedestrian – Vehicle Accidents

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Contributor Dr. Elise Herman

Walking is a great way to exercise for adults and kids alike, but there is a concerning 11% increase in child and adolescent pedestrian fatalities in the US in the last 10 years, resulting in about 600 deaths per year. In response to this, the American Academy of Pediatrics (AAP) released a new policy statement in June 2023. It discusses not only what we can all do to keep our kids safe while walking near cars but addresses how communities can change roads and driving to help prevent pedestrian injuries.

There may be multiple reasons for this spike in pedestrian accidents involving children and youth. Both drivers and walkers tend to be more distracted than in the past, mostly by cell phones. Wearing earbuds makes walkers less aware of their environment. More kids are also walking to school (a good thing) but need to do so safely.

The risk of being hit by a car or other vehicle is greatest in rural areas, according to the AAP, and boys are more likely than girls to be victims. Vehicle speed is the most important factor. In general, the faster the vehicle is going, the greater the risk of a collision with a pedestrian and the more severe the injury. For this reason, it is recommended by the American Academy of Pediatrics that communities change policies and planning regarding roads. Speed bumps, roundabouts, and lower speed limits all work well to slow vehicles down. Photo speed limit enforcement, particularly in school zones, is very effective. Simply extending curbs is an easy way to help protect pedestrians.

There are steps we can all take to help kids be safe when around cars, both in advising our children and being safer drivers ourselves.

  • Pedestrians should be on a path or sidewalk if at all possible; if walking on the shoulder, walk facing oncoming traffic
  • Hold your younger child’s hand when crossing the street, cross at designated intersections or crosswalks, and always observe traffic safety laws. You are a role model– no jaywalking!
  • Teach your child to cross the street: look left, right, and left again, and keep looking around while crossing
  • Kids should not play in driveways or areas next to driveways
  • Children 10 and under should have adult supervision when walking near traffic
  • Pedestrians should not wear earbuds or look at smartphones
  • Increased visibility is important; brightly colored clothing, hats, and backpacks help anytime, and a flashlight or headlamp is crucial at night
  • Drivers should not be distracted by smartphones or interacting with the touchscreen on the dashboard
  • It is the law to allow walkers to cross a crosswalk completely before beginning to drive
  • Use the rear-view camera in addition to car mirrors when backing up and keep the camera clean and ice-free

Resources

more about The contributor

Dr. Elise Herman

Blog Posts
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Dr. Herman is passionate about community health outreach, school programs, and child/family health and wellness. She has more than 31 years of experience as a pediatrician in Ellensburg, Washington, the last 3 with KVH Pediatrics. In 2022 Dr. Herman mostly retired from practice and continues to contribute blog posts and remain a visible advocate for kids in the community.

Wildfire Smoke Exposure and Children

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Contributor Dr. Elise Herman

As climate change causes a longer and more severe wildfire season, exposure to wildfire smoke in children is an increasing problem. Wildfire smoke is felt to be more dangerous than typical air pollution and kids (especially those under 5 years) are more vulnerable for multiple reasons. Children’s smaller airways are more adversely affected by swelling and inflammation from smoke. Kids also breathe more rapidly than adults, thereby taking in more of the dangerous particles. Children who have underlying lung problems including asthma are at increased risk and are more likely to need medical care.

Children typically have coughing, sneezing, and increased congestion with wildfire smoke exposure. They may also have burning or discomfort of their eyes, nose, and throat. If there is more serious exposure, a child may become lethargic or have shortness of breath. Signs of trouble breathing in kids include breathing rapidly, the ribs sticking out with each breath (“retractions”), and the abdomen moving a lot with breathing (“belly breathing”). Babies may also have head bobbing and grunting as signs of respiratory distress.

Being aware of the air quality can guide your actions. Airnow.gov is a good site to check; if the AQI (air quality index) is over 150, avoid any outdoor activity if possible. Kids 2 years and over can wear a mask to somewhat reduce smoke exposure. NIOSH N95 or KN95 masks are 80-95% effective at reducing smoke exposure (depending on the fit of the mask) but do not come in sizes for younger kids. Surgical masks are only 20% effective and therefore are not ideal. Cloth masks really do not help filter smoke.

Here are steps child you can take to protect your child if there is wildfire smoke in your area :

  • Ideally, temporarily relocate to an area free of smoke
  • If the AQI is over 150, stay inside and close windows and doors
  • If possible, use a HEPA air filter or MERV13 filter (this is a rating for a filter’s effectiveness) on your air-conditioning unit; the Environmental Protection Agency (EPA) also has information on creating a DIY air cleaner that is effective
  • Set your air conditioning to ‘recirculate’
  • If you do not have air-conditioning and the weather is very hot, consider going to a cooling center (a place with air conditioning to provide temporary respite from the heat)
  • Avoid lighting candles, vacuuming, or using a gas stove which can worsen indoor air quality
  • Rinse your child’s eyes with water if they are stinging or itchy
  • If your child has a lung condition like asthma, make sure you have enough medication, especially a rescue inhaler
  • Call your healthcare provider if your child feels short of breath, or complains of dizziness or chest pain
  • Seek emergency care if you see signs of shortness of breath as listed above or if your child seems less alert or very lethargic

Resources

more about The contributor

Dr. Elise Herman

Blog Posts
Profile

Dr. Herman is passionate about community health outreach, school programs, and child/family health and wellness. She has more than 31 years of experience as a pediatrician in Ellensburg, Washington, the last 3 with KVH Pediatrics. In 2022 Dr. Herman mostly retired from practice and continues to contribute blog posts and remain a visible advocate for kids in the community.