Can I take antihistamines everyday? More than the recommended dose? What if I’m pregnant? Here’s what the research says

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Allergies happen when your immune system overreacts to a normally harmless substance like dust or pollen. Hay fever, hives and anaphylaxis are all types of allergic reactions.

Many of those affected reach quickly for antihistamines to treat mild to moderate allergies (though adrenaline, not antihistamines, should always be used to treat anaphylaxis).

If you’re using oral antihistamines very often, you might have wondered if it’s OK to keep relying on antihistamines to control symptoms of allergies. The good news is there’s no research evidence to suggest regular, long-term use of modern antihistamines is a problem.

But while they’re good at targeting the early symptoms of a mild to moderate allergic reaction (sneezing, for example), oral antihistamines aren’t as effective as steroid nose sprays for managing hay fever. This is because nasal steroid sprays target the underlying inflammation of hay fever, not just the symptoms.

Here are the top six antihistamines myths – busted.

Andrea Piacquadio/Pexels

Myth 1. Oral antihistamines are the best way to control hay fever symptoms

Wrong. In fact, the recommended first line medical treatment for most patients with moderate to severe hay fever is intranasal steroids. This might include steroid nose sprays (ask your doctor or pharmacist if you’d like to know more).

Studies have shown intranasal steroids relieve hay fever symptoms better than antihistamine tablets or syrups.

To be effective, nasal steroids need to be used regularly, and importantly, with the correct technique.

In Australia, you can buy intranasal steroids without a doctor’s script at your pharmacy. They work well to relieve a blocked nose and itchy, watery eyes, as well as improve chronic nasal blockage (however, antihistamine tablets or syrups do not improve chronic nasal blockage).

Some newer nose sprays contain both steroids and antihistamines. These can provide more rapid and comprehensive relief from hay fever symptoms than just oral antihistamines or intranasal steroids alone. But patients need to keep using them regularly for between two and four weeks to yield the maximum effect.

For people with seasonal allergic rhinitis (hayfever), it may be best to start using intranasal steroids a few weeks before the pollen season in your regions hits. Taking an antihistamine tablet as well can help.

Antihistamine eye drops work better than oral antihistamines to relieve acutely itchy eyes (allergic conjunctivitis).

Myth 2. My body will ‘get used to’ antihistamines

Some believe this myth so strongly they may switch antihistamines. But there’s no scientific reason to swap antihistamines if the one you’re using is working for you. Studies show antihistamines continue to work even after six months of sustained use.

Myth 3. Long-term antihistamine use is dangerous

There are two main types of antihistamines – first-generation and second-generation.

First-generation antihistamines, such as chlorphenamine or promethazine, are short-acting. Side effects include drowsiness, dry mouth and blurred vision. You shouldn’t drive or operate machinery if you are taking them, or mix them with alcohol or other medications.

Most doctors no longer recommend first-generation antihistamines. The risks outweigh the benefits.

The newer second-generation antihistamines, such as cetirizine, fexofenadine, or loratadine, have been extensively studied in clinical trials. They are generally non-sedating and have very few side effects. Interactions with other medications appear to be uncommon and they don’t interact badly with alcohol. They are longer acting, so can be taken once a day.

Although rare, some side effects (such as photosensitivity or stomach upset) can happen. At higher doses, cetirizine can make some people feel drowsy. However, research conducted over a period of six months showed taking second-generation antihistamines is safe and effective. Talk to your doctor or pharmacist if you’re concerned.

A man sneezes into his elbow at work.
Allergies can make it hard to focus. Pexels/Edward Jenner

Myth 4. Antihistamines aren’t safe for children or pregnant people

As long as it’s the second-generation antihistamine, it’s fine. You can buy child versions of second-generation antihistamines as syrups for kids under 12.

Though still used, some studies have shown certain first-generation antihistamines can impair childrens’ ability to learn and retain information.

Studies on second-generation antihistamines for children have found them to be safer and better than the first-generation drugs. They may even improve academic performance (perhaps by allowing kids who would otherwise be distracted by their allergy symptoms to focus). There’s no good evidence they stop working in children, even after long-term use.

For all these reasons, doctors say it’s better for children to use second-generation than first-generation antihistimines.

What about using antihistimines while you’re pregnant? One meta analysis of combined study data including over 200,000 women found no increase in fetal abnormalities.

Many doctors recommend the second-generation antihistamines loratadine or cetirizine for pregnant people. They have not been associated with any adverse pregnancy outcomes. Both can be used during breastfeeding, too.

Myth 5. It is unsafe to use higher than the recommended dose of antihistamines

Higher than standard doses of antihistamines can be safely used over extended periods of time for adults, if required.

But speak to your doctor first. These higher doses are generally recommended for a skin condition called chronic urticaria (a kind of chronic hives).

Myth 6. You can use antihistamines instead of adrenaline for anaphylaxis

No. Adrenaline (delivered via an epipen, for example) is always the first choice. Antihistamines don’t work fast enough, nor address all the problems caused by anaphylaxis.

Antihistamines may be used later on to calm any hives and itching, once the very serious and acute phase of anaphylaxis has been resolved.

In general, oral antihistamines are not the best treatment to control hay fever – you’re better off with steroid nose sprays. That said, second-generation oral antihistamines can be used to treat mild to moderate allergy symptoms safely on a regular basis over the long term.

Janet Davies, Respiratory Allergy Stream Co-chair, National Allergy Centre of Excellence; Professor and Head, Allergy Research Group, Queensland University of Technology; Connie Katelaris, Professor of Immunology and Allergy, Western Sydney University, and Joy Lee, Respiratory Allergy Stream member, National Allergy Centre of Excellence; Associate Professor, School of Public Health and Preventive Medicine, Monash University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

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  • California Becomes Latest State To Try Capping Health Care Spending

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    California’s Office of Health Care Affordability faces a herculean task in its plan to slow runaway health care spending.

    The goal of the agency, established in 2022, is to make care more affordable and accessible while improving health outcomes, especially for the most disadvantaged state residents. That will require a sustained wrestling match with a sprawling, often dysfunctional health system and powerful industry players who have lots of experience fighting one another and the state.

    Can the new agency get insurers, hospitals, and medical groups to collaborate on containing costs even as they jockey for position in the state’s $405 billion health care economy? Can the system be transformed so that financial rewards are tied more to providing quality care than to charging, often exorbitantly, for a seemingly limitless number of services and procedures?

    The jury is out, and it could be for many years.

    California is the ninth state — after Connecticut, Delaware, Massachusetts, Nevada, New Jersey, Oregon, Rhode Island, and Washington — to set annual health spending targets.

    Massachusetts, which started annual spending targets in 2013, was the first state to do so. It’s the only one old enough to have a substantial pre-pandemic track record, and its results are mixed: The annual health spending increases were below the target in three of the first five years and dropped beneath the national average. But more recently, health spending has greatly increased.

    In 2022, growth in health care expenditures exceeded Massachusetts’ target by a wide margin. The Health Policy Commission, the state agency established to oversee the spending control efforts, warned that “there are many alarming trends which, if unaddressed, will result in a health care system that is unaffordable.”

    Neighboring Rhode Island, despite a preexisting policy of limiting hospital price increases, exceeded its overall health care spending growth target in 2019, the year it took effect. In 2020 and 2021, spending was largely skewed by the pandemic. In 2022, the spending increase came in at half the state’s target rate. Connecticut and Delaware, by contrast, both overshot their 2022 targets.

    It’s all a work in progress, and California’s agency will, to some extent, be playing it by ear in the face of state policies and demographic realities that require more spending on health care.

    And it will inevitably face pushback from the industry as it confronts unreasonably high prices, unnecessary medical treatments, overuse of high-cost care, administrative waste, and the inflationary concentration of a growing number of hospitals in a small number of hands.

    “If you’re telling an industry we need to slow down spending growth, you’re telling them we need to slow down your revenue growth,” says Michael Bailit, president of Bailit Health, a Massachusetts-based consulting group, who has consulted for various states, including California. “And maybe that’s going to be heard as ‘we have to restrain your margins.’ These are very difficult conversations.”

    Some of California’s most significant health care sectors have voiced disagreement with the fledgling affordability agency, even as they avoid overtly opposing its goals.

    In April, when the affordability office was considering an annual per capita spending growth target of 3%, the California Hospital Association sent it a letter saying hospitals “stand ready to work with” the agency. But the proposed number was far too low, the association argued, because it failed to account for California’s aging population, new investments in Medi-Cal, and other cost pressures.

    The hospital group suggested a spending increase target averaging 5.3% over five years, 2025-29. That’s slightly higher than the 5.2% average annual increase in per capita health spending over the five years from 2015 to 2020.

    Five days after the hospital association sent its letter, the affordability board approved a slightly less aggressive target that starts at 3.5% in 2025 and drops to 3% by 2029. Carmela Coyle, the association’s chief executive, said in a statement that the board’s decision still failed to account for an aging population, the growing need for mental health and addiction treatment, and a labor shortage.

    The California Medical Association, which represents the state’s doctors, expressed similar concerns. The new phased-in target, it said, was “less unreasonable” than the original plan, but the group would “continue to advocate against an artificially low spending target that will have real-life negative impacts on patient access and quality of care.”

    But let’s give the state some credit here. The mission on which it is embarking is very ambitious, and it’s hard to argue with the motivation behind it: to interject some financial reason and provide relief for millions of Californians who forgo needed medical care or nix other important household expenses to afford it.

    Sushmita Morris, a 38-year-old Pasadena resident, was shocked by a bill she received for an outpatient procedure last July at the University of Southern California’s Keck Hospital, following a miscarriage. The procedure lasted all of 30 minutes, Morris says, and when she received a bill from the doctor for slightly over $700, she paid it. But then a bill from the hospital arrived, totaling nearly $9,000, and her share was over $4,600.

    Morris called the Keck billing office multiple times asking for an itemization of the charges but got nowhere. “I got a robotic answer, ‘You have a high-deductible plan,’” she says. “But I should still receive a bill within reason for what was done.” She has refused to pay that bill and expects to hear soon from a collection agency.

    The road to more affordable health care will be long and chock-full of big challenges and unforeseen events that could alter the landscape and require considerable flexibility.

    Some flexibility is built in. For one thing, the state cap on spending increases may not apply to health care institutions, industry segments, or geographic regions that can show their circumstances justify higher spending — for example, older, sicker patients or sharp increases in the cost of labor.

    For those that exceed the limit without such justification, the first step will be a performance improvement plan. If that doesn’t work, at some point — yet to be determined — the affordability office can levy financial penalties up to the full amount by which an organization exceeds the target. But that is unlikely to happen until at least 2030, given the time lag of data collection, followed by conversations with those who exceed the target, and potential improvement plans.

    In California, officials, consumer advocates, and health care experts say engagement among all the players, informed by robust and institution-specific data on cost trends, will yield greater transparency and, ultimately, accountability.

    Richard Kronick, a public health professor at the University of California-San Diego and a member of the affordability board, notes there is scant public data about cost trends at specific health care institutions. However, “we will know that in the future,” he says, “and I think that knowing it and having that information in the public will put some pressure on those organizations.”

    This article was produced by KFF Health News, which publishes California Healthline, an editorially independent service of the California Health Care Foundation. 

    KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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  • What Omega-3 Fatty Acids Really Do For Us

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    What Omega-3 Fatty Acids Really Do For Us

    Shockingly, we’ve not previously covered this in a main feature here at 10almonds… Mostly we tend to focus on less well-known supplements. However, in this case, the supplement may be well known, while some of its benefits, we suspect, may come as a surprise.

    So…

    What is it?

    In this case, it’s more of a “what are they?”, because omega-3 fatty acids come in multiple forms, most notably:

    • Alpha-linoleic acid (ALA)
    • Eicosapentaenoic acid (EPA)
    • Docosahexanoic acid (DHA)

    ALA is most readily found in certain seeds and nuts (chia seeds and walnuts are top contenders), while EPA and DHA are most readily found in certain fish (hence “cod liver oil” being a commonly available supplement, though actually cod aren’t even the best source—salmon and mackerel are better; cod is just cheaper to overfish, making it the cheaper supplement to manufacture).

    Which of the three is best, or do we need them all?

    There are two ways of looking at this:

    • ALA is sufficient alone, because it is a precursor to EPA and DHA, meaning that the body will take ALA and convert it into EPA and DHA as required
    • EPA and DHA are superior because they’re already in the forms the body will use, which makes them more efficient

    As with most things in health, diversity is good, so you really can’t go wrong by getting some from each source.

    Unless you have an allergy to fish or nuts, in which case, definitely avoid those!

    What do omega-3 fatty acids do for us, according to actual research?

    Against inflammation

    Most people know it’s good for joints, as this is perhaps what it’s most marketed for. Indeed, it’s good against inflammation of the joints (and elsewhere), and autoimmune diseases in general. So this means it is indeed good against common forms of arthritis, amongst others:

    Read: Omega-3 fatty acids in inflammation and autoimmune disease

    Against menstrual pain

    Linked to the above-referenced anti-inflammatory effects, omega-3s were also found to be better than ibuprofen for the treatment of severe menstrual pain:

    Don’t take our word for it: Comparison of the effect of fish oil and ibuprofen on treatment of severe pain in primary dysmenorrhea

    Against cognitive decline

    This one’s a heavy-hitter. It’s perhaps to be expected of something so good against inflammation (bearing in mind that, for example, a large part of Alzheimer’s is effectively a form of inflammation of the brain); as this one’s so important and such a clear benefit, here are three particularly illustrative studies:

    Against heart disease

    The title says it all in this one:

    A meta-analysis shows that docosahexaenoic acid from algal oil reduces serum triglycerides and increases HDL-cholesterol and LDL-cholesterol in persons without coronary heart disease

    But what about in patients who do have heart disease?

    Mozaffarian and Wu did a huge meta-review of available evidence, and found that in fact, of all the studied heart-related effects, reducing mortality rate in cases of cardiovascular disease was the single most well-evidenced benefit:

    Read more: Omega-3 fatty acids and cardiovascular disease: effects on risk factors, molecular pathways, and clinical events

    How much should we take?

    There’s quite a bit of science on this, and—which is unusual for something so well-studied—not a lot of consensus.

    However, to summarize the position of the academy of nutrition and dietetics on dietary fatty acids for healthy adults, they recommend a minimum of 250–500 mg combined EPA and DHA each day for healthy adults. This can be obtained from about 8 ounces (230g) of fatty fish per week, for example.

    If going for ALA, on the other hand, the recommendation becomes 1.1g/day for women or 1.6g/day for men.

    Want to know how to get more from your diet?

    Here’s a well-sourced article about different high-density dietary sources:

    12 Foods That Are Very High in Omega-3

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  • Sunflower Seeds vs Pumpkin Seeds – Which is Healthier?

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    Our Verdict

    When comparing sunflower seeds to pumpkin seeds, we picked the pumpkin seeds.

    Why?

    Both seeds have a good spread of vitamins and minerals, but pumpkin seeds have more. Sunflower seeds come out on top for copper and manganese, but everything else that’s present in either of them (in the category of vitamins and minerals, anyway), pumpkin seeds have more.

    There is one other thing that sunflower seeds have more of than pumpkin seeds, and that’s fat. The fat is mostly of healthy varieties, so it’s not a negative factor, but it does mean that if you’re eating a calorie-controlled diet, you’ll get more bang for your buck (i.e. better micronutrient-to-calorie ratio) if you pick pumpkin seeds.

    If you’re not concerned about fat/calories, and/or you actively want to consume more of those, then sunflower seeds are still a fine choice.

    When it comes down to it, a diverse diet is best, so enjoying both might be the best option of all.

    Want to get some?

    We don’t sell them, but here for your convenience are example products on Amazon:

    Sunflower Seeds | Pumpkin Seeds

    Enjoy!

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  • Loaded Mocha Chocolate Parfait

    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    Packed with nutrients, including a healthy dose of protein and fiber, these parfait pots can be a healthy dessert, snack, or even breakfast!

    You will need (for 4 servings)

    For the mocha cream:

    • ½ cup almond milk
    • ½ cup raw cashews
    • ⅓ cup espresso
    • 2 tbsp maple syrup
    • 1 tsp vanilla extract

    For the chocolate sauce:

    • 4 tbsp coconut oil, melted
    • 2 tbsp unsweetened cocoa powder
    • 1 tbsp maple syrup
    • 1 tsp vanilla extract

    For the other layers:

    • 1 banana, sliced
    • 1 cup granola, no added sugar

    Garnish (optional): 3 coffee beans per serving

    Note about the maple syrup: since its viscosity is similar to the overall viscosity of the mocha cream and chocolate sauce, you can adjust this per your tastes, without affecting the composition of the dish much besides sweetness (and sugar content). If you don’t like sweetness, the maple syrup be reduced or even omitted entirely (your writer here is known for her enjoyment of very strong bitter flavors and rarely wants anything sweeter than a banana); if you prefer more sweetness than the recipe called for, that’s your choice too.

    Method

    (we suggest you read everything at least once before doing anything)

    1) Blend all the mocha cream ingredients. If you have time, doing this in advance and keeping it in the fridge for a few hours (or even up to a week) will make the flavor richer. But if you don’t have time, that’s fine too.

    2) Stir all the chocolate sauce ingredients together in a small bowl, and set it aside. This one should definitely not be refrigerated, or else the coconut oil will solidify and separate itself.

    3) Gently swirl the the mocha cream and chocolate sauce together. You want a marble effect, not a full mixing. Omit this step if you want clearer layers.

    4) Assemble in dessert glasses, alternating layers of banana, mocha chocolate marble mixture (or the two parts, if you didn’t swirl them together), and granola.

    5) Add the coffee-bean garnish, if using, and serve!

    Enjoy!

    Want to learn more?

    For those interested in some of the science of what we have going on today:

    Take care!

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  • Tilapia vs Cod – Which is Healthier?

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    Our Verdict

    When comparing tilapia to cod, we picked the tilapia.

    Why?

    Another case of “that which is more expensive is not necessarily the healthier”!

    In terms of macros, tilapia has more protein and fats, as well as more omega-3 (and omega-6). On the downside, tilapia does have relatively more saturated fat, but at 0.94g/100g, it’s not exactly butter.

    The vitamins category sees that tilapia has more of vitamins B1, B3, B5, B12, D, and K, while cod has more of vitamins B6, B9, and choline. A moderate win for tilapia.

    When it comes to minerals, things are most divided; tilapia has more copper, iron, phosphorus, potassium, manganese, and selenium, while cod has more magnesium and zinc. An easy win for tilapia.

    One other thing to note is that both of these fish contain mercury these days (and it’s worth noting: cod has nearly 10x more mercury). Mercury is, of course, not exactly a health food.

    So, excessive consumption of either is not recommended, but out of the two, tilapia is definitely the one to pick.

    Want to learn more?

    You might like to read:

    Farmed Fish vs Wild Caught: Know The Health Differences

    Take care!

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  • Children can be more vulnerable in the heat. Here’s how to protect them this summer

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    Extreme heat is increasingly common in Australia and around the world and besides making us uncomfortable, it can harm our health. For example, exposure to extreme heat can exacerbate existing medical conditions, or cause problems such as heat stroke.

    Due to a combination of physiology and behaviour, children are potentially more vulnerable to severe heat-related illness such as heat stroke or heat exhaustion.

    But these are not the only heat-related health issues children might experience on a very hot day. In a new study, we looked at emergency department (ED) visits and unplanned hospital admissions among children in New South Wales on heatwave days.

    We found a significant increase in children attending hospital compared to milder days – with a range of health issues.

    maxim ibragimov/Shutterstock

    Why are children more vulnerable in the heat?

    Sweating is the main way we lose heat from our bodies and cool down.

    Children have a greater skin surface area to body mass ratio, which can be an advantage for sweating – they can lose more heat through evaporation for a given body mass. But this also means children can lose fluids and electrolytes faster through sweating, theoretically making them more susceptible to dehydration.

    Meanwhile, younger children, particularly babies, can’t sweat as much as older children and adults. This means they can’t cool down as effectively.

    Children in general also tend to engage in more outdoor physical activity, which might see them more exposed to very hot temperatures.

    Further, children may be less in-tune to the signals their body is giving them that they’re overheating, such as excessive sweating or red skin. So they might not stop and cool down when they need to. Young children especially may not recognise the early signs of heat stress or be able to express discomfort.

    A boy drinking from a drink bottle, appears hot and bothered.
    Children may not easily be able to communicate that they’re hot and bothered. christinarosepix/Shutterstock

    Our study

    We wanted to examine children’s exposure to extreme heat stress and the associated risks to their health.

    We measured extreme heat as “heatwave days”, at least two consecutive days with a daily maximum temperature above the 95th percentile for the relevant area on a universal thermal climate index. This ranged from 27°C to 45°C depending on the area.

    We assessed health outcomes by looking at ED visits and unplanned hospital admissions among children aged 0–18 years from NSW between 2000 and 2020. This totalled around 8.2 million ED visits and 1.4 million hospital admissions.

    We found hospital admissions for heat-related illness were 104% more likely on heatwave days compared to non-heatwave days, and ED visits were 78% more likely. Heat-related illness includes a spectrum of disorders from minor conditions such as dehydration to life-threatening conditions such as heat stroke.

    But heat-related illness wasn’t the only condition that increased on heatwave days. There was also an increase in childhood infections, particularly infectious enteritis possibly related to food poisoning (up 6% for ED visits and 17% for hospital admissions), ear infections (up 30% for ED visits and 3% for hospital admissions), and skin and soft tissue infections (up 6% for ED visits and 4% for hospital admissions).

    A boy standing in front of a sprinkler.
    Kids can be more vulnerable in the heat because of their behaviour and physiology. K-FK/Shutterstock

    We know many infectious diseases are highly seasonal. Some, like the flu, peak in winter. But heat and humidity increase the risk of certain infections caused by bacterial, viral and fungal pathogens.

    For example, warmer weather and higher humidity can increase the survival of bacteria, such as Salmonella, on foods, which increases the risk of food poisoning.

    Hot weather can also increase the risk of ear infections. Children may be at greater risk during hot weather because they often swim or play at the beach or pool. Water can stay in the ear after swimming and a moist environment in the ear canal can cause growth of pathogens leading to ear infections.

    Which children are most vulnerable?

    During heatwaves, we found infants aged under one were at increased risk of ED visits and hospital admission for any reason compared to older children. This is not surprising, because babies can’t regulate their body temperature effectively and are reliant on their caregivers to keep them cool.

    Our study also found children from the most disadvantaged areas were more vulnerable to heat-related illness on heatwave days. Although we don’t know exactly why, we hypothesised families from poorer areas might have limited access to air-conditioning and could be more likely to live in hotter neighbourhoods.

    Keeping kids cool: tips for parents

    The highest levels of heat exposure on hot days for young children is usually when they’re taken outside in prams and strollers. To protect their children from direct sunlight, parents often instinctively cover their stroller with a cloth such as a muslin.

    However, a recent study from our group showed this actually increases temperatures inside a stroller to as much as 3–4˚C higher than outside.

    But if the cloth is wet with water, and a small fan is used to circulate the air close to the child, stroller temperatures can be 4–5˚C lower than outside. Wetting the cloth every 15–20 minutes (for example, with a spray bottle) maintains the cooling effect.

    When young children are not in a stroller, and for older children, there are a few things to consider to keep them cool and safe.

    Remember temperatures reported on weather forecasts are measured in the shade, and temperatures in the sun can be up to 15˚C higher. So sticking to the shade as much as possible is important.

    Exercise generates heat inside the body, so activities should be shortened, or rescheduled to cooler times of the day.

    Sunscreen and hats are important when outdoors, but neither are especially effective for keeping cool. Spraying water on the child’s skin – not just the face but arms, legs and even the torso if possible – can help. Wetting their hats is another idea.

    Proper hydration on hot days is also essential. Regular water breaks, including offering water before, during and after activity, is important. Offering foods with high water content such as watermelon and orange can help with hydration too.

    Wen-Qiang He, Research Fellow in Biostatistics and Epidemiology, Faculty of Medicine and Health, University of Sydney; James Smallcombe, Post-doctoral Research Associate, Faculty of Medicine and Health, University of Sydney; Natasha Nassar, Professor of Paediatric and Perinatal Epidemiology and Chair in Translational Childhood Medicine, University of Sydney, and Ollie Jay, Professor of Heat & Health; Director of Heat & Health Research Incubator; Director of Thermal Ergonomics Laboratory, University of Sydney

    This article is republished from The Conversation under a Creative Commons license. Read the original article.

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