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Policy updates guidance for health appraisal, preparation of young campers :

June 17, 2019

More than 14,000 camps exist in the United States, and approximately 14 million children attend camp assisted by 1.5 million staff members annually.

With the support of the American Camp Association and Association of Camp Nursing, the updated AAP policy statement Improving Health and Safety at Camp guides parents, camp administrators and camp health care providers to ensure the best possible care for children while they are away from home.

It also recommends that pediatricians provide complete medical information to camps, as needed, following a precamp health evaluation.

The policy, from the Council on School Health, is available at and will be published in the July issue of Pediatrics.

Expanding the definition of camp

Over the last decade, a variety of new camp programs have become available for youths, including special needs camps (e.g., for children with cancer, diabetes, asthma) and camps for special populations (e.g., LGBTQ youths, grieving and bereaved children, and gifted and talented children).

For decades, camp policies have applied only to traditional day and residential camps. The updated policy expands its discussion to include nontraditional camps, such as family camps, those run on college and university campuses, and camps run by municipalities and parks and recreation departments.

It is essential that all youth programs follow policies and best practices to keep children healthy and safe.

Protecting against communicable diseases

Camps are inherently at a higher risk for illness outbreaks given close contact and confined environments.

Routine vaccination is important to public health, and camps should require all campers, staff and volunteers to receive all age-appropriate vaccines and provide documentation of vaccination. Participation by campers and staff who are incompletely immunized or unimmunized because of nonmedical exemptions is inappropriate for individual, public health and ethical reasons. The policy recommends that camps eliminate nonmedical exemptions.

The current measles outbreak is troubling, as the number of cases reported in the U.S. is the highest since 1992 and since measles was declared eliminated in 2000. It is more important than ever for camps to protect their campers and staff from vaccine-preventable diseases.

Electronic records and reporting
Relying on handwritten records can lead to errors. The policy recommends the use of an electronic health record (EHR) to capture camper and staff medical information. As camps document illness and injury reports, the use of an EHR also can help decrease risk and improve health and safety for campers and staff.

When camps create their medication management policies each summer, they should consider using an electronic medication administration system to minimize the potential for human error and ensure the right camper gets the right drug at the right dose, route and time, and that documentation is correct.

Key recommendations

  • All camps should have written health policies and protocols reviewed by a physician with specialized children’s health training. Policies and protocols on both major and minor illnesses and injuries should include information on the camp’s relationship and coordination with local emergency services.
  • Camps should create disaster and emergency plans, as children are particularly vulnerable and limited in their ability to escape or protect themselves from harm in the event of a natural or manmade disaster.
  • All campers, staff and volunteers should be up to date on vaccinations as recommended by the AAP, Centers for Disease Control and Prevention (CDC) and American Academy of Family Physicians. Nonmedical exemptions to required immunizations are inappropriate and should be eliminated by camps.
  • Camp activities should be designed to limit the risk of head injuries. Camp personnel need a clear understanding of concussion symptoms and treatment, and should follow CDC and state-specific return-to-play guidelines.
  • As camps see an increase in campers with food allergies, they should create and provide their food allergy policies to families before the start of camp.
  • Camps should review local regulations and requirements for stocking unassigned epinephrine and other emergency medications for seizures, diabetes mellitus or opioid overdose.
  • Camp staff should be trained to respond effectively to mental, emotional and social health needs of campers. Camps also should teach staff to support campers who need extra help and help facilitate communication with parents.
  • Pediatricians should discuss homesickness with families and campers as part of the anticipatory guidance associated with the health evaluation before camp. Parents should avoid making “pick-up” arrangements in the event of homesickness because these arrangements may undermine the child’s confidence in his or her own independence.

Dr. Ambrose, a lead author of the policy statement, is a member of the AAP Council on School Health.

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