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It’s undeniable: modern medicine offers ever-expanding ways to heal and prevent disease. But it’s also true that health care can cause harm. One analysis found that about 6% of health care encounters caused preventable harm, leading to thousands of deaths each year. And it’s not just errors that cause trouble. Highly skilled health care providers can cause harm even when they do everything right.

So, how can you reduce your chances of being harmed? Understanding what you can do to lessen the possibility of harm and what’s beyond your control are good first steps.

Whatever happened to “first do no harm”?

Fortunately, it remains a central tenet of medical care. Yet our health care system is complex and fragmented. Each year new medications are added to an ever-growing list, and people live longer with more chronic medical conditions than happened in the past. So in one sense, the successes of modern medical care may contribute to the high rate of health care–related harm.

These harms are often due to our complicated system of health care rather than one individual’s mistake. Harm due to substandard or negligent care is known as medical malpractice. Both health care providers and health care systems have important roles to play in preventing harm to patients.

Are there harms that cannot be prevented?

An enormous volume of scientific research teaches the best ways to diagnose, treat, and prevent disease. Yet people can react to treatments in completely unpredictable ways.

For example, a common and standard antibiotic treatment (think penicillin) can cause anaphylaxis, a life-threatening allergic reaction. Fortunately this is rare, but unless you or your doctor know to avoid it due to past side effects, there’s always a small chance of a severe reaction.

Often less dramatic — yet also unpreventable — harms are:

• Medication side effects. Every medicine comes with potential side effects, such as nausea, sleepiness, or rash.
• Misdiagnosis. Because no one has perfect diagnostic skills, even the most skillful health care provider can be wrong. This can result in unnecessary or delayed treatment.
• Inaccurate test results. Just as no health care provider is perfect, no test is either. False-positive results (indicating an abnormality when none is present) and false-negative results (normal results when disease is present) are common in medical practice. These results can lead to unnecessary treatment or false reassurance.

Which harms can be prevented?

Preventable harms can be dramatically reduced. They’re often due to mistakes that can be caught and corrected. Frequently, it takes a combination of things to go wrong for harm to occur.

The “Swiss cheese model” is often applied here: imagine you’re a fly trying to travel through several chunks of Swiss cheese. (I know it’s an odd scenario, but stick with me here.) It’s impossible to fly through the cheese unless the holes line up just so.

Frequently in health care, several factors must line up for an error to sneak through — for example, giving a hospitalized patient a medication to which they are allergic. For that to happen, the wrong drug has to get past the prescribing doctor, the computerized ordering system, the hospital pharmacist, the nurse giving the medication, and the patient. That’s a lot of layers, so most often an error like this will be caught.

What can you do to avoid preventable harms?

Where do you fit in? In these three scenarios, here’s what you can do to avoid preventable harms.

The problem: Taking medicines you no longer need or more medicines than necessary.

It might not seem like a big deal to keep taking a medicine if it isn’t causing any problems. But all medicines can cause side effects that you’d do better to avoid if you can safely stop taking it or reduce the dose. Plus, harmful interactions can occur if another medicine is added to your list.

What you can do: Make sure you know why you need to take each of your medicines. Ask the providers who prescribe each medicine if it is still necessary to take it or if the dose can be safely reduced. Reducing a dose may reduce the risk of side effects and the likelihood of a harmful interaction.

The problem: Taking the wrong medicine or the wrong dose.

What you can do: At your doctors’ visits, take notes or bring a friend or family member to help you remember medicine instructions. Ask whether you can record the medication instructions your doctor gives you. Take a photo of the instructions you’re given in case you lose the written version. Double-check details of your medicine list with your pharmacist. And ask questions if you’re unsure about the medicines recommended to you.

The problem: Wrong site surgery.

Despite efforts to make this a “never error,” surgery on the wrong part of the body still happens.

What you can do: Make sure you and your surgeon agree on what part of your body and which side requires surgery. Most surgeons now mark the site with a special pen before surgery and ask you to confirm the site by adding your initials. (The ink doesn’t come off easily with skin cleaners applied prior to surgery).

Some of these tips require time or resources that aren’t available to everyone: you might not be able to bring another person with you to medical visits or have a recording device. But asking questions — and getting answers you understand — should be routine.

Where does malpractice fit in?

When the topic of health care–related harm comes up, malpractice may be the first thing you think about. Yet, the approximately 10,000 malpractice payments made each year in the US likely represent only a small portion of all harm related to health care.

There are several reasons for this, including:

• Even when negligent or substandard care occurs, it doesn’t always cause major or long-lasting harm that leads to a malpractice claim.
• Many people who could file malpractice suits elect not to, or may not even realize that they’ve experienced negligent care. Past studies suggest that less than 5% of people experiencing harm related to medical care file malpractice claims.
• Increasingly, health care providers and health care systems accept responsibility for preventable harm occurring on their watch, and offer compensation rather than waiting for a legal claim to be filed.

The bottom line

It’s an unfortunate reality that some harms due to health care are inevitable. But there are steps you can take to avoid preventable harm and lessen the chances that the person harmed is you.

About the Author

Robert H. Shmerling, MD, Senior Faculty Editor, Harvard Health Publishing; Editorial Advisory Board Member, Harvard Health Publishing

Dr. Robert H. Shmerling is the former clinical chief of the division of rheumatology at Beth Israel Deaconess Medical Center (BIDMC), and is a current member of the corresponding faculty in medicine at Harvard Medical School. … See Full Bio View all posts by Robert H. Shmerling, MD

When you live in a coastal area, preparing early for potential hurricanes is a must. Storms can develop quickly, leaving little time to figure out where you’ll be safe or which items to pack if you have to evacuate. And health care necessities, such as medications or medical equipment, are often overlooked in the scramble.

“People might bring their diabetes medication but forget their blood sugar monitor, or bring their hearing aids but forget extra batteries for them,” says Dr. Scott Goldberg, medical director of emergency preparedness at Brigham and Women’s Hospital and a longtime member of a FEMA task force that responds to hurricane-damaged areas.

Here’s some insight on what to expect this hurricane season, and how to prioritize health care in your hurricane kit.

What will the 2024 hurricane season look like?

This year’s hurricane predictions underscore the urgency to start preparations now.

Forecasters with the National Oceanic and Atmospheric Administration’s National Weather Service expect above-normal activity for the 2024 hurricane season (which lasts until November 30).

Meteorologists anticipate 17 to 25 storms with winds of 39 mph or higher, including eight to 13 hurricanes — four to seven of which could be major hurricanes with 111 mph winds or higher.

What kinds of plans should you make?

Preparing for the possibility of big storms is a major undertaking. Long before ferocious winds and torrential rains arrive, you must gather hurricane supplies, figure out how to secure your home, and determine where to go if you need to evacuate (especially if you live in a flood zone). Contact the emergency management department at your city or county for shelter information.

If you’ll need help evacuating due to a medical condition, or if you’ll need medical assistance at a shelter, find out if your county or city has a special needs registry like this one in Florida. Signing up will enable first responders to notify you about storms and transport you to a special shelter that has medical staff, hospital cots, and possibly oxygen tanks.

What should you pack?

While a shelter provides a safe place to ride out a storm, including bathrooms, water, and basic meals, it’s up to you to bring everything else. It’s essential to pack medical equipment and sufficient medications and health supplies.

“It’s natural to just grab the prescription medications in your medicine cabinet, but what if it’s only a two-day supply? It might be a while before you can get a refill. We recommend at least a 14-day or 30-day supply of every prescription,” Dr. Goldberg says. “Talk to your doctor about the possibility of getting an extra refill to keep on standby for your go bag.”

Other health-related items you’ll want to pack include:

• medical supplies you use regularly, such as a blood pressure monitor, heart monitor, CPAP machine, wheelchair, or walker
• over-the-counter medicines you use regularly, such as heartburn medicine or pain relievers
• foods for specific dietary needs, such as gluten-free food if you have celiac disease (if you have infants or children, you’ll need to bring foods they can eat)
• healthy, nonperishable snacks such as nuts, nut butters, trail mix, dried fruit, granola bars, protein bars, and whole-grain bread, crackers, or cereals
• hygiene products such as soap, hand sanitizer, toothbrushes and toothpaste, shampoo, deodorant, infant or adult diapers, lip balm, moist towelettes, and toilet paper — because shelters often run out of it.

Remember the basics

In some ways, you can think of shelter living like camping. You’ll need lots of basic supplies to get through it, including:

• a sleeping bag or blanket and pillow for each person in your family
• clean towels and washcloths
• a few extra changes of clothes per person
• a first-aid kit
• flashlights and extra batteries
• chargers for your electronic gadgets
• rechargeable battery packs.

Bring important paperwork

In addition to supplies, bring important documents such as:

• a list of your medications, vitamins, and supplements (include the name, dose, and frequency of each one)
• a list of the names, addresses, and phone numbers of your primary care provider and any specialists who treat you
• a list of your emergency contacts and their phone numbers
• your pharmacy’s phone number and address
• copies of your birth certificate and driver’s license
• copies of home, car, or life insurance policies
• copies of your health insurance cards
• a copy of your advance directive — which includes your living will and health care proxy form.

“Store these documents on a flash drive. Also make photocopies of them, which are easiest for doctors to consult in an emergency setting. Place them in a plastic zip-top bag to keep them dry,” Dr. Goldberg advises.

Prepare right now

Start today. Gather as many go-bag supplies as you can, including the bags. A small suitcase, backpack, or duffel bag for each person in your family will work well.

And try not to put off these important preparations. “Hurricanes are major stressors. You might be worried, sleep deprived, fatigued, and emotional,” Dr. Goldberg says. “All of that will make it hard to think clearly. You’ll do yourself and your family a favor by having discussions now and getting started on your hurricane plan.”

About the Author

Heidi Godman, Executive Editor, Harvard Health Letter

Heidi Godman is the executive editor of the Harvard Health Letter. Before coming to the Health Letter, she was an award-winning television news anchor and medical reporter for 25 years. Heidi was named a journalism fellow … See Full Bio View all posts by Heidi Godman

About the Reviewer

Howard E. LeWine, MD, Chief Medical Editor, Harvard Health Publishing

Dr. Howard LeWine is a practicing internist at Brigham and Women’s Hospital in Boston, Chief Medical Editor at Harvard Health Publishing, and editor in chief of Harvard Men’s Health Watch. See Full Bio View all posts by Howard E. LeWine, MD

Animals renowned for their outstanding night vision include owls, cats, tarsiers (a tiny primate in Southeast Asia) — and even the dung beetle.

But humans? Not so much.

Over time, many people suffer from night blindness, also known as nyctalopia. This condition makes seeing in dim or dark settings difficult because your eyes cannot adjust to changes in brightness or detect light.

What are the dangers for those experiencing night blindness?

Night blindness is especially problematic and dangerous when driving. Your eyes cannot adjust between darkness and the headlights of oncoming vehicles, other cars may appear out of focus, and your depth perception becomes impaired, which makes it difficult to judge distances.

Night blindness also may affect your sight at home by making it hard for your vision to quickly adjust to a dark room after turning off the lights. “This can cause people to bump into furniture or trip and suffer an injury,” says Dr. Isabel Deakins, an optometrist with Harvard-affiliated Massachusetts Eye and Ear.

What happens in the eye to create night blindness?

The ability to see in low-light conditions involves two structures in the eye: the retina and the iris.

The retina, located in the back of the eye, contains two types of light-detecting cells called cones and rods. The cones handle color vision and fine details while the rods manage vision in dim light.

The iris is the colored part of your eye. It contains muscles that widen or narrow the opening of your pupil to adjust how much light can enter your eyes.

If your irises don’t properly react, the pupils can dilate and let in too much light, which causes light sensitivity and makes it hard to see in bright light. Or your pupils may remain too small and not allow in enough light, making it tough to see in low light.

What causes night blindness?

Night blindness is not a disease but a symptom of other conditions. “It’s like having a bruise on your body. Something else causes it,” says Dr. Deakins.

Several conditions can cause night blindness. For instance, medications, such as antidepressants, antihistamines, and antipsychotics, can affect pupil size and how much light enters the eye.

Eye conditions that can cause night blindness include:

• glaucoma, a disease that damages the eye’s optic nerves and blood vessels
• cataracts, cloudy areas in the lens that distort or block the passage of light through the lens
• dry eye syndrome.

However, one issue that raises the risk of night blindness that you can’t control is age. “Our eyes react more slowly to light changes as we age, and vision naturally declines over time,” says Dr. Deakins.  “The number of rods in our eyes diminish, pupils get smaller, and the muscles of the irises weaken.”

What helps if you have night blindness?

If you notice any signs of night blindness, avoid driving and get checked by an eye care specialist like an optometrist or ophthalmologist. An eye exam can determine if your eyeglass prescription needs to be updated.

“Often, a prescription change is enough to reduce glare when driving at night," says Dr. Deakins. “You may even need separate glasses with a stronger eye prescription that you wear only when driving at night.”

Adding an anti-reflective coating to your lens may help to cut down on the glare of the headlights of an oncoming car. However, skip the over-the-counter polarized driving glasses sold at many drug stores. "These may help cut down on glare, but they don't address the causes of night blindness," says Dr. Deakins.

An eye exam also will identify glaucoma or cataracts, which can be treated. Glaucoma treatments include eyedrops, laser treatment, or surgery. Cataracts are corrected with surgery to replace the clouded lens with an artificial one. Your eye care specialist can also help identify dry eye and recommend treatment.

Ask your primary care clinician or a pharmacist if any medications that you take may cause night blindness. If so, it may be possible to adjust the dose or switch to another drug.

Three more ways to make night driving safer

You also can take steps to make night driving safer. For example:

• Wash the lenses of your glasses regularly. And take them to an optician to buff out minor scratches.
• Keep both sides of your front and rear car windshields clean so that you can see as clearly as possible.
• Dim your dashboard lights, which cause glare, and use the night setting on your rearview mirror.

About the Author

Matthew Solan, Executive Editor, Harvard Men's Health Watch

Matthew Solan is the executive editor of Harvard Men’s Health Watch. He previously served as executive editor for UCLA Health’s Healthy Years and as a contributor to Duke Medicine’s Health News and Weill Cornell Medical College’s … See Full Bio View all posts by Matthew Solan

About the Reviewer

Howard E. LeWine, MD, Chief Medical Editor, Harvard Health Publishing

Dr. Howard LeWine is a practicing internist at Brigham and Women’s Hospital in Boston, Chief Medical Editor at Harvard Health Publishing, and editor in chief of Harvard Men’s Health Watch. See Full Bio View all posts by Howard E. LeWine, MD

Each year, more than 4.5 million dog bites occur in the United States. Despite what you might assume, most of these incidents don’t happen when an unfamiliar dog attacks someone in a park or another outdoor location. Instead, most dog bites are inflicted by a pet dog in a home.

Here’s advice for avoiding these upsetting and potentially serious injuries — and the steps you should take if you sustain a dog bite.

Why do dog bites happen?

Some dog bites happen by accident when people wrestle or play tug-of-war with their dog. But most of the time, dogs bite people as a reaction to feeling stressed, threatened, scared, or startled, according to the American Veterinary Medical Association (AVMA). More than half of dog bites occur in children, and they’re far more likely to be seriously injured than adults.

“People don’t always heed the behavioral signals that a dog is uncomfortable,” says Dr. Christopher Baugh, associate professor of emergency medicine at Harvard Medical School. For example, some dogs are highly territorial and will bark, growl, snap, and lunge if outsiders enter their space — whether that’s an apartment, yard, or crate. Or dogs may exhibit resource guarding, which shows up as anxious, aggressive behavior around food, toys, or beds.

“These situations can be high-risk, and children in particular have less awareness of that risk,” says Dr. Baugh, who has children and two mixed-breed rescue dogs, Harley and Roxi.

What can you do to prevent dog bites?

Any dog — even a sweet, cuddly dog — can bite if provoked, according to the AVMA. Never leave young children alone with a dog without adult supervision. And teach children to never disturb a dog while it’s eating, sleeping, or caring for puppies.

In a study of 321 facial dog bites treated at Harvard-affiliated Massachusetts General Hospital over a 20-year period, 88% of the bites were from known dogs. Most were in adults and occurred after playing with the dog, feeding the dog, and placing their face close to the dog. However, the hand (usually a person’s dominant hand) is probably the most common location for a dog bite in an adult, says Dr. Baugh.

Other tips from the CDC to prevent dog bites include the following:

• Always ask a dog’s owner if it’s okay to pet their dog, even if the dog appears friendly.
• Make sure the dog sees and sniffs you before reaching out to pet it.
• Don’t pet a dog that seems to be hiding, scared, sick, or angry.

What if an unfamiliar dog approaches you? Remain calm and still, avoiding eye contact with the dog. Stand with the side of your body facing the dog and say “no” or “go home” in firm, deep voice. Wait for the dog to retreat or move yourself slowly away.

What should you do if you’re bitten by a dog?

Clean the wound with mild soap and running water, then cover it with a clean bandage or cloth. Some online resources recommend applying an antibiotic ointment or cream. But these products are recommended only for people with clear evidence of an infection, such as redness, pus, pain, swelling, or warmth, according to the American Academy of Dermatology.

If the injury is serious — with a bite on the face, heavy bleeding, or a possible broken bone — go to the emergency room. That’s also a good idea if you’re bitten by an unknown or stray dog, in the rare event that you might need medicines to prevent rabies (rabies post-exposure prophylaxis).

“Often, people are shocked after being bit and will understandably focus all their attention on their wound,” says Dr. Baugh. The dog’s owner may check in to see if you’re okay, but then walk away. But you should get the person’s contact information and make sure the dog is vaccinated against rabies, he says.

Keep in mind that:

• Emergency rooms are often crowded with long waits, so an urgent care clinic is a good option if the injury doesn’t require immediate attention.
• Some wounds require stitches, ideally within 12 to 24 hours.
• The doctor may prescribe antibiotics to prevent possible infections, especially if you have health problems such as a weakened immune system or diabetes.
• You may also need a tetanus booster if you haven’t had one in the past 10 years. If your vaccine history isn’t available or you can’t remember, you’ll get a tetanus booster just in case.

What if a dog bite is less serious?

Let’s say you have a less serious bite from a family dog known to have a current rabies vaccine. Bites that don’t require stitches can be cleaned with mild soap and running water, then evaluated by your regular health care provider. They may tell you to simply monitor the wound for signs of infection.

“Doctors are trying to be more thoughtful about prescribing antibiotics and limit their use in low-risk situations, because overuse contributes to antibiotic resistance and exposes people to potential side effects without any benefit,” says Dr. Baugh.

About the Author

Julie Corliss, Executive Editor, Harvard Heart Letter

Julie Corliss is the executive editor of the Harvard Heart Letter. Before working at Harvard, she was a medical writer and editor at HealthNews, a consumer newsletter affiliated with The New England Journal of Medicine. She … See Full Bio View all posts by Julie Corliss

About the Reviewer

Howard E. LeWine, MD, Chief Medical Editor, Harvard Health Publishing

Dr. Howard LeWine is a practicing internist at Brigham and Women’s Hospital in Boston, Chief Medical Editor at Harvard Health Publishing, and editor in chief of Harvard Men’s Health Watch. See Full Bio View all posts by Howard E. LeWine, MD

Nantucket, a beautiful, 14-mile-long island off the coast of Massachusetts, has a 40-point resiliency plan to help withstand the buffeting seas surrounding it as climate change takes a toll. Perhaps we can all benefit from creating individual resilience plans to help handle the big and small issues that erode our sense of well-being. But what is resilience and how do you cultivate it?

What is resilience?

Resilience is a psychological response that helps you adapt to life’s difficulties and seek a path forward through challenges.

“It’s a flexible mindset that helps you adapt, think critically, and stay focused on your values and what matters most,” says Luana Marques, an associate professor of psychiatry at Harvard Medical School.

While everyone has the ability to be resilient, your capacity for resilience can take a beating over time from chronic stress, perhaps from financial instability or staying in a job you dislike. The longer you’re in that situation, the harder it becomes to cope with it.

Fortunately, it’s possible to cultivate resilience. To do so, it helps to exercise resiliency skills as often as possible, even for minor stressors. Marques recommends the following strategies.

Shift your thoughts

In stressful situations, try to balance out your thoughts by adopting a broader perspective. “This will help you stop using the emotional part of your brain and start using the thinking part of your brain. For example, if you’re asking for a raise and your brain says you won’t get it, think about the things you’ve done in your job that are worthy of a raise. You’ll slow down the emotional response and shift your mindset from anxious to action,” Marques says.

Approach what you want

“When you’re anxious, stressed, or burned out, you tend to avoid things that make you uncomfortable. That can make you feel stuck,” Marques says. “What you need to do is get out of your comfort zone and take a step toward the thing you want, in spite of fear.”

For example: If you’re afraid of giving a presentation, create a PowerPoint and practice it with colleagues. If you’re having conflict at home, don’t walk away from your partner — schedule time to talk about what’s making you upset.

Align actions with your values

“Stress happens when your actions are not aligned with your values — the things that matter most to you or bring you joy. For example, you might feel stressed if you care most about your family but can’t be there for dinner, or care most about your health but drink a lot,” Marques says.

She suggests that you identify your top three values and make sure your daily actions align with them. If being with family is one of the three, make your time with them a priority — perhaps find a way to join them for a daily meal. If you get joy from a clean house, make daily tidying a priority.

Tips for success

Practice the shift, approach, and align strategies throughout the week. “One trick I use is looking at my calendar on Sunday and checking if my actions for the week are aligned with my values. If they aren’t, I try to change things around,” Marques says.

It’s also important to live as healthy a lifestyle as possible, which will help keep your brain functioning at its best.

Healthy lifestyle habits include:

• getting seven to nine hours of sleep per night
• following a healthy diet, such as a Mediterranean-style diet
• aiming for at least 150 minutes of moderate-intensity activities (such as brisk walking) each week — and adding on strength training at least twice a week
• if you drink alcohol, limiting yourself to no more than one drink per day for women and two drinks per day for men
• not smoking
• staying socially connected, whether in person, by phone or video calls, social media, or even text messages.

Need resilience training?

Even the best athletes have coaches, and you might benefit from resilience training.

Consider taking an online course, such as this one developed by Luana Marques. Or maybe turn to a therapist online or in person for help. Look for someone who specializes in cognitive behavioral therapy, which guides you to redirect negative thoughts to positive or productive ones.

Just don’t put off building resilience. Practicing as you face day-to-day stresses will help you learn skills to help navigate when dark clouds roll in and seas get rough.

About the Author

Heidi Godman, Executive Editor, Harvard Health Letter

Heidi Godman is the executive editor of the Harvard Health Letter. Before coming to the Health Letter, she was an award-winning television news anchor and medical reporter for 25 years. Heidi was named a journalism fellow … See Full Bio View all posts by Heidi Godman

About the Reviewer

Howard E. LeWine, MD, Chief Medical Editor, Harvard Health Publishing

Dr. Howard LeWine is a practicing internist at Brigham and Women’s Hospital in Boston, Chief Medical Editor at Harvard Health Publishing, and editor in chief of Harvard Men’s Health Watch. See Full Bio View all posts by Howard E. LeWine, MD

On the Gulf Coast of Florida where I live, the telltale sign of summer is not an influx of beachcombers, afternoon storms that arrive exactly at 2 p.m., or the first hurricane warning, but the appearance of hundreds of paddleboarders dotting the inlet waters.

From afar, paddleboarding looks almost spiritual — people standing on nearly invisible boards and gliding across the surface as if walking on water.

But this popular water sport offers a serious workout, just as kayaking and canoeing do. While floating along and casually dipping a paddle in the water may look effortless, much goes on beneath the surface, so to speak.

As warm weather beckons and paddle season arrives, it pays to get key muscles in shape before heading out on the water.

Tuning up muscles: Focus on core, back, arms, and shoulders

“Paddling a kayak, canoe, or paddleboard relies on muscles that we likely haven’t used much during winter,” says Kathleen Salas, a physical therapist with Spaulding Adaptive Sports Centers at Harvard-affiliated Spaulding Rehabilitation Network. “Even if you regularly weight train, the continuous and repetitive motions involved in paddling require endurance and control of specific muscles that need to be properly stretched and strengthened.”

While paddling can be a whole-body effort (even your legs contribute), three areas do the most work and thus need the most conditioning: the core, back, and arms and shoulders.

• Core. Your core comprises several muscles, but the main ones for paddling include the rectus abdominis (that famed “six-pack”) and the obliques, located on the side and front of your abdomen. The core acts as the epicenter around which every movement revolves — from twisting to bending to stabilizing your trunk to generate power.
• Back: Paddling engages most of the back muscles, but the ones that carry the most load are the latissimus dorsi muscles, also known as the lats, and the erector spinae. The lats are the large V-shaped muscles that connect your arms to your vertebral column. They help protect and stabilize your spine while providing shoulder and back strength. The erector spinae, a group of muscles that runs the length of the spine on the left and right, helps with rotation.
• Arms and shoulders: Every paddle stroke engages the muscles in your arms (biceps) and the top of your shoulder (deltoids).

Many exercises specifically target these muscles, but here are three that can work multiple paddling muscles in one move. Add them to your workouts to help you get ready for paddling season. If you haven’t done these exercises before, try the first two without weights until you can do the movement smoothly and with good form.

Three great exercises to prep for paddling

Wood chop

Muscles worked: Deltoids, obliques, rectus abdominis, erector spinae
Reps: 8–12 on each side
Sets: 1–3
Rest: 30–90 seconds between sets

Starting position: Stand with your feet about shoulder-width apart and hold a dumbbell with both hands. Hinge forward at your hips and bend your knees to sit back into a slight squat. Rotate your torso to the right and extend your arms to hold the dumbbell on the outside of your right knee.

Movement: Straighten your legs to stand up as you rotate your torso to the left and raise the weight diagonally across your body and up to the left, above your shoulder, while keeping your arms extended. In a chopping motion, slowly bring the dumbbell down and across your body toward the outside of your right knee. This is one rep. Finish all reps, then repeat on the other side. This completes one set.

Tips and techniques:

• Keep your spine neutral and your shoulders down and back
• Reach only as far as is comfortable.
• Keep your knees no farther forward than your toes when you squat.

Make it easier: Do the exercise without a dumbbell.

Make it harder: Use a heavier dumbbell.

Bent-over row

Muscles worked: Latissimus dorsi, deltoids, biceps
Reps: 8–12
Sets: 1–3
Rest: 30–90 seconds between sets

Starting position: Stand with a weight in your left hand and a bench or sturdy chair on your right side. Place your right hand and knee on the bench or chair seat. Let your left arm hang directly under your left shoulder, fully extended toward the floor. Your spine should be neutral, and your shoulders and hips squared.

Movement: Squeeze your shoulder blades together, then bend your elbow to slowly lift the weight toward your ribs. Return to the starting position. Finish all reps, then repeat with the opposite arm. This completes one set.

Tips and techniques:

• Keep your shoulders squared throughout.
• Keep your elbow close to your side as you lift the weight.
• Keep your head in line with your spine.

Make it easier: Use a lighter weight.

Make it harder: Use a heavier weight.

Superman

Muscles worked: Deltoids, latissimus dorsi, erector spinae
Reps: 8–12
Sets: 1–3
Rest: 30–90 seconds between sets

Starting position: Lie face down on the floor with your arms extended, palms down, and legs extended.

Movement: Simultaneously lift your arms, head, chest, and legs off the floor as high as is comfortable. Hold. Return to the starting position.

Tips and techniques:

• Tighten your buttocks before lifting.
• Don’t look up.
• Keep your shoulders down, away from your ears.

Make it easier: Lift your right arm and left leg while keeping the opposite arm and leg on the floor. Switch sides with each rep.

Make it harder: Hold in the “up” position for three to five seconds before lowering.

About the Author

Matthew Solan, Executive Editor, Harvard Men's Health Watch

Matthew Solan is the executive editor of Harvard Men’s Health Watch. He previously served as executive editor for UCLA Health’s Healthy Years and as a contributor to Duke Medicine’s Health News and Weill Cornell Medical College’s … See Full Bio View all posts by Matthew Solan

About the Reviewer

Howard E. LeWine, MD, Chief Medical Editor, Harvard Health Publishing

Dr. Howard LeWine is a practicing internist at Brigham and Women’s Hospital in Boston, Chief Medical Editor at Harvard Health Publishing, and editor in chief of Harvard Men’s Health Watch. See Full Bio View all posts by Howard E. LeWine, MD

Before going any further, here’s the main thing parents should know about swimming lessons: all children should have them.

Every year, over 4,500 people die from drowning in the United States — and, in fact, drowning is the leading cause of death for children ages 1 to 4. Swimming lessons can’t prevent all of those deaths, but they can prevent a lot of them. A child doesn’t need to be able to swim butterfly or do flip turns, but the ability to get back to the surface, float, tread water, and swim to where they can stand or grab onto something can save a life.

10 things parents should know about swimming lessons

As you think about swimming lessons, it’s important to know:

1. Children don’t really have the cognitive skills to learn to swim until they are around 4 years old. They need to be able to listen, follow directions, and retain what they’ve learned, and that’s usually around 4 years old, with some kids being ready a little earlier.

2. That said, swim lessons between 1 and 4 years old can be useful. Not only are some kids simply ready earlier, younger children can learn some skills that can be useful if they fall into the water, like getting back to the side of a pool.

3. The pool or beach where children learn must be safe. This sounds obvious, but safety isn’t something you can assume; you need to check it out for yourself. The area should be clean and well maintained. There should be lifeguards that aren’t involved in teaching (since teachers can’t be looking at everyone at all times). There should be something that marks off areas of deeper water, and something to prevent children from getting into those deeper areas. There should be lifesaving and first aid equipment handy, and posted safety rules.

4. The teachers should be trained. Again, this sounds obvious — but it’s not always the case. Parents should ask about how teachers are trained and evaluated, and whether it’s under the guidelines of an agency such as the Red Cross or the YMCA.

5. The ratio of kids to teachers should be appropriate. Preferably, it should be as low as possible, especially for young children and new swimmers. In those cases, the teacher should be able to have all children within arm’s reach and be able to watch the whole group. As children gain skills the group can get a bit bigger, but there should never be more than the teacher can safely supervise.

6. There should be a curriculum and a progression — and children should be placed based on their ability. In general, swim lessons progress from getting used to the water all the way to becoming proficient at different strokes. There should be a clear way that children are assessed, and a clear plan for moving them ahead in their skills.

7. Parents should be able to watch for at least some portion. You should be able to see for yourself what is going on in the class. It’s not always useful or helpful for parents to be right there the whole time, as it can be distracting for children, but you should be able to watch at least the beginning and end of a lesson. Many pools have an observation window or deck.

8. Flotation devices should be used thoughtfully. There is a lot of debate about the use of “bubbles” or other flotation devices to help children learn to swim. They can be very helpful with keeping children safe at the beginning, and helping them learn proper positioning and stroke mechanics instead of swimming frantically to stay afloat, but if they are used, the lessons should be designed to gradually decrease any reliance on them.

9. Being scared of the water isn’t a reason not to take, or to quit, swimming lessons. It’s common and normal to be afraid of the water, and some children are more afraid than others. While you don’t want to force a child to do something they are terrified of doing, giving up isn’t a good idea either. Start more gradually, with lots of positive reinforcement. The swim teacher should be willing to help.

10. Just because a child can swim doesn’t mean he can’t drown. Children can get tired, hurt, trapped, snagged, or disoriented. Even strong swimmers can get into trouble. While swimming lessons help save lives, children should always, always be supervised around water, and should wear life jackets for boating and other water sports.

The Centers for Disease Control and Prevention website has helpful information on preventing drowning. The American Red Cross offers an online water safety course for caregivers and parents and water safety videos for children. Many public pools and organizations like Boys & Girls Clubs and the YMCA offer swimming classes for all ages.

About the Author

Claire McCarthy, MD, Senior Faculty Editor, Harvard Health Publishing

Claire McCarthy, MD, is a primary care pediatrician at Boston Children’s Hospital, and an assistant professor of pediatrics at Harvard Medical School. In addition to being a senior faculty editor for Harvard Health Publishing, Dr. McCarthy … See Full Bio View all posts by Claire McCarthy, MD

About the Reviewer

Howard E. LeWine, MD, Chief Medical Editor, Harvard Health Publishing

Dr. Howard LeWine is a practicing internist at Brigham and Women’s Hospital in Boston, Chief Medical Editor at Harvard Health Publishing, and editor in chief of Harvard Men’s Health Watch. See Full Bio View all posts by Howard E. LeWine, MD

If you spend time outdoors — which we all should do, for all sorts of reasons — you are likely to encounter biting bugs. Most of the time the bites are just a nuisance. But besides the fact that sometimes they can be painful or itchy, bug bites can lead to illness — like Lyme disease from ticks, or Zika, malaria, or West Nile disease from mosquitoes. So preventing bites is a good idea for all of us, and certainly for children.

Simple precautions will help

Before talking about insect repellents, it’s important to remember that there are simple and effective precautions, nearly all of which don’t involve any chemicals. For example:

• Empty out any standing water outside your home. That’s where mosquitoes breed.
• Wear long-sleeved shirts and long pants if you are going to be in areas with lots of biting insects. If you treat clothes (and shoes and gear) with 0.5% permethrin, it can be helpful.
• Be aware that mosquitoes are most likely to be out at dusk and dawn, and plan activities accordingly.
• To avoid tick bites, avoid wooded and brushy areas and keep to the center of paths when you hike. Be sure to do a tick check when you come home — not just of all the people in your group, but also any pets or gear that came along. Taking a shower soon after arriving home can help with both tick checks and washing off any unattached ticks.

Make choices about insect repellent

Insect repellents can be very useful. Some are more effective than others, and some can have side effects, so it’s important to do your homework. The Environmental Protection Agency has a great interactive tool that can help you choose the best repellent for your particular situation.

The most effective repellent is DEET (N, N-diethyl-meta-toluamide). It works against both mosquitoes and ticks, and is definitely the go-to repellent if you really want or need to prevent bites. The higher the concentration, the longer it lasts: 10% will give you about two hours of coverage, while 30% can protect you for about five hours. The American Academy of Pediatrics (AAP) recommends not using more than 30% on kids, and not using any repellents on infants less than 2 months old.

The most common side effect is skin irritation, and if you ingest it (you never know with little kids) it can lead to nausea and vomiting. Eye irritation is possible, which is why you should never spray any repellent directly to the face, but rather put it on your hands and then carefully apply to the face. In very rare cases, like one in every 100 million users, DEET can lead to brain problems such as seizures if used in high doses. This is an incredibly rare side effect, and not something that should stop you from using it, especially if you are in an area with a lot of ticks, or an area with lots of disease-carrying mosquitoes.

Here are some alternatives with minimal to no side effects (eye irritation most common; avoid as noted above):

• oil of lemon eucalyptus, or PMD (the manmade alternative). This works nearly as well as DEET.
• picaridin, which works better against mosquitoes than ticks
• 2-undecanone
• IR-3535, the active ingredient in Avon products, although it is not very effective
• citronella, although it is even less effective.

Applying insect repellent — and sunscreen

Whatever you use, follow label directions and be sure that you are careful as you apply it to all exposed skin. It’s best to spray in an open area — and spray clothing too. Pump bottles and wipes with insect repellent may help you apply products carefully. Try to choose the best product for your situation so that you can apply it just once; the EPA tool is great for that. Don’t forget sunscreen; apply that first so your skin can absorb it.

The Centers for Disease Control and Prevention (CDC) has more information about applying insect repellent on children and preventing bites from mosquitoes and ticks.

Also visit the Harvard Health Publishing Lyme Wellness Initiative to learn about preventing –– or living with –– Lyme disease and other tick-borne illnesses.

About the Author

Claire McCarthy, MD, Senior Faculty Editor, Harvard Health Publishing

Claire McCarthy, MD, is a primary care pediatrician at Boston Children’s Hospital, and an assistant professor of pediatrics at Harvard Medical School. In addition to being a senior faculty editor for Harvard Health Publishing, Dr. McCarthy … See Full Bio View all posts by Claire McCarthy, MD