Many of us know how a family outing can quickly go awry. Here's an example you can probably relate to in some way. As summer's end is coming up, Bobby convinces his parents to go to Six Flags this weekend. They wake up early to be the first ones in the park. It is now 11:30— Bobby is moping and says he wants to go home. His younger sister, Sally, is throwing tantrums because she thinks no one is paying attention to her. On top of this, Grandma is looking pale and doesn't want to walk anymore.

As parents, you had planned to spend a full day there—tickets are expensive! But Bobby and Sally are both acting out. And why does Grandma not look well? Let's use this mnemonic to try to figure it out:


  • Hungry/Thirsty
  • Environmental issues (Could it be altitude? Is it the right activity level?)
  • Angry
  • Lonely
  • Injured
  • Tired
  • Temperature (Is it too hot or cold?)

Kids often exhibit challenging behaviors when off of their regular routine during the summer and this can be incredibly difficult for parents. It might even ruin a vacation. However, we sometimes forget that many of these issues are easily solvable by remembering a child's basic needs. Here's a breakdown of our example:

Hungry/Thirsty: It's before lunch and both children had snacks, so the parents think they aren't hungry. But did they eat foods that provided actual nourishment or unhealthy foods? Did they drink enough hydrating liquids or unhelpful sugary liquids?

Environmental issues: These aren't limited to altitude for families vacationing away from our area or going on big hiking trips. Environmental considerations can also include things such as the activity level extending beyond our capability. Both Sally and Grandma are not used to walking so extensively. And is everyone wearing the right clothing and comfortable shoes?

Anger, Lonely: When we consider anger, we also consider other emotions. Bobby is becoming angry that Sally and Grandma can't keep up as he wanted to race from one ride to another. Dad is becoming frustrated because his children are acting out. Similarly, even when engaging in family activities, one person can be left feeling lonely. Sally cannot go on the majority of rides as she is not tall enough. She waits with Mom, but feels left out of the main action.

Injured: An often unseen symptom is pain. Sally has a belly ache from eating an entire funnel cake. While she is not injured, she is suffering physically and Mom can't see it. Sally is afraid to say anything as she fears her parents won't allow her to have funnel cake next time. And, she's wearing shoes that are causing pain in her heels.

Tired: Everyone is tired as the family got up early to drive to the park and make the most of the day. They rushed through their snack time to get Bobby on the next ride without taking the time to sit and relax.

Temperature: Finally, it is a sunny day and everyone is hot without being well hydrated. Grandma is on a medication that makes her particularly responsive to temperature, making it difficult for her to keep walking.

Almost any situation can be resolved when using our HEAL ITT mnemonic. Remember that these issues are much easier to prevent than to treat. Take all of the above into consideration when planning for trips, whether local or afar, and the trip will be more enjoyable for all. In this case, the family has a longer lunch providing Sally and Grandma a break. The parents go to rent a stroller for Sally. They also break up for a couple of hours in the afternoon so Sally can go on more kiddie rides and Dad takes Bobby so he doesn't feel held back by the group.

The bottom line? Don't forget to HEAL ITT! Exertion, temperature, and altitude are things that people need to acclimatize over a period of time, so try to build that in to your plans. Function over fashion should be your guidance for attire and footwear. Plus, schedule time for healthy snacks, hydration, rest breaks, and checking in with everyone.

Terri A Erbacher, Ph.D., is a member of the Inquirer Health Advisory Panel, a school psychologist and clinical associate professor at Philadelphia College of Osteopathic Medicine. She is also author of the text Suicide in Schools: A Practitioner's Guide to Multi-level Prevention, Assessment, Intervention, and Postvention. Rick Shandler, W-EMT, is a Clinical Specialist in Cardiac Arrhythmias, National Ski Patrol Nordic/Backcountry Program Director, and Wilderness Medicine Educator.