Millions of American kids are starting to head off to summer camp, to begin making memories and friends that may last a lifetime. Whether it's day camp or sleep-away, sports or computers, miles away or around the corner, camp gives kids a fun outlet to learn and grow.

More than 10 million children attend more than 12,000 U.S. camps each summer. About 60 percent of camps are overnight camps, 24 percent are day camps, and 16 percent offer both day and overnight programs.

But as millions of parents load their kids on the camp bus or kiss them goodbye at the cabin door this summer, many may quietly worry about entrusting their children's health and safety to camp staff.

Thousands of children are injured each year at camp -- some seriously -- and a few die. Sports camps and adventure camps are physically demanding, often in brutal summer heat. And more campers than ever have health conditions like asthma, allergies and diabetes, raising special issues at camp.

Still, parents can do a lot to keep their kids safe and healthy at summer camp, said a University of Michigan doctor who has special expertise in camp health and safety.

No matter what kind of camp a child might attend, parents should ask camp organizers the same basic questions about how they keep kids safe, handle medical emergencies, and deal with routine health needs, said Dr. Edward Walton, a pediatric emergency medicine specialist at the University of Michigan Health System.

"Summer camp is great, and there's a summer camp for every kid," he said. "But parents need to be honest about their children. What are their likes and dislikes? What is their health status? Parents need to ask a lot of questions of the camp staff before camp starts to make sure the camp is a really good fit for their child and that the camp is able to protect campers' safety and respond to health emergencies."

Walton advises parents to check whether their child's camp is accredited with the American Camping Association, which has even more stringent health requirements than state laws.

As parents prepare to send their kids to camp, Walton offers a list of questions to ask:

What's the camp's philosophy?
Is it a general camp or a specialized one? How much physical activity do campers have, and what's the potential for injury during those activities? If it's a sports camp, are trainers and coaches prepared to handle sprains, strains, heat stroke and other emergencies?
Who supervises the children, and what's their age, experience, and first-aid training?
Inexperienced or young counselors may not be able to respond as well in an emergency as more experienced ones. Instructors in risky activities -- such as horseback riding, swimming, water sports and adventure hiking -- should have more training in safety measures and first aid.
Walton notes that the majority of the small number of deaths that occur each year at American camps are caused by drowning.
"Aquatic staff is very important," he said. "Parents should ask about the emergency medical training level of the aquatic staff."

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What kind of medical staff works at the camp? What are the medical facilities nearby?
Ask if the camp you're considering has a nurse or person with emergency medical training on site at all times, and how quickly they are available in emergencies, Walton advises. Also, ask about the nearest hospital and urgent care clinic, and the local ambulance service.
"It can be very hard for camps to get health care providers, so parents need to ask what training the staff has," Walton said. "Ask the camp director how long it takes for an ambulance to get to the camp, and which hospital would someone who is sick or injured be transported to. If a camp has a first aid provider but they're five minutes by ambulance from a major trauma center, it's not as important to have a highly trained provider at the camp as it might be for a camp that's an hour into the wilderness from any kind of care whatsoever."
What's the supervision for trips away from camp?
Field trips are often an exciting change of pace for campers, but parents should ask about the ratio of chaperones to campers, and the requirements for drivers of vehicles campers ride in.
How are campers' medications and special dietary needs handled?
More children than ever use prescription medications for asthma, behavior and mental health disorders, allergies, diabetes and other conditions.
"Parents need to ask about medications, and who controls medications," Walton advises. "Ask, 'Who dispenses medications?', 'What time of day are they given?', 'What kinds of medications are allowed to be out with the child if necessary?', and 'What kinds of medications are taken on trips away from camp?'"
Awareness of food allergies and dietary restrictions is also rising, so parents may want to check if a camp can tailor meals to meet special diet needs.
Walton also cautions parents of children with attention deficit disorder and other behavioral conditions not to see summer camp as a time for their child to take a "medication holiday" and halt their use of drugs like Ritalin. The new experiences and social situations of camp don't mix well with a sudden change in medication.
"It's really important that parents are honest with the counselors and staff, who are often very supportive," Walton said. "Camp can be stressful and kids need to have their best coping skills available, which means continuing their medications."
If my child has a chronic condition, is the camp prepared to handle it?
Many parents of children with diabetes, asthma, epilepsy and other chronic conditions know that drugs and special precautions make it possible for their child to have a normal life most of the year. But camp can present special challenges, especially if a child needs routine medicines or foods, or might suffer an emergency that camp counselors don't know how to handle. Parents should be realistic about their child's health and choose a camp that can handle day-to-day issues such as insulin shots, and crises such as seizures. Parents of kids with serious health problems may be able to find a special-needs camp designed for children with certain illnesses.
"A parent of a child with a chronic illness needs to ask a lot more specific questions than a parent of a healthy child," Walton said. "It helps that older kids with these conditions are becoming more involved in their own care. When kids with asthma go to camp, they should have access to an inhaler, because they know when they need them and how to use them."
Do I need to buy extra health insurance? Will my insurance cover local medical care?
Many camps require parents to buy additional insurance coverage for their children, or to provide proof that the child is covered by an existing policy. And many HMOs and other insurance plans require special permission or immediate notification for medical care delivered in areas outside a local "network" of doctors and hospitals, even for emergencies.
Walton advises parents to check with both the camp and their own insurance company.
"Ask your health insurance company whether or not your insurance is portable, and what are the requirements if a child needs to be seen by a doctor while they're at camp," he said.
What's the camp's policy about phone calls and homesickness?
Psychological well-being is just as important as physical health, Walton said, and he urges parents to find out whether their child will be allowed to call home if he or she is feeling homesick. But parents should resist the temptation to retrieve a homesick child from camp immediately; they should talk with counselors first and see if they can address the issue. And they should avoid sending mixed messages.
"If you get a call from a homesick camper, you should say, 'We're glad to hear from you, we're really glad that you're at camp, and we think you need to keep trying and hanging there, because this will be great if you give it some time.'"
A lot can be done to address homesickness before camp even begins -- starting with a realistic assessment of whether a child is ready to go to a sleep-away camp.
"It's always good to try to 'play at camp' a little bit, and sleepovers are great for that," Walton said. Parents should talk frankly with children in the weeks before they leave about how it's all right to miss home, while emphasizing the fun and new experiences camp will bring.

Additional Resources:

• American Camping Association
• National Camp Association
• CampPage.com
• CampSearch.com
• AllensGuide.com