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Quick reference medical handouts used by Pediatric offices


Nine Things You Don't Want your Child to Ingest or Inhale


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Acetaminophen

The safety and effectiveness of acetaminophen (Tylenol, Tempra) is well established. The most common mistake is that parents put medications in a conve­nient location (and accessible to the child), so they can easily give the medication during a period of illness. Parents may fail to read and understand the label instructions, use of an incorrect measuring device (for example, dispensing the more concentrated infant drops by teaspoon), or use of an adult preparation for a child. Some parents mistakenly use acetaminophen with an over-the-counter, combination product without realizing that the combination product (often sold as flu, cold, sinus nr allergy formulations) also contains acetaminophen.

Actions you can take: Be sure to put all medicine away each time you use it, preferably in a locked cabinet. Dispense medicine only with the dropper or measur­ing cup that came with the bottle, and read the label to determine the correct dose. Read the list of “active ingredients” for each medication, particularly cold, sinus and flu medications, which often contain acetaminophen.

Iron

In a recent eight-year period, iron ingestions caused nearly one-third of the deaths in children due to ingestion —making iron the most common cause of pediatric ingestion deaths. Despite this, iron remains a common household product, and many people are not aware that iron can be a very toxic substance in high doses. Iron can be found in many children’s vitamins, also in much higher concentrations in adult vitamins, especially prenatal vitamins, as well as in liquid and tablet formulations of iron alone. These medications may be colorful, character-shaped chewables, or tiny coated brightly-colored tablets which resemble candies. A child who ingests iron may initially have vomiting or other gastrointesti­nal symptoms, which then may subside temporarily, falsely reassuring caregivers. In the stage which follows this apparent recovery, children who have ingested iron may progress within 12 to 48 hours to gastrointestinal bleeding, liver failure and even death.

In 1997, regulations went into effect which required that pills which contain more than 30 mg. of iron each be individu­ally packaged, for example in blister packs, thereby increasing the length of time it would take for a child to have a serious ingestion. Simply being aware that iron is a dangerous substance to ingest can increase the vigilance of adults regarding storage and handing of this medication.
Actions you can take: Never override safe packaging features like child-proof caps and blister-packs.

Hydrocarbons

These are dangerous substances found in products such as baby oil, suntan oil, bubble bath, lotions, make-up, lamp oil and furniture polish —products that aren’t required to be in child-resistant packaging. They are generally low viscosity items, so easily drinkable, and they are easily aspirated (which means that they go down the “wrong tube”— i.e., into the trachea instead of the esophagus). Aspiration is the main problem, because it causes a horrible chemical reaction (pneumonitis) which can be deadly. Actions you can take: Limit kids’ access to these things, nearly all of which contain hydrocarbons: baby oil, suntan oil, bubble bath, lotion, liquid makeup, lamp oil and furniture polish. If a child swallows any of these items, DO NOT induce vomiting, which can increase the chance of aspiration.

. Button Batteries

These small round batteries are found in many children’s sing-along books, and if swallowed can cause severe gastrointestinal-damage. Technology that focuses on electronic miniaturization has led to the increased use of button batteries in other products as well (e.g., greeting cards, musical ties, watches, calculators, cameras, hearing aids and games). Not only young children are at risk for this ingestion. In one study, a surprising 24% of children who swallowed button batteries were in the 5 to 12 year age range. Most of the time when children swallow these batteries, they will pass through the person without any problem, just as many other swallowed foreign bodies would. Occasionally, however, severe complications and even some deaths have been reported. This generally occurs when the batteries become stuck in the esophagus or intestine, leaking alkaline electrolytes which cause an internal chemical burn.

Actions you can take: Securely wrap and dispose of all button batteries. If your child does swallow a button battery, he or she should go to a hospital emergency room immediately to be evaluated with an x-ray, since the damage from a button battery can occur quickly.

Ethanol (Alcohol)

This is found in mouthwash as well as alcoholic beverages. Although it is not common, children can drink enough mouthwash (which can be tasty) to make them seriously ill or even kill them. Popular adult mouthwashes contain between 14% and 27% alcohol. By compari­son, beer contains 5% to 7% alcohol, and most wines 12% to 14%. It is for this reason that mouthwashes now have childproof caps. In addition, alcohol-containing drinks, especially those mixed with sweet beverages (juices and soda) can be very attractive to children. :

Actions you can take: Keep the childproof top on mouthwashes, and be sure to dispose of unused alcoholic beverages without delay.

Lead

High lead levels can cause brain damage, growth problems, kidney problems and gastrointestinal symptoms, and even modestly elevated lead levels can cause learning and behavioral problems. The most common sources for lead exposure are paint, dirt and water. You can tell if there is lead paint in your home if you know when the home was built. About two-thirds of the homes built before 1940, and one-half of the homes built from 1940 to 1960 contain lead-based paint. Some homes built between 1960 and 1978 may also contain lead paint. Most paint made after 1978 contains no intentionally added lead.

Other sources of lead include leaded gasoline~ and plumbing materials generally used in older homes (lead pipes or copper pipes with iron soldering) which can allow lead to leach into drinking water.

Actions you can take: Have children wash their hands before a meal, periodically rinse off their toys, encourage them to play in grassy areas of the yard or playground. If you have older plumbing in your home, run cold water for about a minute before drinking it, and do not drink water which comes out of the tap hot (hot water can help leach lead out of the pipes and into the water.) Make certain that infants, children and pregnant women are not in a home where renovations are taking place.

Second Hand Smoke

The Environmental Protection Agency estimates that in children under 18 months of age, second-hand smoke causes 150,000 to 300,000 cases of lower respiratory tract infection (bronchitis and pneumonia) each year. Children exposed to second-hand smoke are at higher risk of having middle ear infections, asthma symptoms, and even Sudden Infant Death Syndrome.

Actions you can take: Talk to your doctor about the best methods to quit smoking. Be clear with family and friends that smoking is not permitted in any home or car in which your child spends time.

Poisonous Plants

Despite its reputation as a poisonous plant, the poinset­tia has only been reported to kill one person (in 1919), and its effects are probably more irritating to the mouth and throat than deadly. There are a number of other common plants, however, that can be dangerous if ingested. These include lily of the valley (ingesting leaves and flowers can cause an irregular heartbeat, mental confusion, and digestive upset), rhododendron and azalea (all parts of these shrubs are highly poisonous, causing nausea, vomiting, difficulty breathing and coma) and yew (foliage is more toxic than berries, causing death usually without warning symptoms).
Actions you can take: All plants should be out of the reach of small children as they can cause choking even if they are not toxic. To see if you have any poisonous plants at home, read the list posted on www.safekids.org.

Carbon Monoxide

This gas results in more fatal unintentional poisonings in this country than any other agent. In fact, carbon monoxide is responsible for more than 500 unintentional deaths in the U.S. each year. This gas is odorless and colorless. The majority of these toxic exposures occur in the winter months, and the most common source of carbon monoxide poisoning in the home is due to non-vented supplemental heaters. Other sources are car exhaust fumes and charcoal grills.

 

Actions you can take:  Buy carbon monox­ide detectors to install in your home. Avoid exposing yourself or your family to car exhaust fumes by never falling asleep in a car that is running, and never leaving a car in running a closed attached garage. Homeowners should check if extra ventila­tion is needed when they enclose heating equipment to gain additional living space, and when they do any major renovation to the home. Never burn charcoal in an enclosed space (such as a home, garage or tent) as there is a high risk of carbon monoxide poisoning, even if doors or windows are open or fans are operating. Because people who are sleeping cannot recognize the early effects of carbon monoxide poisoning, space heaters should be turned off and fires put out in the fireplace / wood stove while people are sleeping.

adapted from an article that appeared in the October 2003 issue of San Diego Family and posted on kidsgrowth.com 10-10-03

 

As a reminder, this information should not be relied on as medical advice and is not intended to replace the advice of your child’s pediatrician. Please read our full disclaimer.

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