My goal here is to educate people about the risks and realities of e-cigarettes amid an environment full of popular misconceptions and half-truths. Talking about e-cigarette use in adults will NEVER be the same as talking about e-cigarette use and dangers for children and teens. Different groups, different realities, different risks, different use, and different vulnerabilities. Period.
If we don’t get real about protecting children and teens from the availability, allure, and marketing of these e-cigs my fear is we’ll find ourselves rewinding progress made on nicotine addiction via declining teen use of tobacco cigarettes this past decade. In the past I’ve called e-cigs the gateway to the gateway drug which I still believe today. Nothing is currently better about e-cigs and liquid nicotine for teens today. There is no data to prove any benefit in having e-cigs around for teens and as time progresses liquid nicotine is still in arm’s reach for many children (one child has died from a toxic ingestion). Just this month the FDA has announced they will consider making changes to the packaging of liquid nicotine, but it will literally take congress and the FDA stepping up and prioritizing child safety to ensure in minimum liquid nicotine is sold in child-resistant packaging. Can you believe it’s this much of a challenge to protect children?
This is part two of the “What To Do If Your Child Is Drowning” series. Read about infants/toddlers here.
The purpose of these posts is to find out what you should do if you realize your child is actually drowning or struggling in the water rather than repeat the warnings of how to prevent it. I want to put a couple thoughts and tools in your hands to know WHAT to do if faced with an emergency.
Dr. Linda Quan, an emergency attending physician and drowning expert at Seattle Children’s shares information on what to do if you come upon a school-age child or teenager who is drowning. Preparing for this can help boost awareness and response if ever you support or discover a child in need for rescue.
Keep Your Own Safety In Mind
One of the most important things to be aware of if you see an older child or teen drowning is they are usually in water that is deeper and poses more risk to the rescuer. Always take time to consider personal risks before attempting a rescue. This requisite step plays counter to our instincts to act fast as parents and guardians of children…but I can’t overstate this. The size and strength of the child who is drowning should always be taken into consideration. Children and teens can be large enough to actually drown the rescuer. Dr. Quan says,
For this age, the “Throw or Reach” rule is the key safest rescue action.
Reach to the child with something they can grab (a stick, paddle or your hands), only if you’re in a safe place and not at risk of being pulled in by the victim. Alternatively, you can throw something that floats (a life jacket, ball or safety ring) toward the child. Do not jump in to the water to rescue a drowning child or teen unless you are trained to do so. Only those who are experienced in water rescue and have some type of floatation with them should go into the water to perform a rescue.
If possible, get your child or teen comfortable in the water. If they have had some experience in water it might be easier for them to overcome panic and either reach for a flotation device or flip over, float and breathe.
If You Think A Child Or Teen Might Be In Trouble:
Tell someone to call for help – a lifeguard or 9-1-1
Stay well clear of the water and any incoming surf unless you are trained, qualified and equipped to make an in-water rescue in these conditions
If the child has been taught to float, yell to them to flip over, float and not fight the current.
Immediately throw the child who is old enough something that floats (e.g., a lifejacket, ball, body board, empty cooler with lid secured)
If you can safely do so, reach to the child with something they can grab (eg., stick, paddle) – STAY out of the water.
Safely remove the child from the water without endangering yourself.
When you get the child to shore, if the child is conscious, provide warming and comfort. If the child continues to have any breathing trouble, such as shortness of breath, fast breathing, coughing, labored breathing or seems too tired, seek medical care immediately. If the child is unconscious, lie the child down on his back, chin up.
If the child is blue or not breathing, give several rescue breaths ( mouth to mouth).
If the child does not take breaths or respond on his own, start CPR (chest compressions with ventilation).
After several rounds of CPR, call 911 if they have not been called yet.
Last week a proposal was introduced that would give Washington State the toughest e-cigarette laws in the country. If passed, House Bill 1645 would significantly raise the taxes on e-cigarettes, ban the sale of flavored vaping liquids, ban online sales to Washington residents and require producers to list ingredients on labels. And while opponents of the bill argue that e-cigarettes are “healthier” than tobacco, there’s no denying the dangers of having such a highly addictive substance in arm’s reach to children and teens in an unregulated manner. Washington isn’t the only state taking action. This week California released a campaign calling out marketers of e-cigs for targeting teens. Teens are using e-cigs more and more with 1 in 5 high school sophomores here reporting having used them in the last month. E-cigarettes and e-hookahs may carry an illusion of safety they don’t warrant.
What House Bill 1645 Proposes
Instill a 95% tax on vaping products similar to tobacco product taxes
Right now only North Carolina and Minnesota have imposed taxes on E-cigarettes
Make it illegal to sell flavored liquid nicotine or other vaping fluids
Ban internet sales to Washington residents
Require ingredients list on all labels
Curbing An Urge To Smoke: An App For That
Supporters of e-cigarettes and those fighting against regulation often claim the devices are helpful in helping tobacco users quit, so-called harm reduction. I certainly won’t and can’t argue with anecdotes that this is useful for those wanting to quit. While this concept hasn’t been entirely disproved or entirely proven, there is still a lot we don’t know about vaping and the effects of liquid nicotine. If you or someone you know wants to quit tobacco, there are some new digital resources available to help you kick the habit. The good news is we can be hopeful that dual-pronged approaches may help those wanting to quit earnestly succeed. Download this app?
Image courtesy: Washington Department of Health
Washington State residents have access, for a limited time, to a free app called SmartQuit. Sponsored by the Department of Health, the app is a tobacco cessation program that proved three times more effective than trying to quit on your own, according to a recent study from Fred Hutchinson Cancer Research Center. SmartQuit users create a personal plan to become aware of their urges to smoke, they then learn new ways of thinking about those urges to suppress the desire to smoke. The Washington Department of Health is offering the app for free to a limited number of users. Because the funding is limited, please don’t download unless you’re serious about using the app as the number of free downloads will run out. Consider it? If you or someone you know does, report back on your opinions?
Teens in the U.S. aren’t getting enough sleep and it’s not getting better as time unfolds. After days of too little sleep we accrue a “debt” of sleep. An article out earlier this month details the long-term effects of chronically tired teens, “The Great Sleep Recession” the reality that as teens progress from middle school and into high school, the majority don’t get the sleep they need. National Sleep Foundation has found that over 85% of teens lack adequate sleep. Sleep matters: deprivation and tiredness affect schoolwork, attention, mood, interactions, unhealthy weight risk and lifelong health habits. Teens need between 8 – 10 hours of sleep each night (imagine — that means if in bed at 10:30 a teen shouldn’t hear an alarm prior to 6:30am!) but the data out this month shows a growing number of teens from all ethnicities and backgrounds are getting less than 7 hours of sleep, 2 hours less than what is recommended. This has big effects on the culture we’re rearing. Typically teens won’t naturally get tired and drift off to sleep prior 10 pm, so one way to combat this sleep deficit is to push school start times to a later hour.
Why Teens Need Sleep
Sleep deprivation changes the experience of life. There an increase in risk for anxiety and for depression in young adulthood in those who don’t get adequate sleep and it’s harder to focus, pay attention, perform at school and make decisions when we’re tired.
Less sleep leads to more car accidents and poor judgment. Changing the time teens start school can improve safety:
Delayed start time lowered one county’s teen crash rates during study, while statewide teen crash rates (that reflected schools that stayed on the same schedule) rose 7.8% over same time period.
In a two county comparison in Virginia, the one with an earlier start time had a crash rate of 48.8/1,000 drivers vs the county with later start times 37.9/1,000 drivers.
Sleep deprivation can lead to substance abuse later in life and is tied to more use of caffeine and other stimulants.
Caffeine in the morning and afternoon, naps throughout the day and evening and/or sleeping in on the weekend help teens cope with fatigue but these band-aids and catch-ups will not restore brain alertness like sufficient sleep does.
Legal never has meant “safe” but the two words may at times overlap in our minds. When it comes to marijuana I’d suggest there is quite a bit of confusion right now about safety, recreational and medicinal use, and the effects of use on our population. In general, as laws change and access to marijuana increases we have a responsibility to be clear about what is known.
The adverse effects of marijuana in children and teens have been well-documented. Marijuana use can impair memory, decrease concentration, and change problem-solving capacity. It’s not good for the lungs nor long-term health; teens who use pot have a higher likelihood of drug addiction later on in life, the risks increase the earlier they start using. Research also finds that teens who use marijuana are less likely to finish high school, are more likely to use other (illicit) drugs, and have an increase in suicide attempts compared to those who don’t. The more they use, the more the effect. I can’t help but think about what a mom to a teen said to me recently in clinic, “marijuana is everywhere now.”
One in 5 high school students says they have used marijuana in the last month and up to 1 in every 16 students says they use it every single day. Who are we if we ignore these numbers?
As legal may mean “safe” to some a strong statement from pediatricians everywhere from The American Academy of Pediatrics (AAP) was released today to set the record straight. The two things to know:
Research has found marijuana has adverse effects on teen health. It’s now known that the brain isn’t fully developed until the mid-20’s raising real concerns about what the drug does while the brain is still forming. The effects of marijuana change how teens think in school, how safe they are on the road, and potentially how they act for a lifetime (lifelong addiction risks increase with use, teens who use are less likely to finish high school, teens who use have higher suicide risk).
Use Coupled With Criminalization Can Change Lives For Good: Legalization for medical and recreational use may imply marijuana is benign; for children and teens this is untrue. History shows that teens, especially those of racial minority groups, are incarcerated at higher rates secondary to possession or use of marijuana. A criminal record can have lifelong negative effects — the AAP is advocating to decrease marijuana crimes from felonies to misdemeanors, study effects of legalization in states like WA or Colorado, Alaska or in DC, and strictly limit access to and marketing of marijuana to youth. The big concern here as well is that policies that lead to more adult use will likely lead to more adolescent use. Decriminalization is especially important in states where recreational use is legal for those over 21 years of age.
This girl in a tanning bed should provoke the same response in you that a photo of a 5 year-old smoking a cigarette would.
More than a million people go indoor tanning every day and research says the average city has more tanning salons than they do Starbucks or McDonalds (I’m wondering about Seattle though since coffee shops truly dot every block). I’m also guessing the tanning industry is somewhat seasonal; if we did the research on which week people go tanning, we’d find a bump during winter break, yes?
The pre-vacation tan is often used as a handy excuse for hitting the indoor tanning salon this time of year. There’s no such thing as a “safe” tan since tanning is a reflection of damage to the skin cells — a tan is the body’s response to damaged DNA in the skin cells. However, vacationers (lucky you!) often feel that getting a tan before they go to the equator will protect them. Instinct here is wrong.
Data finds that those who indoor tan before their trip are careless while on the trip, thinking they are protected, and in the end have more sun exposure and ultimately more sunburn than those who don’t.
People may visit a tanning salon to prepare the skin for a sunny vacation, the “prevacation tan”, thinking that a “base tan” will protect against subsequent skin damage during the vacation. This leads to extra radiation before the vacation and also afterward, because people may use fewer sun-protection precautions during the vacation because of a mistaken belief that the tan will protect them. The “prevacation tan” results in minimal protection (an estimated SPF of 3) and provides virtually no protection against sun induced DNA damage. ~ Pediatrics, April 2013
E-cigarette use is growing among teenagers. Vaping is on the rise among high-school students in particular, with rates increasing steadily each year. I still think of e-cigs as the gateway to the gateway drug. In my experience, teens remain confused. They hear about health benefits (harm reduction) in adults and they may think that confers safety. In addition, some teens have reported to me they have heard it will improve their sports and school performance.
Nope. No data to show e-cigs are good for anything in teens, in fact we know nicotine increases HR and BP which in the end could decrease sport skills. Just a teaspoon of liquid nicotine can be lethal to a young child and we know nicotine can have lasting adverse consequences on teen brain development. Becoming addicted to nicotine (the big worry with teen use) could have secondary health effects leading athletes to cigarettes which we know won’t improve their talent on the field.
It’s not just use among teenagers that’s cause for concern. Young children living with or near nicotine may be at highest risk from e-cigs due to their curiosity and lagging judgment and ultimate exposure. The first child death related to exposure of liquid nicotine was reported last week. A child in NY has died from exposure to liquid nicotine after officials have been warning of the risks from sales lacking regulation. The risks are being felt everywhere as the rates of calls to poison control rose from 1 report in September of 2010 to 215 calls in February of 2014. This NY death represents an enormous tragedy for this family but also for our ability to prioritize safety over sales. We can’t forget that the flavored nicotine used in e-cigs appeals to many senses in a toddler exploring their environment. Dr Alexander Garrard, Clinical Managing Director of the Washington Poison Center said, “The products smell very sweet, akin to a jolly rancher so they’re enticing to a number of different senses in kids. The packaging is very colorful as well.” All these things draw a child to experiment and possibly ingest.
Protecting children from this toxin, I would say, is a true failure of pediatric public health.
A Seattle high school recently announced a minor outbreak of whooping cough: 13 students were diagnosed with laboratory-confirmed pertussis. None of the teens are contagious as of today, but it poses an interesting question about protecting our children and communities. A health advocate and friend on twitter suggested a savvy reminder: we can help teenage babysitters get up to date to protect young babies and children. Yes! Is it our parental responsibility to make sure babysitters, nannies or even sweet grandmas are properly vaccinated? Should it be the question we ask before we inquire if they’ve completed CPR training? Perhaps.
It’s hard enough to ask grandparents and friends to vaccinate or “cocoon” to protect our youngest and most vulnerable. It may be a challenge with the neighbor babysitter as well. I’d suggest just saying, “Hey, did you get your 11 year-old shots and your flu vaccine this year?” Thing is, one hurdle may be that your 15 year-old sitter may not know if they’ve had their teen pertussis shot. As a reminder, all children are given immunizations for whooping cough (DTaP) at 2, 4, 6, and 15 months. They then receive another dose at age 4. Then a tween booster dose (the Tdap shot) at age 11 years.
Many children prepare for the big job of babysitting by taking classes. At Children’s our next Better Babysitters class is November 22nd. I’m working to ensure that instructors make sure they help teens determine if they’re up-to-date on immunizations during the course!
Highly contagious bacterial infection (pertussis) of the nose and throat causes “whooping cough.”
Easily spread by coughing and sneezing. Symptoms appear 7-10 days after exposure (on average)
Symptoms differ by age, babies & young children may have severe coughing spells or even pauses in breathing. We worry most about newborns, young infants under 2 months of age but also consider babies under 6 months of age “high-risk.”
Adults and older children could have fever, runny nose and bad cough that progresses into coughing fits, “whooping” sounds with cough, or even a cough that lasts over 100 days (even if treated). Treatment prevents spread, not the cough.
The 2nd recreational pot store opened in Washington State recently while store #3 opens later this week. Pace will quicken with several more stores expected to open by year-end. This puts parents and pediatricians in our state in a unique situation (shared only with Colorado) as we’re tasked to explain to children and teens the dangers of legalized drugs used by adults. However, the complexity extends even to those of us with young children. Growing concern (and evidence) finds accidental ingestion of pot among children, often in the form of edibles, is also accelerating. Online in social channels I’ve heard some argue that marijuana legalization is to be thought of like alcohol but the packaging and delivery of the drug really are far different.
35 different marijuana-infused food & beverages have been approved by WSLCB (cookies, trail mix, peanut brittle, gummy bears, and chocolate bars for example). Often the packaging for these products looks as attractive as a fruit roll-up or delicious candy bar typically marketed to children.
There have been 68 pediatric marijuana exposures voluntarily reported to Washington State poison control already this year. Because reporting isn’t mandatory this is potentially an underestimate of the number of children exposed to marijuana accidentally.
I’ve been lucky enough to interact with teens on a regular basis for my entire career. As a previous middle and junior high school teacher, people often express pity when they hear I taught middle-school, as if teens are “too” tough, histrionic, and irresponsible to have wanted the job. I really did want the job. I love the drama and rate of change during adolescence. In my experience I see teens take on huge responsibility, make good choices, care deeply about their family and friends, and work diligently to improve their world. Their interest and work on evolving into an ideal self is captivating. Most teens are highly motivated. Many are over-extended because they are so committed. Lazy teens just aren’t the norm…
Sometimes teens get a bad rap. Sometimes they make choices without thinking of the consequences too. That’s normal when you’re still developing. Those mistakes pave the road of opportunity for us to give teens information that keeps them safe.
October is a lot of things (more on that this month) but know it’s National Medicine Abuse Awareness Month and there’s a big push to both educate parents on signs of over-the-counter (OTC) medicine abuse and encourage parents to talk with teens about the risks of using medications as recreational drugs.
Thing is, approximately 1 in 25 teens reports abusing excessive amounts of Dextromethorphan (DXM) to get high. DXM is a safe ingredient found in more than 100 OTC medicines. It’s typically found in cough suppressants or medicines for cough and colds. Because it’s a stimulant, when DXM is consumed in excess it can cause a rapid heart beat, vomiting, stomach pain, hallucinations, confusion, and loss of motor control. It also can induce a high — hence why teens experiment with it.
Seattle Children’s provides healthcare for the special needs of children regardless of race, color, creed, national origin, religion, sex (gender), sexual orientation or disability. Financial assistance for medically necessary services is based on family income and hospital resources and is provided to children under age 21 whose primary residence is in Washington, Alaska, Montana or Idaho.