‘safety’

All Articles tagged ‘safety’

Radiation Disasters And Children: Why No Potassium Iodide Now

There is a lot of talk about radiation and radiation effects because of the ongoing tragedy in Japan. It’s a bit overwhelming and confusing, to say the least. Ultimately, fear motivates us to act in bizarre ways and this current catastrophe in Japan is no exception. I find myself a bit nauseated when my mind drifts to Japan, yet I can’t seem to curb the urge to watch the updates. I don’t normally watch live news because I sincerely don’t think it’s good for me. But this horrific human tragedy steals me away from my typical distance while simultaneously reminding me of two quotes, one posted earlier:

Disasters are about people and planning, not nature’s pomp.” ~The Economist

and

Human inability to detect radiation can pose more of a psychological threat than a physical one. ~The Washington Post

The ongoing tragedy in Japan will help motivate us to prepare. But fear of the unknown can eat away at us, too. Anxiety surrounding Japan’s struggle may be higher than what we experience typically with catastrophic events, in part because of the complexity in understanding the effects of radiation. Because radiation is invisible to the eyes and undetectable to the nose, its presence is difficult to detect. We know that fear and anxiety are common in children affected by natural and radiation disasters but its psychological effect may be the most lasting and intrusive to health.

We can do things to protect our health, too. First, if your children are watching TV, sit with them and provide honest, age-appropriate explanations. Turn the TV off whenever possible. Next, discuss what your family is doing to help prepare for unexpected emergencies. Preparing your home and family for disasters with both a communication plan and an emergency kit can be a great way to decrease anxiety for both you and your children and will arm them with tools to protect themselves. A great antidote to fear is to regain your sense of control. I hope this post, and ongoing ones, help us all calm down.

The bottom line is this: with what we know now about Japan’s current disaster, even with the possible worsening nuclear crisis, medical countermeasure such as potassium iodide (KI) are not indicated here in the US. Don’t pop the Potassium Iodide (KI). And don’t feed it to your kids! Although Japan is advising KI use in the close vicinity to the damaged reactors, the US Nuclear Regulatory Agency and the Washington State Department of Health have both said that harmful effects of radiation are not expected in Hawaii or the US West Coast.

I believe every decision we make in medicine is a balance between risk and benefit, from intervention to doing nothing. This radiation question is no exception. Potassium iodide can protect the thyroid gland from the devastating effects of high levels of ionizing radiation. But, when used inappropriately or unnecessarily, potassium iodide has the potential to cause very serious side effects such has abnormal heart rhythms, bleeding, nausea, vomiting, and electrolyte abnormalities.

The risk of using KI far exceeds any benefit right now. Read full post »

RECALL: Baby Monitors, Cords, and Strangulation Risk

The Consumer Product Safety Commission (CPSC) issued a recall on video monitors made by Summer Infant Inc today. Summer Infant makes over 40 models of video monitors. Look at their recall information if you have one, or call their information line Monday through Friday at 1-800-426-8627 for more information about getting a kit to secure the cord properly.

Recalls always make me feel uneasy; the photos accompanying recalls are often terrible to look at and the messages are impregnated with fear. As a mom and doctor, however, I tend to be reminded of things I can do to refresh the layers of safety I have at home for my children. I’m also reminded of the times I messed up. I end most 15, 18, and 24 month-old checks-up talking about our role as parents: to provide a safe and loving home for our children. I mean “home” in the greater sense, but also in the functional one. We need to create a place that allows for exploration. Our infants’ and toddlers’ curiosity is constantly expanding; and most importantly, their judgment lags behind their curiosity.  We have to have a safe place for them to mature. This recall can serve as a great reminder of ensuring your baby, toddler, or preschooler has no cords within 3 feet of their crib, bassinet, or bed. Strangulation can easily be prevented.

After two recent strangulation deaths, and one near strangulation (20 month old was found with cord wrapped around neck), the CPSC announced a voluntary recall of these products. And although most of us don’t have this particular model, most of us have baby monitors. Check your baby monitor (video or not) to make sure the cord is not within 3 feet reach of a crib, changing table, or the floor.

Video and audio baby monitors are designed to work when distant from your baby or child’s crib/bed. You’ll still hear that baby screaming when it’s parked across the room!

The American Academy of Pediatrics says:

Place your baby’s crib away from windows. Cords from window blinds and draperies can strangle your child. Use cordless window coverings, or if this is not possible, tie cords high and out of reach. Do not knot cords together.

As I said, I had MANY lapses in creating a perfectly safe environment for my boys. We moved a number of times during their infant/early toddler years and I remember realizing at one point after a move that I had the baby monitor (we didn’t have a fancy video one) too close to O’s crib. I’d rested it on the top of his crib rail one time after vacuuming. O was about 11 months-old and exploring every corner of the crib at nap time (read: not sleeping). Only when I heard (through the receiver) that O was playing with the monitor did I understand the mistake I’d made! I’d unnecessarily plugged the monitor into the same wall as the crib.  Eeeeps.

I moved the monitor to the other side of the room, about 6 feet away. Of course the monitor still worked fine. And yes, I felt a little stupid but I also wasn’t the only adult caring for my boys in our home. All of us had carelessly been using the monitor in that location. We all can use reminders…

As parents, we change rooms around, particularly with moves and new babies or transitions. Remember that all cords, those from blinds, monitors, and nightlights, need to be at least 3 feet from the crib and up out of reach of the floor. Using cordless blinds can be a great solution, too.

Do you remember a time when you realized you’d lapsed in creating a safe room for your child? Tell me I’m not alone…

500 Words on a $5M Fine

No photo for this post. You can imagine why.

I’m a little stunned by the news that a politician in Florida is trying to stifle pediatricians from asking questions about guns in the home. My reaction is utterly predictable. Should I YELL IT or write it down or leave it up to your genius (and imagination)?

(silence)

The Skinny on the Florida Proposal:

  • Florida Rep. Jason Brodeur said “he has heard about a number of cases in which doctors asked about guns. He thinks the topic should be off-limits.”
  • Brodeur says he’s concerned about doctors asking patients about guns in the home. He’s concerned that information could get into the hands of the government or insurance companies.
  • Under the proposed legislation, a doctor could face a fine of up to $5 million or be sent to prison for up to five years for asking about guns in the home.

The idea of blocking the right to advocate for children is preposterous. Clearly pediatricians don’t like censorship, particularly when it gets in the way of protecting the lives of children. We don’t even like censorship from our patients; we like it when adolescents tell us the truth about having sex, doing drugs, and self-tattooing. We like it when parents tell us what truly keeps them up at night. Really. Transparency and a lack of censorship is an imperative ingredient in the doctor-patient relationship. The exam room is a space and place where you’re not faulted for telling the truth. Read full post »

Ban on Drop-Side Cribs

The Consumer Product Safety Commission (CPSC) officially banned manufacturing, sale, and resale on all drop-side cribs today. Laws will go in place June 2011. These cribs, with movable sides that come down to make it easier to place your baby or toddler in the crib, have been under scrutiny for years due to safety concerns. Previous CPSC warnings and recalls have been loudly amplified in the media. Many parents have had concerns.

Here is a nice summary of the announcement. If you have a crib with moving or drop-sides, check out these suggestions for ensuring your crib is safe by doing routine checks. Ensure the crib isn’t wobbly, that joints for the sides of the crib are secure, that there is not excess space between the mattress and the side of the crib (no more than 2 fingers should fit), and that parts are intact and unbroken. If any parts are broken, replace parts by following manufacturer recommendations by looking online at their site or calling the company who made the crib.

This is another great step in protecting our children. What’s your experience with drop-side cribs? Have any of you had experiences raising concerns while using them?

Here’s additional tips from the AAP on choosing a crib (hasn’t been updated to include today’s information).

(And yes, I look like I’m attacking the screen or eager to eat a large drumstick in the still above; I know. No comments necessary :-))

Dosing Liquid OTC Medications

Over the counter (OTC) liquid medications for children are packaged with a diverse set of various measuring tools. The dropper that comes with liquid acetaminophen (Tylenol) will look very different than the dropper that comes with liquid Vitamin D or infant multivitamins. Even more discrepant are all the various caps for medications used in older children like liquid Motrin or Benadryl. If your cabinet looks anything like mine, caps and syringes are scattered about and distant from the bottle with which they were originally packaged. Because of this, many of us get confused when dosing medications for children. It’s time OTC liquid medications for children were packaged with a universal dosing device. And….time that pediatricians and all physicians be required to use only one unit of measurement (whenever possible) to avoid ongoing confusion for prescription medications, too. A new study functions as a wake-up call for drug makers and pediatricians alike; we need to do a better job helping families learn how to safely dose OTC liquid medications for infants and children. Current practice isn’t going to cut it.

A recent study in JAMA found… Read full post »

Wednesday Before Thanksgiving

Be safe today. With travel defining many of our days, this is a day I think about safety every year. Now more than ever because of my kids. Motor vehicle injuries are the leading cause of death for children in the United States. The CDC statistics on child passenger safety state that child safety seats reduce the risk of death in passenger cars by 71% for infants and 54% of toddlers age 1 to  4 year of age. Car and booster seats are an awesome way to protect our kids.

Wednesday before Thanksgiving was changed for me forever while training in pediatrics.

Wait, a warning: this is a slightly morbid thought. So if it will do you no good, don’t read on. I share this only to show you how and why pediatric training and the profession of caring for ill children shapes how and why we pediatricians believe so strongly in preventing illness and injury. Terrible stories are instructive.

One year in residency, I rotated into the pediatric ICU during November. I was on-call the Wednesday before Thanksgiving until middle of the day Thursday. I was taking care of critically ill patients, some who were on the transplant list waiting for organs. I remember as colleagues left for the day on Wednesday afternoon and evening, one doctor mentioned she wasn’t worried. She knew the patients in the ICU were going to get the organs they needed shortly. It was the biggest travel day of the year, she explained, and organs were going to be much more available.

Entirely morbid, and then entirely hopeful, too. Yes, the organs did arrive over the weekend…

The memory of that conversation really stuck with me. I don’t know if it’s true that more organs are available soon after the Wednesday before Thanksgiving (biggest travel day defined) because of travel related accidents, but it comes into my head every year. Makes me double check the car seats, re-examine the buckles, and drive a bit more slowly.

Be safe today, all. Don’t take risks you don’t need to take, and buckle up. Ensure the carseats are properly installed, particularly if you’re putting a seat in a relative’s or a rented car while you travel away from home.

I like this USA Today article with tips about traveling with infants and children, too.

And here’s my take on why I don’t recommend using Benadryl on the plane if you were thinking about throwing it in the travel bag.

Be well. Enjoy time with friends, family, and your Thanksgiving traditions. I am so thankful for all of you…

If It Were My Child: No Teething Tablets

On Saturday, the FDA released a recall of Hyland’s teething tablets. The recall stems from concerns for increased and varying amounts of belladonna, a toxic substance that could cause serious systemic effects to babies. It’s unclear how much belladonna is found in these tablets normally although it is well known it’s in them. Recently, infants have developed symptoms consistent with belladonna toxicity after using the tablets (change in consciousness, constipation, skin flushing, dry mouth). Homeopathic supplements and medications are unregulated and therefore it’s hard to know what is in them, how consistent one bottle is from the next, and how different brands of the same products compare. Local and national poison control previously deemed teething tablets safe even though it is known that they have trace amounts of belladonna (and possible caffeine). The FDA states it is “unaware of any proven clinical benefit from the product.” Because of safety concerns and no known benefit, I’ve always recommended against using teething tablets. If it were my child, I didn’t, and would not use teething tablets. If you have these at home, throw them out. Here’s some FDA tips of safe disposal of unwanted medications. If your child has had these tablets in the past, there is no reason to worry. Ill effects would have been seen soon after using them.

Some Teething Truths:

Why I Hate Sleep Positioners

I hate infant sleep positioners. They are not safe or helpful. If you have one or know a family/friend who uses one for their infant, throw it out. Trash compact it. Stomp on it. Cut it up in bits. This is one rare thing you should feel good about putting in landfill.

When I was first started in practice, I didn’t even know sleep positioners existed; I was shocked at how many parents told me they were using them. We are led to believe (by manufacturers) that positioners confer safety by keeping babies on their back. Since 1994, the Back to Sleep campaign has helped parents become vigilant (yes!) about putting babies to sleep on their backs. But after my sons were born, and while roaming the super-store aisles for bottles, crib sheets, overpriced silicon, and breast pads (oh the glory), I realized why parents get so confused.

In the infant sleep section, I found plenty of products designed for babies I would never recommend. Never. Sleep positioners, head positioners, comforter-like blankets for the crib, bumpers and stuffed animals. Many products went against what I was taught in my pediatric training and what I’ve learned thereafter. Like so many things in life and medicine, less is more. When asked about setting up a safe infant crib I say, “Boring, bare, basic.”

In 2005, the AAP (American Academy of Pediatrics) issued an updated guideline on the prevention of SIDS. Though the message has been effective, sleep positioners have persisted to sell. Two weeks ago, prompted by 12 deaths (over 13 yrs)  due to sleep positioners, the AAP reiterated their position citing the dangers from sleep positioners after the CPSC and FDA (photos seen here) sent out a warning. Even though these positioners go clearly against safety data and medical advice, companies have kept them on the market.

Why? Read full post »

Little Boy = Violent Play?

So parenting news is aflutter with research talking about little boys, their genetic make-up, and their aggressive and violent make believe play. New writing posits that this violent and aggressive play may be needed, that boys will process their aggression via this play. But the jury is still out for some educators and parents. The debate is timely for me after a recent weekend with my two little boys and their 4 year old cousin. I must say, I have the experience in observation part down pat. I’ve seen this behavior, yes.

Boys Need Aggressive Make Believe Play

From how I see it, boys may gravitate to aggressive play but as parents, we never have to condone their violent or aggressive actions. I really believe the lines between imagination, play, and the “real world” are often blurred. There are countless examples of children not understanding the consequences of their actions precisely because they are children. If I let my son pretend to kill/shoot/fight, aren’t I somehow complicit in equating a violent response as an okay one?

What do you think? Do you think aggressive, violent play is an essential part of boyhood?

Moving Day: Double Take

Baby eating a popsicleDoes this photo look familiar? We moved again today. Yup, we moved homes just 10 months ago. Crazy or stupid, you decide.

I’m just home from a late night in clinic. The boys are in their new spaces while the boxes tower amidst the palpable tired. But the night still swells with possibility. I can see the stars from the back yard. And the bare walls blended with the smell of cardboard boxes, makes me feel like I just turned the page in a new hard-covered book. Moving, albeit chaotic and uniquely stressful, can feel like hope. Optimism prevails tonight.

But I’m still thinking of the last time around.

Here’s my moving day post from last year. Read about our terrible misfortune and improper planning. Learn from our mistakes. Especially if you’re about to do a moving-double-take, too.
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My story of 9 stitches, 2 parents who feel as deflated, flat and small as the bottom of your worn shoe, a near 3-year-old boy, and 1 orange Popsicle. This is about our mistakes and the dangers of the events that followed moving day in my world, October 31, 2009.

But let’s go back in time; history is supposed to be one of our most sage instructors.

Circa 2003. I took care of a 3-year-old girl in the ER when I was an intern (my first year as a physician, while training in pediatrics) after medical school. In medical training, there are certain patients that stick out, jump off the exam-room-pages, of the hundreds of patients you can see in a month’s time. I know some will stay with me forever. Read full post »