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Medication Safety

The difference between a tablespoon and a teaspoon is a mere 0.33 liquid ounces. That’s barely two-hundredths of a pound. Yet that minuscule amount can also be the difference between a healthy child and a terrifying trip to the emergency room.medsafety

One of the biggest dangers to children can be found in the small bottles that are supposed to make them feel better. In 2011, nearly 68,000 children in the United States were seen in emergency rooms for medicine poisoning, according to safekids.org. And some of those emergencies were prompted not by children getting into medicines on their own, but rather by their parents accidentally giving them the incorrect drug or dosage.

Karen Cochrane, a nurse and educator in Patient Health and Safety Information at Children’s of Alabama, says there are several simple but important steps parents should take whenever they are giving medication to their children.

“First, it’s very important to realize that children are not small adults,” Cochrane says. “Sometimes people think that medicines that are taken frequently, such as ibuprofen or acetaminophen are no big deal. But for small children, you have to be very, very careful. Because there are some medicines you shouldn’t give to children until they are a certain age or weight.”

Cochrane says parents should begin with a triple-check of the medicine itself. “Check the outside packaging to make sure it’s intact, that there are no cuts or tears,” she says. “Then when you are home, check the label on the inside package to make sure you have the right medicine. And then check the color, shape, size, smell, everything. If it doesn’t look or smell right, talk to the pharmacist.”

Other tips from the U.S. Food and Drug Administration include:

  • Do not mix two different over-the-counter medicines without knowing the active ingredient. Acetaminophen, for example, is in more than 600 medications. “So you don’t want to give something for a headache and then something for a fever and double-dose,” Cochrane says. “That’s a very easy thing to do. You want to know exactly what you’re giving, especially if you’re giving more than one. So be sure to check the active ingredients on the bottle.”
  • Use the dosing tool that comes with the medicine, and have a firm understanding of measurement sizes and abbreviations, particularly the difference between tablespoon (tbsp.) and teaspoon (tsp.), and milligram (mg.) and milliliter (mL). “A kitchen spoon isn’t going to measure out the correct amount,” Cochrane says.
  • Do not increase the dosage if the child isn’t improving, or try to catch-up if you miss a scheduled dosage time. “You don’t want to play doctor,” Cochrane says. “If one strength works a little bit, doubling it is not going to make them feel twice as good. Instead it could cause some harm. And if the child misses a dose, make sure to check with the doctor to see what to do. Never just go ahead and give another dose.”
  • Treat the medicine as medicine, and make sure children understand what they are receiving. “Never tell them that it’s candy,” Cochrane says. “There are a lot of medicines that look like candy, and they’re flavored to make it easy to take. Tell children it’s time for their medicine, and then put it away each time up and out of sight, even if you’re going to give it to them again in four hours.”
  • Communicate with your doctor and pharmacist. Let your physician know every medicine that you give your child, including vitamins and herbal supplements. Ask questions about potential side effects. Have your pharmacist mark the correct dosing amount on the syringe. “It’s OK to ask a lot of questions and double-check everything just to be sure,” Cochrane says.
  • Finally, program the number for the Regional Poison Control Center at Children’s of Alabama (800-222-1222) into your phone. “They can give you any information about medicine safety,” Cochrane says. “Hopefully you never need to call them, but if you do the number will be right there.”

Because when it comes to medication safety for children, the smallest things can make a big difference.

Hope and Cope

 Dr. Avi Madan-Swain, is an associate professor of pediatrics and director of the Hope and Cope Avi Madan-SwainPsychosocial Program in the Division of Pediatric Hematology-Oncology at Children’s of Alabama.  She has worked extensively with children diagnosed with cancer and other blood disorders and their families in both inpatient and outpatient settings. 

Most people know that the Alabama Center for Childhood Cancer and Blood Disorders at Children’s of Alabama provides cutting-edge cancer treatments. But our care goes well beyond the lifesaving surgeries, chemotherapy and radiation therapy. Since 2008, our Hope and Cope Psychosocial Program has been providing support and services from diagnosis onward using a family-centered approach, where the family and health care providers are partners working together to best meet the needs of the patient.

Our interdisciplinary Family Support team, consists of skilled and compassionate specialists, including social workers, child life specialists, pediatric psychologists, pediatric neuropsychologists, chaplains, hospital-based teachers, school liaisons, art and music therapists, as well as a rhythm drumming specialist to provide emotional, psychological and spiritual support and also assist with concrete needs. Theyfocus on identifying family strengths and resiliency factors, as well as risk factors, and provides evidence-based interventions. Some families need emotional help. Some need financial help. Some need spiritual help.

To ease the stress and distress from frequent hospitalizations or lengthy outpatient visits, the Hope and Cope Psychosocial Program offers a variety of emotional health and well-being activities including: Art/Music/Drumming and Rhythm Circle, Beads of Courage, Gardening on the Terrace, group school or bedside instruction, STAR (School/Social Transition & Re-entry), Hand in Paw Animal-Assisted Therapy, Hand of Hope Volunteers, individual therapy for patients or family members to help with specific individual challenges being faced, Parent 2 Parent Mentoring, as well as a weekly inpatient Caregiver Dinner Support Group to give families a break from hospital food. Many of these activities are made possible through partnerships with local community businesses and organizations.

Many of our diversionary activities are popular and fun. For example, our rhythm drumming attracts entire families and allows them to express themselves through music.  We plan on soon adding drama therapy, and hope to have all of our patients work together on a theatrical production describing their medical journey.

On the more practical side, our STAR initiative focuses upon the often complex educational needs of childhood cancer patients. School is one of the most important parts of a child/teen’s life. Focusing on school helps the child/teen look to the future and is a step toward returning to a more normal lifestyle. We believe that when a child/teen diagnosed with cancer or a blood disorder is medic ally able, they should return to classroom. It is important to keep children on track with their education, because it sends a strong message about our confidence in their continued growth and development. We offer group school daily in the hospital, along with bedside instruction when the child is medically unable to attend.

Our STAR team school liaisons work with education systems to help cancer survivors successfully transition back to school. The school liaisons work closely with the family and serve as a link to provide ongoing communication between the hospital and school. When the child/teen is ready to attend school regularly, the school liaisons work with the child/teen, parent and school personnel to develop an individualized school re-entry plan to ensure a smooth transition.

 

STAR school liaisons also teach parents how to navigate the educational system. They learn about their child’s learning difficulties that are associated with the cancer diagnosis and treatment, their child’s educational rights and how to successfully advocate on their behalf. Sometimes our school liaisons attend school meetings to help ensure that educational accommodations are included in the child’s educational program. The school liaisons advise parents on what is reasonable to expect from schools and connect them to resources that help ensure those expectations are met.

Childhood cancer survival rates have risen dramatically in recent decades, but not all children win their battle against cancer. The Hope and Cope Psychosocial Program has designed activities to assist children with a terminal diagnosis. For instance, our art therapist works with the patient and their family to create a “legacy” piece of art that serves as a remembrance after the child’s death. Additionally, we host an annual “Honoring Their Journey” memorial service for families who have lost their child to cancer or blood disorder in the past year. It is a time for families to reconnect with staff and share memories.

It’s important that parents become active participants in their child’s medical care; after all, no one knows their child better than they do! Parents are equal partners on their child’s care team, and their voices needs to be heard during family-centered rounds. Through sharing information openly and honestly, the medical team, patient and family work collaboratively to develop daily goals as well as discharge goals.  Parents need to be engaged and empowered. They need to feel comfortable asking questions and providing input during daily inpatient rounds or outpatient visits.

Childhood cancer knows no boundaries. It can strike young children and older children. It can strike the wealthy and the impoverished, black or white. Similarly, the needs of a family are boundless, too, and vary widely. Until childhood cancer is eliminated, the Hope and Cope Psychosocial Program is here to empower young people and their families to foster a sense of healing throughout the medical journey.

Lice

This time of year as the kids are going back to school, some may bring home some unwanted guests… Lice!   Lice are highly contagious and extremely common.  Six to 12 million American children get head lice very year.

The head louse is a tiny, wingless parasitic insect that lives among human hairs and feeds on tiny amounts of blood drawn from the scalp. They can spread quickly from person to person.

“Contrary to common belief, anyone can get head lice,” said Stephanie Armstrong, RN, a registered nurse at Greenvale Pediatrics-Brook Highland. “It doesn’t matter if you’re rich or poor, if you have clean hair or dirty hair– you can get lice,” she said. “Lice aren’t dangerous but they are a nuisance and can be difficult to deal with.”


Symptoms

Some of the symptoms of head lice include itching and scratching.  This is due to a reaction to the saliva of lice.  Parents may also notice small red bumps or sores from scratching.  And children may complain of feeling like something is moving around on or tickling their heads.


How to identify lice:

If your child is showing symptoms of head lice, they should be easy to identify.  The lice and the nits (eggs) can be seen by the naked eye.  “Usually at the nape of the neck or behind the ears there are small eggs that are attached to the hair shaft,” said Armstrong. “They may be white or yellowish brown. They look different than dandruff as dandruff flakes away pretty easily and quickly, while lice eggs are pretty hard to pull out.”


Treatment

Treatment for lice is highly effective. Options include over the counter medicated shampoos as well as more natural shampoos designated for treating lice.  Armstrong says the key is to follow directions carefully to avoid recurrence.  Most treatments require a follow up application after 7 to 10 days. This is to kill any newly hatched nits.

Still, it’s important to keep in mind that lice medication is a pesticide.  Applying too much or using it too often can increase the risk of causing harm.  Always read the product label carefully and follow directions precisely.

Here are some simple ways to get rid of the lice and their eggs, and help prevent a lice re-infestation:

  • Wash all bed linens and clothing that’s been recently worn by anyone in your home who’s infested in very hot water (130°F [54.4°C]), then put them in the hot cycle of the dryer for at least 20 minutes.
  • Put anything that can’t be washed (like stuffed animals) in airtight bags for at least 3 days.
  • Vacuum carpets and any upholstered furniture (in your home or car), then throw away the vacuum cleaner bag.
  • Soak hair-care items like combs, barrettes, hair ties or bands, headbands, and brushes in rubbing alcohol or medicated shampoo for 1 hour. You also can wash them in hot water or just throw them away.

Because lice are easily passed from person to person in the same house, bedmates and infested family members also will need treatment to prevent the lice from coming back.

Prevention

While highly contagious, it’s important to remember that lice cannot jump or fly.  The only way of transmitting them is by direct contact.

Teach your children to never share combs or brushes, hats, scarves, jackets or headphones.

In addition a popular pastime of young people has become a common lice transmitter: taking selfies! Tell children to avoid any kind of head-to-head contact.

Lice can be hard to eliminate.  If after following every recommendation your child still has lice it could be because:

  • Some nits were left behind
  • Your child is still being exposed to someone with lice
  • The treatment you’re using isn’t effective

If your child still has lice two weeks after you started treatment or if your child’s scalp looks infected, call your doctor.  While lice can be a hassle and embarrassing, reassure your child that anyone could get them and that there is light at the end of the tunnel.  Be patient, follow all instructions carefully, and soon your family will be lice free.