Children’s

Ann P. Slattery  DrPH, RN, RPh, CSPI, DABAT is the Managing Director and Clinical Toxicologist of the Regional Poison Control Center at Children’s of Alabama. She is a registered nurse, registered pharmacist and holds both a Master’s degree and Doctorate in Public Health. Ann is a member of member of the American Association of Poison Control Centers, the American Academy of Clinical Toxicology and the American Board of Applied Toxicology. 

The dangers and side effects of smoking cigarettes are well documented, but electronic cigarettes that are promoted as a “safer” alternative can be just as harmful.
Electronic cigarettes, or e-cigarettes, are battery-powered smoking devices. They use cartridges filled with a liquid that contains nicotine, flavorings and other chemicals. A heating element in the e-cigarette converts the e-liquid into a vapor that can be inhaled. Using e-cigarettes is sometimes called “vaping.”

“Even without the tobacco, there are several dangers associated with vaping,” said Ann Slattery, managing director of the Regional Poison Control Center at Children’s of Alabama. “When you are vaping, you are inhaling substances that your lungs aren’t equipped to handle.”

One such ingredient in the e-liquid is propylene glycol. This is a substance that has many applications, including aircraft de-icing fluid. When propylene glycol is heated, as in the e-cigarette, it produces known carcinogens. Because the liquid used in e-cigarettes isn’t regulated by the U.S. Food and Drug Administration, there could be other harmful substances lurking there in addition to the listed ingredients.

There are also concerns similar to the secondhand smoke associated with traditional tobacco cigarettes. “If you are using e-cigarettes near children, some of the vapor will escape into the air. Therefore, there is potential that the child is being exposed to the same chemicals that you are inhaling,” Slattery said.

One of the primary dangers associated with the e-liquid is the high concentration of nicotine. One 30 milliliter (ml) bottle of e-liquid with a concentration of 3.6 percent (36 milligrams of nicotine per milliliter) is equivalent to smoking 600 traditional tobacco cigarettes. With the variety of familiar flavorings and bright colors that are added, these e-liquids could easily attract the interest of a curious child. And just a small amount – as little as 1/8 teaspoon – of this e-liquid can be potentially fatal for a child who ingests it. Even touching liquid nicotine is dangerous because it can be easily absorbed through the skin.

“The number of accidental exposures to liquid nicotine reported to poison centers has increased,” Slattery said. Data from across the country between 2011 and 2014 show an alarming 2810 percent increase in the number of calls about children ages 5 and under who had been exposed to liquid nicotine.

Those using e-cigarettes are susceptible to overexposure to liquid nicotine as well. “The devices can leak, and the user could ingest a dangerous amount of the liquid,” Slattery said.

Direct contact with liquid nicotine can cause:

• eye irritation
• skin irritation
• severe stomach pain
• vomiting
• seizures
• difficulty breathing
• fast heart rate
• high blood pressure

If you suspect a child has come in contact with liquid nicotine, call 1-800-222-1222 immediately. The hotline to the Regional Poison Control Center at Children’s of Alabama is available 24 hours a day, 7 days a week.

Door knobs. Stair rails. Elevator buttons. Just the thought of touching any of those during cold and flu season may send you running for the nearest bottle of hand sanitizer. Hand sanitizer is a convenient way to keep your hands clean and germ-free, but parents should be aware of the potential harm it can cause.

“There are times when you don’t have access to good old-fashioned soap and water to wash your hands,” said Ann Slattery, managing director of the Regional Poison Control Center at Children’s of Alabama. “Using hand sanitizer is an easy way to stay healthy when you’re on the go, but it’s not without its own inherent danger because it contains alcohol.”

Hand sanitizers contain 40 to 95 percent alcohol, and many formulas contain a stronger alcohol concentration than most hard liquors. Just 1 ounce of hand sanitizer – most are greater than 60 percent – has the same alcohol content as a 12 ounce can of beer. Therefore, accidental ingestion or intentional misuse of hand sanitizer is cause for concern.

“From a young child’s perspective, hand sanitizer may smell good, and it’s usually in brightly colored, glittery bottles,” Slattery said. “With older children, there are reports of them daring others to drink it.”

The number of reported cases of hand sanitizer exposure in Alabama has grown since 2011. That year, there were 159 calls to the Regional Poison Control Center involving hand sanitizer. Through October 2015, Slattery said there have been about 300 calls involving hand sanitizer, already surpassing the total 269 calls involving hand sanitizer in all of 2014. Nationally, there were nearly 15,000 reported exposure cases through August 2015.

To prevent potentially harmful exposure to hand sanitizer:

• Keep hand sanitizer well out of reach of children at all times.
• Children should use hand sanitizer only with adult supervision.
• Apply a dime-sized amount of sanitizer to dry hands, and rub together until completely dry.

If you suspect your child may have ingested any amount of hand sanitizer, Slattery encourages parents to call Poison Control at 1-800-222-1222 immediately. The signs won’t always be as obvious as an empty bottle lying around. “When in doubt, check it out,” she said.

Some potential symptoms of harmful exposure to hand sanitizer include:

• Drowsiness
• Stumbling
• Falling

Some delayed symptoms could include a drop in blood sugar and a drop in body temperature.

The Regional Poison Control Center’s hotline is available 24 hours a day, 7 days a week. Established in 1958, The Regional Poison Control Center at Children’s of Alabama more than 50,000 poison calls annually, plus more than 60,000 follow-up calls. For more information, visit https://www.childrensal.org/rpcc.

Pinkeye is the most common eye problem children can have, but it can be alarming when it happens to your child. Pinkeye, or conjunctivitis, is an inflammation of the conjunctiva, the clear membrane that covers the white part of the eye and the inner surface of the eyelids.

Dr. Christina Fettig, a pediatrician with Mayfair Medical Group in Homewood, says the most common symptoms of pinkeye include:

Symptoms

• Reddening of the eye
• Discomfort
• Tearing or draining from the eye
• Feeling like there’s sand in the eye

You’ve probably heard that pinkeye is highly contagious. Dr. Fettig explains there are actuallyfour different types of pinkeye, two that are contagious and two that are not.

Contagious Forms of Pinkeye

• Viral (often accompanied by the common cold, usually goes away on its own)
• Bacterial (very common, can be treated with drops)

Non Contagious Forms of Pinkeye

• Allergy based (more prone in children with allergies, especially seasonal allergies)
• Irritant caused (swimming)

Because there are multiple types of pinkeye, it’s especially important to see your child’s pediatrician early to identify which type it is and the course of treatment.

“It is important, especially with bacterial pinkeye,” Fettig said. “If started early enough eye drops can decrease the duration of symptoms.”

In addition, doctors usually recommend keeping kids who have been diagnosed with contagious conjunctivitis out of school or daycare until the symptoms have been resolved.

Prevention

Simple hand washing is the number one way to prevent pinkeye. Children should be taught to wash their hands well and frequently with warm water and soap. Parents should remember to wash their own hands thoroughly after touching their child’s eyes, particularly after treating their infected child with eye drops.

While contagious pinkeye may be uncomfortable and inconvenient, there is good news. Pinkeye caused by a virus will usually resolve on its own. Bacterial pinkeye is easily treatable. And in most cases, conjunctivitis causes no long term eye or vision damage.

Fall is a time of year when kids often pick up colds and other viruses. Unfortunately they’re also more at risk of getting something more serious, meningitis.

Meningitis is a disease involving inflammation of the meninges, the membranes that cover the brain and spinal cord.

There are two types of meningitis: viral and bacterial.

“The prognosis for viral meningitis is very good,” according to Dr. Mark Baker, a physician in the Emergency Department at Children’s of Alabama. “It’s relatively common and usually goes away in about a week. The prognosis for bacterial meningitis depends on how quickly you get treatment.

Viral meningitis

As Dr. Baker indicated, viral meningitis is the most common form. It’s usually less serious than bacterial meningitis. It’s caused by many different types of viruses, including those that infect the skin, urinary tract, or digestive and respiratory systems.

Children with viral meningitis may present a lot of flu like symptoms.

• These include:
• fever
• headache
• sensitivity to light
• fatigue
• fussiness
• nausea
• neck stiffness
• vomiting

To identify meningitis, doctors may do a spinal tap (lumbar puncture) to get a sample of the cerebrospinal fluid for testing. Most people recover on their own within 7-10 days.

Bacterial meningitis

Bacterial meningitis is rare, but is usually more serious and can be life threatening if not treated immediately.

Bacterial meningitis is caused by different types of bacteria. Bacteria that infect the skin, urinary tract, gastrointestinal and respiratory system can spread via the bloodstream to the meninges.

Sometimes bacteria may spread from severe head trauma or a severe local infection, such as a serious ear or nasal infection.

A person with bacterial meningitis may have:

• fever
• headache
• stiff neck
• sensitivity to light
• extreme tiredness
• irritability
• nausea
• vomiting

If untreated, bacterial meningitis can lead to seizures, coma and even death.

For this reason Baker said it’s important to see your child’s physician anytime they are ill and don’t seem to be acting like themselves.

“Anytime you think your child is seriously ill, or something doesn’t seem right,” he said. “It’s a good idea to have your doctor check them out or come to the emergency room and have a doctor check them. Also, if your child has had contact with someone who has meningitis, you should call your doctor to see if preventive medication is recommended.”

Treatment for bacterial meningitis includes an extended hospital stay with a strong dose of IV fluids and antibiotics.

There is encouraging news, though, in terms of prevention. Routine immunizations can go a long way toward preventing meningitis. The vaccines against Hib, measles, mumps, polio, meningococcus, and pneumococcus can protect against meningitis caused by these microorganisms.

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.

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.

Respiratory illnesses like asthma are the number one reason why patients come to Children’s of Alabama.  Asthma is an inflammatory lung disease that is very common in children and adults.

Having asthma causes:

• airway muscles to tighten
• inflammation to increase
• swelling in the airways
• mucus to build up

Airways become swollen, tight and narrow making it hard to breathe.

Common symptoms include:

• coughing which is often worse at night
• chest tightness
• wheezing
• coughing or difficulty breathing with exercise

In persistent asthma, children have more frequent symptoms and flare-ups.  This is caused by increased airway inflammation, swelling and narrowing that is present every day.

Children with intermittent asthma have few symptoms because they only have rare times of airway swelling and narrowing.

Janet Johnston, CRNP, is a nurse practitioner and asthma educator at Children’s of Alabama.   She said even though there’s no cure for asthma, in most cases families can learn how to make sure their child’s asthma is well controlled.

One of the most important ways to do that is to know the triggers of asthma.

Common triggers are:

• respiratory infection
• allergies
• irritants such as smoke
• exercise

Oftentimes, just avoiding the triggers can help reduce the occurrence of symptoms.

The exception is exercise. “One trigger you don’t want to avoid is exercise,” she said. “If the child’s asthma is well controlled, they shouldn’t have to avoid exercise.”

Johnston said another concern is making sure the child gets the full dose of medicine through an inhaler alone.  She recommends always using a spacer with the inhaler.

“Using a spacer ensures the proper dose of medicine is going deeply in the child’s lungs,” she said. “It’s important to get the full dose of medicine.  Otherwise, it’s like pouring half of it on the floor.”

Johnston encourages families to have an action plan to help keep their child’s asthma well controlled. The plan should include:

• seeing the child’s health care provider regularly for asthma
• having clear instructions about using the inhaler and any other medicine
• know what to do when symptoms increase
• know when to call the doctor
• know when to seek care

Well-controlled asthma means a child is:

• symptom-free most of the time and not needing frequent quick relief medicine
• able to play and exercise like other children
• sleeping through the night
• not missing school or work due to frequent asthma fare ups

More information about managing asthma is available at www.childrensal.org/asthma.

Alabama is known for its beautiful lakes and enjoying them is a rite of summer.  However, before your family heads to the water, you’ll want to take these precautions to ensure your visit is enjoyable and safe.

Always Wear a Coast Guard Approved Vest

Debbie Coshatt, RN, and nurse educator in Patient Health and Safety at Children’s of Alabama reminds us the importance of being safety conscious at the lake, “Drowning is the second leading cause of death in children,” she says, “Anytime the children are outside, near water, you want to make sure they are wearing a Coast Guard approved life vest.”

Coshatt points out that pool toys like floats and rings are not Coast Guard approved and should not be used; they can give children a false sense of security.  Instead, check your child’s life vest, and be sure it says, “Coast Guard approved” on the tag.

In addition, children should never be left to swim without adult supervision.   Coshatt reminds parents that drowning is often a silent emergency, and that a child can disappear in seconds.

No Diving

Kids and adults often enjoy jumping into a lake, but this can pose a danger because lake water is dark and the floor has different depths, as well as rocks beneath the surface.

For this reason, never dive into a lake head first.  Always jump feet first, and it’s a good idea to know how deep the water is before going in.

Boat Safety

It’s important to obey the law in and around boats as well.  Alabama law states

minors under the age of 16 must wear a life jacket when on a boat.  This law went into effect in 2009 and replaces an older law that required children ages 12 and under to wear a life vest.

In addition, the law states that everyone over the age of 16 must have a life jacket readily accessible and available on any kind of vessel.

Also, make sure the engine and propeller are turned off before getting in and out of a boat. Children should not be operating a boat or Jet Ski at any time.

These other tips will help to keep your family safe on the lake this summer:

• Don’t let kids swim without adult supervision — lakes or ponds might be shallow near the bank, but increase in depth sharply farther out from shore.
• Ponds and lakes may hide jagged rocks, broken glass, or trash.
• Make sure kids wear foot protection; even in the water, they should wear aqua socks or water shoes.
• Watch out for weeds and grass that could entangle a leg or arm.
• Most boating accidents, particularly among teens, are related to alcohol. When you and your family are boating, assign a designated driver who won’t drink. Be sure teens know about the dangers of alcohol, on and off the water.

By following these tips, you’ll ensure your trips to the lake are enjoyable and safe for your entire family.