DC Child Accident & Safety Blog

With an average of one child every two weeks strangled on the cords of window blinds, it’s no wonder that the Consumer Product Safety Commission (CPSC) has asked manufacturers to come up with a way to eliminate the risks to children from the cords or possibly face mandatory regulations.

In response, window blind manufacturers, working with a task force of regulators and consumer advocates, say they will come up with a fix by the fall. The decision to speed up work on solving the problem comes after an article in the Journal of the American Medical Association (JAMA) revealed that 49% of the deaths of children who strangle in window cords go unreported.

The article, which was co-authored by a CPSC staff member, estimates that the total number of window cord strangulations in the U.S. from 1981 to 1995 was 359 (i.e. one child strangling in window cords every 2 weeks). Most of the deaths (93%) are children 3 years and under.

Although window blind makers already install safety features and offer tips to parents to try to minimize the dangers from their products, critics complain that the manufacturers have dragged their feet on addressing safety hazards for decades, making minor tweaks or putting the onus on parents to shorten cords or buy tie-down devices, while regulators have done little to crack down.

In the current negotiations, manufacturers of window blinds have offered several fixes that they say would reduce the hazards, but consumer advocates on the task force say they are inadequate and have threatened to quit. “It was my understanding that we were eliminating the hazard,” said Carol Pollack-Nelson, a safety consultant and member of the task force. “Now they are talking about reducing the hazard. We don’t want reduced strangulation. We want no chance of it.”

CPSC regulators also rejected the industry’s proposals and urged the manufacturers to try again. Inez Tenenbaum, the commission’s chairwoman, emphasized that the commission staff plans to continue negotiating with manufacturers to find a solution.

One solution to the problem – cordless blinds -- has been available for several decades, but they are more difficult to produce and can cost twice as much as corded blinds. Due to the additional cost, CPSC also wants the task force to find cheaper alternatives, such as retractable cords or cords that are covered and therefore inaccessible to children.

Source: The New York Times

You can read the latest news release on window-blind safety from CPSC here, and the abstract of the JAMA article here.

Small medical clinics sprouting at the back of drug stores, grocery stores and big box outlets stress speedy service, but at what price? According to pediatrician Roy Benaroch, MD, who publishes the online blog The Pediatric Insider, these “McClinics” are the medical equivalent of fast food -- filling but not nourishing.

McClinics offer exactly what children don’t need, Benaroch says. Good pediatric care "looks at the whole child, the whole history, and the whole story. To do a good job I have to review the history, the growth charts, the prior blood pressures, the immunization records, and more. At the retail-based clinic, the encounters are just a quick toss-off: an opportunity for genuinely improving health that’s thrown away.”

Good pediatric care requires good training, Benaroch says, whereas McClinics are staffed by midlevel providers who may have minimal pediatric experience. Children are not the same as adults, and without specific, ongoing, significant pediatric training, the nurses at the local McClinic may not have the skills to adequately assess a child.

Benaroch recently reviewed two cases of children from his own practice who were clearly mishandled by a local McClinic. . One was a child given a vaccine he didn’t need, the other involved treating a urinary tract infection without doing the appropriate testing beforehand.

Benaroch also notes that some clinics offer special cut-rate sports and camp physicals to lure patients away from their primary care physicians for well-checks, even though “the heart of the well-check is to review all current issues, to look at the big picture, to make sure all health-maintenance tests and immunizations are up-to-date.” McClinics, he says, cannot offer that service without a thorough review of past records.

Source: The Pediatric Insider

The Food and Drug Administration (FDA) says it continues to receive reports of methemoglobinemia, a serious and potentially fatal adverse effect, associated with benzocaine products both as a spray used during medical procedures to numb the mucous membranes of the mouth and throat, and benzocaine gels and liquids sold over-the-counter and used to relieve pain from a variety of conditions, such as teething, canker sores, and irritation of the mouth and gums.

Methemoglobinemia is a rare but serious condition in which the amount of oxygen carried through the blood stream is greatly reduced. In the most severe cases, methemoglobinemia can result in death. Patients who develop methemoglobinemia may experience signs and symptoms such as pale, gray or blue colored skin, lips, and nail beds; headache; lightheadedness; shortness of breath; fatigue; and rapid heart rate.

While methemoglobinemia has been reported with all strengths of benzocaine gels and liquids, most cases occurred in children aged two years or younger who were treated with benzocaine gel for teething. The signs and symptoms usually appear within minutes to hours of applying benzocaine and may occur with the first application of benzocaine or after additional use. The development of methemoglobinemia after treatment with benzocaine sprays may not be related to the amount applied. In many cases, methemoglobinemia was reported following the administration of a single benzocaine spray.

The FDA recommends that Benzocaine products not be used on children under 2 years except under the advice and supervision of a healthcare professional. It also recommends storing these products out of the reach of children.

Source: Food and Drug Administration

Prompted by a lack of consensus on who should get their tonsils removed and how it should be done, the American Academy of Otolaryngology–Head and Neck Surgery has issued the first-ever clinical guidelines for tonsillectomy in children in the U.S.

Child safety advocates have argued for years that tonsillectomy is done way too often. This exposes kids to risks of an operation they may not need -- mainly from anesthesia and bleeding. Because the tonsils are situated at the junction of several blood vessels, the procedure carries a relatively high risk of hemorrhage.)

For example, it's been known for decades that children’s health in areas with high rates of tonsillectomy is no better than in areas in which fewer tonsillectomies are performed.

But the operation still gets done for preventive or “prophylactic” reasons. As a result, tonsillectomy currently is the third most common surgery in U.S. children younger than 15 years, with more than 530,000 performed annually, primarily for recurrent throat infections and sleep-disordered breathing, despite the risks.

The guidelines provide evidence-based guidance in identifying children who may benefit from tonsillectomy. They also offer recommendations intended to optimize the "perioperative" management of children undergoing the procedure and provide guidance on how to improve counseling and education of parents of children who may be candidates for tonsillectomy and suggests ways to reduce inappropriate or unnecessary variations in care.

According to the new guidelines, the need for a tonsillectomy is determined by the frequency of a child’s sore throats. Tonsillectomy should be considered when a child has (a) seven sore throats in a single year; (b) five sore throats for 2 years running; or (c) three sore throats for 3 years running. To count for this purpose, each sore throat must be accompanied by a fever of at least 38.3C (101F), swollen lymph nodes in the neck, pus or blood draining from the tonsils, or documented infection with a bacteria called hemolytic streptococcus.

The guidelines also recommend:

Watchful waiting for recurrent throat infection if there have been fewer than 7 episodes in the past year or fewer than 5 episodes per year in the past 2 years or fewer than 3 episodes per year in the past 3 years.

Assessing the child with recurrent throat infection who does not meet the criteria above for modifying factors that may nonetheless favor tonsillectomy, which may include multiple antibiotic allergy/intolerance, periodic fever, aphthous stomatitis, pharyngitis and adenitis, or history of peritonsillar abscess.

Asking caregivers of children with sleep-disordered breathing and tonsil enlargement about comorbid conditions that might improve after tonsillectomy, including growth retardation, poor school performance, enuresis and behavioral problems.

Counseling caregivers about tonsillectomy as a means to improve health in children with abnormal polysomnography who also have tonsil hypertrophy and sleep-disordered breathing.

Counseling caregivers that sleep-disordered breathing may persist or recur after tonsillectomy and may require further management.

Advocating for pain management after tonsillectomy and educating caregivers about the importance of managing and reassessing pain.

Self-monitoring by clinicians who perform tonsillectomy at least annually to determine their rate of primary and secondary posttonsillectomy hemorrhage.

Source: American Academy of Otolaryngology – Head and Neck Surgery