DC Child Accident & Safety Blog

Few things are more comforting on a cold winter’s night than a roaring fire. That is, unless you’re one of the hundreds of young children burned each year by contact with the unprotected glass on a fireplace. According to FairWarning.org., a public interest investigative news organization, a federal database compiled over 10 years indicated that 2,000 kids younger than 5 suffered 2nd and 3rd degree burns.

After at least a dozen lawsuits and a call by the Consumer Product Safety Commission (CPSC) for federal standards, manufacturers have agreed to provide protective mesh screens as standard equipment with new gas fireplaces.

That’s the good news; the bad news is that although some companies are reconfiguring their products now, manufacturers have until 2015 to outfit them all with the screens. Oh, and the effort is voluntary. Protective screens are not required.

FairWarning says there are approximately 11 million gas fireplaces in the U.S. whose glass fronts can get dangerously hot. Many of their owners inherited them, and were not apprised of warning information when the appliances were new.

Most manufacturers have been reluctant to provide screens or issue prominent safety warnings because the former compromises the visual appeal of the fireplace and the latter might scare off customers.

The standards call for screens to be supplied with each unit, and installed by the homeowner or installer. They can be removed for cleaning. And some homeowners, of course, would choose not to install them in the first place.

According to the FairWarning story, one official of a Canadian fireplace maker was asked in a deposition why the company had not warned that touching the glass could result in 3rd degree burns. The response? That it would be “fear-mongering.” Another official testified that, with that warning, “As a parent, I don’t know if you’d buy such a fireplace.”

But if you’re afraid of something that could hurt your kid, is raising the issue really “fear-mongering” or just telling the truth?

Before providing specific screen regulations, the CPSC is waiting to see how well the industry responds to the need. The FairWarning story indicates that so far, reviews are mixed. One Alabama attorney who has litigated lawsuits against fireplace makers called it “very troubling’’ that it will take more than two years before full compliance with the provision of screens, and that there are no plans to offer retrofits to current owners.

A commission spokesman told FairWarning that it might be tough to meet a shorter deadline for issuing screens because making federal rules takes so much time and because, by law, the commission may not regulate when a voluntary standards groups is taking action similar to what the agency would take.

But Dan Dillard, executive director of the nonprofit Burn Prevention Network and chairman of the prevention committee of the American Burn Association, wants the CPSC to adopt mandatory, not voluntary standards. Dillard also believes the federal estimate of 200 child burn cases per year to be low, and his committee is preparing injury data to prove it.

FairWarning says the voluntary standards allow the glass to reach temperatures between 500 degrees and 1,328 degrees, depending on the type of glass used. Those limits are supposed to prevent the glass from failing, not prevent people from getting burned.

Some people say that the burn risk associated with a fireplace is so obvious that you’d have to simply be a bad parent not to keep your kid safe. Those are probably the people who aren’t aware that the glass in front of a fire can remain dangerously hot for at least a half-hour after the flame is turned off.

Two major manufacturers provide safety screens with new gas fireplaces—Hearth & Home Technologies and Lennox Hearth Products (which began offering a free attachable screen with each fireplace as part of the settlement of a class action lawsuit).

To learn more about how to protect your children from burns and general fire safety tips, the Burn Prevention Network offers help here. And the Hearth, Patio & Barbecue Association has initiated a fireplace safety campaign for consumers.

What’s the No. 1 parents’ complaint about family life?

Somebody else is always hiding the remote?

Somebody never remembers to lower the toilet seat?

Somebody always returns the car with an empty tank of gas?

Wrong, wrong, wrong. According to researchers at Penn State, parents’ chief concern and complaint is sibling rivalry.
As reported on ScienceDaily.com, the researchers studied 174 rural and urban families. Each family had one child in the fifth grade and one in the second, third or fourth grade. They collected data from the parents by questionnaire, and interviewed each sibling privately. They also videotaped family interactions.

Although siblings screaming at and competing with each other can drive parents to distraction, the researchers, from the Prevention Research Center for the Promotion of Human Development, said that a program they designed demonstrates that elementary school age kids can learn to get along. That’s not only a relief for fraught parents, it’s good for the kids’ health and well-being.

"Negative sibling relationships are strongly linked to aggressive, anti-social and delinquent behaviors, including substance use," research Professor Mark Feinberg said in a news release by Penn State. "[But] positive sibling relationships are linked to all kinds of positive adjustment, including improved peer and romantic relationship quality, academic adjustment and success, and positive well-being and mental health.”

The program developed by Feinberg, Susan McHale, director of the Social Science Research Institute at Penn State and their colleagues, is designed to help siblings learn how to manage their conflicts and avoid engaging in troublesome behaviors.

Called SIBlings Are Special (SIBS), it’s intended for families whose oldest children are on the brink of middle school. That’s the age when kids are more likely to be exposed to and involved in risky behaviors for the first time. The families participating in the study were randomly assigned to take part in SIBS or to be in a control group that wasn’t part of the program.
Among other elements, SIBs includes a series of 12 after-school sessions to teach small groups of sibling pairs how to:

• communicate in positive ways;
• solve problems;
• devise win-win solutions;
• see themselves as part of a team rather than as competitors.

"We found that the siblings who were exposed to the program showed more self-control and social confidence; performed better in school, according to their teachers; and showed fewer internalizing problems, such as depressive symptoms, than the siblings in the control group," Feinberg said.

But it wasn’t only the youngsters who were “trained”; SIBs offers parenting strategies that Feinberg said led to “significantly fewer depressive symptoms” among mothers in the intervention group than mothers in the control group.

It’s interesting that no effects of the program were seen for fathers regarding depression.

Parents interested in pulling the plug on sibling rivalry needn’t be involved in a specific program; many of SIBs’ lessons are available to all.

If kids are fighting, don’t intervene with a resolution—instead, help them discuss the problem calmly and let them resolve the problem on their own. It’s a matter of providing tools to fix something that’s broken instead of fixing it for them. Once kids experience success with the tools, they’re more likely to use them again when things get thorny.

Also, staying calm when the children aren’t, models behavior they can use. It shows them how discussion and resolution are more likely to occur when the atmosphere isn’t charged with anger.

Save the Children, one of my favorite charities, is headquartered just 20 miles from Newtown, Connecticut. In this time of sorrow, it's published a practical list of ten things adults can do to help kids cope. Read the whole list and details on Save the Children's web site. Here's the abbreviated list:

Limit television time.
Listen to your children carefully.
Give reassurance.
Be alert for significant changes in behavior.
Understand children's unique needs.
Give your children extra time and attention.
Be a model for your children -- they will learn from your behavior.
Watch your own behavior and make a point of being sensitive to the crisis.
Help children return to a normal routine.
Encourage volunteer work -- doing something for others.

School violence happens often enough that this is a topic we've already covered in this blog, in a good Q&A last March, that you can read here. It also includes a list of warning signals that a child might have violence in their future.

Prospective parents who want to know if their baby has a genetic disorder such as Down syndrome are advised to consider amniocentesis or chorionic villus sampling (CVS). Amnio, generally performed during the second trimester, involves inserting a needle into the amniotic fluid surrounding the fetus. The CVS probe removes a sample of the sac surrounding the fetus toward the end of the first trimester. Both carry a small risk of miscarriage.

So some people are choosing a different procedure that can be done as early as 10 weeks into the pregnancy and involves only drawing the mother’s blood. Three versions of the test have been available for a year, and although its convenience is appealing, according to a recent story by Kaiser Health News and the Washington Post, the decision to use it is complicated. The technology is not subject to regulation by the FDA, and the body of research about its accuracy is slim.

Thousands of the tests have been performed (at a cost of as much as $1,900) while they remain under review. Insurance companies don’t (yet) cover the cost, and because the test is so new, it’s unclear if, eventually, it will reduce miscarriages and the cost of complications by reducing the use of the more invasive tests. Will the tests, instead, increase costs because women who otherwise would pass on amniocentesis will opt for the blood draw?

According to the KHN/Post story, amnio is performed about 200,000 times every year in the U.S. In the Washington, D.C. area it costs about $2,500. As a standard test, it’s generally included in maternity coverage.

The new tests, typically, are offered only to women whose age and medical history put their fetus at a higher risk of having a chromosome abnormality; standard screening tests often are offered to all pregnant women.

The risks of having a fetus with a genetic disorder are greater if the mother:

• is 35 or older;


• has a history of miscarriages or children born with birth defects;


• has a family history of genetic disease.

In addition, prenatal genetic testing is recommended if either parent has a family history of genetic disease or is known to be a carrier of a genetic disease.

The new test examines DNA fragments to see if a fetus carries three instead of the normal two copies of chromosomes 21, 18 or 13. An extra copy of 21, a called trisomy 21, is the main cause of Down syndrome; and extra copy of 18, called trisomy 18, causes a less common disorder, Edwards syndrome. Trisomy 13 is also known as Patau syndrome. All three are linked to serious developmental and medical problems.

Earlier this year, we wrote about the fate of babies handicapped by two of these conditions.

The test checks the mother’s blood levels of pregnancy-associated proteins and hormones and includes an ultrasound to see if there’s extra fluid at the back of the fetus' neck. The two procedures appear to detect about 9 in 10 cases of Down syndrome, and an even higher ratio of trisomies 18 and 13.

As the KHN/Post story says, 5 in 100 tests result in a false-positive—that is, showing a defective gene when there isn’t one. Only amniocentesis or CVS provide definitive answers.

Last month the American College of Obstetricians and Gynecologists said that the tests "should not be part of routine prenatal laboratory assessment." The organization hedged that statement, however, by noting that the tests can be offered to patients at increased risk of having a baby with a trisomy, but must be preceded by counseling about their limitations. Other professional groups, the National Society of Genetic Counselors and the International Society for Prenatal Diagnosis, agreed.

Given the lack of research proving the accuracy of the new test, all three organizations recommend that anybody who received a positive result undergo amniocentesis or chorionic villus sampling to verify the diagnosis.

So the question arises: If you have to confirm a diagnosis, should you have the test in the first place? Is the minimal risk of complication, in comparison to the greater, but still small risk of miscarriage with the standard, proven tests, worth it?

Maybe, especially if you are in the high-risk group for fetal genetic abnormalities. And although cost might be a factor, at this point, the companies who market the tests offer considerable subsidies. According the KHN/Post story, “[T]he most that women with insurance have to pay out of pocket is $235 for the MaterniT21 Plus test (list price $1,900) and $200 for Verifi (list price $1,200), even if their plan declines to cover the test. Both companies offer self-pay options for women without insurance: The price is $450 to $500 for MaterniT21 Plus and an ‘introductory price’ of $495 for Verifi.”

Insurance companies regularly review new technologies and treatments to make decisions about covering them. As the research file about the maternal blood tests grows, if the evidence of their accuracy is compelling, the tests eventually could be considered “standard.”

But that’s not their status today, and their worth must be determined on an individual case basis after frank and full discussion between the obstetrician and the parents.

The American Academy of Pediatrics supports a policy that might discomfit some parents but that speaks to reality: Many teenagers regularly have sex, and they should be protected against unwanted pregnancy and the harms it can cause.

In a policy statement issued last month, the AAP said as part of routine care, pediatricians should counsel their adolescent patients about the use of emergency contraception (commonly known as Plan B, which is the brand name for one of the drugs used). Health-care providers should educate teens on the use and availability of these drugs, which interrupt the process of conception. Also, the AAP said, doctors should provide an advance prescription for one of three emergency contraceptive treatments, because they don’t work unless taken shortly after sexual intercourse, and because parental involvement might not be possible or advisable. Sometimes the risk of pregnancy is the result of sexual assault.

The goal of the policy statement is to:

(1) educate pediatricians and other physicians on available emergency contraceptive methods;
(2) provide current data on safety, efficacy and use of emergency contraception in teenagers; and
(3) encourage routine counseling and advance emergency-contraception prescription as part of a public health strategy to reduce teen pregnancy.

As the statement points out, in most states, kids younger than 17 must obtain a prescription from a physician to get emergency contraception. In all states, females 17 and older and males 18 and older can obtain emergency contraception without a prescription.

Providers should ensure the teens understand the possible side effects and adverse events that such drugs can cause, and make sure they also understand that these contraceptive measures do not offer protection against sexually transmitted infections.

The policy statement, written by the AAP’s Committee on Adolescence, was published in the journal Pediatrics.

The use of emergency contraception can reduce the chance of pregnancy as long as 120 hours after unprotected sex or in the event of contraceptive failure. Emergency contraceptive drugs, however, are most effective if taken within 24 hours after intercourse, which bolsters the need to have a prescription on hand.

Anything to do with contraception use can be fraught with spiritual, political and emotional pressure. Often referred to as the "morning after pill," emergency contraception is not the same drug regimen as that used to induce abortion after conception. Commonly called RU486, that drug is mifepristone (Mifeprex), which disrupts implantation of the fertilized egg. The emergency contraceptives supported for teens by the AAP elevate hormones that create additional uterine mucous, which prevents ovulation and fertilization if taken promptly after intercourse.

The incidence of pregnancy has decline among teenagers in the last two decades, but, as the Journal authors noted, U.S. birth rates remain “significantly higher than other industrialized nations.”

They also said teens are "more likely to use emergency contraception if it has been prescribed in advance of need."

As discussed on MedPageToday.com, each of the three methods the AAP supports for emergency contraception has distinct features:

Plan B requires patients to take two 0.75 mg levonorgestrel tablets 12 hours apart or a single 1.5 mg dose. Patients known to be pregnant should not take it. Also, it can cause nausea, vomiting and heavier menstrual bleeding. Patients should take a pregnancy test if they don’t have a normal period within 3 weeks of taking the drug.

Ulipristal is a single, 30 mg pill that should be taken within 120 hours after unprotected sex or contraception failure. Side effects can include headache, nausea and abdominal pain. Pregnant patients shouldn’t take it, as they risk loss of the fetus. Patients with severe abdominal pain three to five weeks after taking it should be evaluated for ectopic pregnancy.

The Yuzpe method requires patients to take two doses of at least 100 mcg of ethinyl estradiol and at least 500 mcg of levonorgestrel. It’s best for patients with no or limited access to an emergency contraception product. This use is off-label—meaning the patient takes it for a purpose other than what the FDA has approved it for—but the AAP says that this combination of oral contraceptives is safe and effective.

Side effects of the Yuzpe method include nausea and vomiting, fatigue, breast tenderness, headache, abdominal pain and dizziness. Patients who are not supposed to take estrogen should not use the Yuzpe method.

It’s always best when parents and teens can discuss the possible consequences of sexual activity and the provision of health care as appropriate. But it’s difficult, and just saying “no” is head-in-the-sand parenting. The medical establishment agrees that simply being young shouldn’t deprive people of getting the care they need to prevent unwanted, and often lifelong, consequences of accidents, immature behavior or victimization.