DC Child Accident & Safety Blog

If you give your baby acetaminophen to reduce fever and pain, pay close attention to the packaging.

Several months ago, we reported about the FDA’s interest in more accurate dosing information for children’s Tylenol . It’s still a hot topic. Last week, the feds issued a warning about the potential for dosing errors with liquid acetaminophen for infants. As explained on MedPage Today, in 2009 the FDA recommended introducing a new, single strength version of the drug. Adverse event reports from babies given the drug indicated that the problem was dosing errors.

Many manufacturers who made liquid acetaminophen in different strengths agreed to produce only a single concentration—160 mg/5 mL. The quantities refer to how much of the active ingredient (160 mg) is in each dose (5 mL). But the effort to simplify appears to have complicated things.

The recommendation to produce only a single dose was voluntary, and not every manufacturer followed it. Acetaminophen strengths of 80 mg/mL and 80 mg/0.8mL are still available for purchase. Some consumers have both versions of the drug, and some of the newer packaging is similar to the old. For the Little Fevers brand, the FDA noted, “both boxes … say ‘New’ on the front, but only one of the contains the new concentration of liquid acetaminophen.”

Parental tip: If your package of liquid acetaminophen includes a dropper, that’s the older version. The 160 mg/5 mL products include an oral syringe that is supposed to make dosing more precise. To eliminate the risk of giving the wrong dose, use only products with the syringe, and dispose of any other liquid acetaminophen. If you’re uncertain how to measure, contact a pharmacy or your doctor’s office.

What sort of misadventure do you think brings most young children into the emergency room? Most people would guess car accidents. Most people would be wrong.

It’s poisoning by drugs. According to the National Capital Poison Center, this stark reality is the result of more children having access to and swallowing prescription drugs at home.

More adults are using prescription medication, especially of the pain-killing variety such as oxycodone, hydromorphone, morphine, methadone and fentanyl. And older children with chronic conditions are adding to the prescription drug bottom line with meds to treat their attention deficit disorders and, increasingly, Type 2 diabetes.

The danger to the wee ones simply reflects the law of averages: The more medicines present in young children’s homes, the greater the likelihood they will find and swallow them.

The most dangerous prescription medicines for children are those that treat:

• diabetes;


• pain (opioids, or narcotics);


• anxiety, muscle spasms and sleep problems;


• heart disease and high blood pressure.

Medicines should be locked up, but that can be tough if the rightful patient requires frequent dosing. Travel also complicates safe storage. And even the most vigilant parent gets interrupted and distracted while taking medicines.

To minimize the incidence of childhood poisoning, researchers such as those involved in a Journal of Pediatrics study propose that packaging limit the amount of drug available (children can’t open many child-resistant blister packs at one time). Liquid medicines as well could be dispensed in single-dose containers.

Other poison-prevention measure suggested by the Poison Center:

• Use child-resistant packaging. Replace caps tightly after use.


• Lock all medicines up high, out of sight and reach of children.


• Take medicines when children aren’t looking—children imitate adults.


• When traveling, ensure that medicines are locked away from children.

If you think a child may have swallowed too much medicine or someone else’s medicine, call the poison center immediately at 800-222-1222.

Because nicotine is possibly the most difficult addiction to kick, because inhaling smoke carries so much destructive potential, you can never try too hard or too often to quit. Now another study shows why smoking around children is a terrible idea.

“Not only are children who are surrounded by secondhand smoke at greater risk for asthma and other health problems,” says the Los Angeles Times, “but they may be more likely to have attention-deficit/hyperactivity disorder or learning disabilities too.”

Researchers at the Harvard School of Public Health found that children who lived with smokers were 50% more likely to suffer from a learning disability, a behavioral or conduct problem or attention deficit disorder/attention deficit hyperactivity disorder (ADD/ADHD).

Although the study was less than scientifically ideal—it was a phone survey of parents—and some variables were not considered, such as whether the mothers smoked during pregnancy, this is not the first study to connect mental health problems and secondhand smoke.

Another study published in Archives of Otolaryngology–Head and Neck Surgery concludes that exposure to secondhand smoke is associated with increased risk of hearing loss among adolescents.

Fetuses and young children exposed to secondhand smoke are vulnerable to an array of possible problems, including low birth weight, respiratory and ear infections and behavioral problems. Now evidence suggests that adolescents are at risk of compromised hearing.

In the new study, adolescents who were exposed to secondhand smoke showed higher rates of hearing loss than teens who weren’t exposed.

If your teens have been exposed to secondhand smoke, the researchers suggest they be closely monitored for hearing loss, and informed that noise from recreational or occupational endeavors can further impair hearing, even if the kids aren’t aware of it.

A review of studies about the contents of energy beverages has raised serious questions about their efficacy and safety. The review, published in the November issue of the Mayo Clinic Proceedings, noted that the drinks contain high levels of caffeine and could pose dangerous, even life-threatening effects on blood pressure, heart rate and brain function to some susceptible individuals.

The study found four documented cases of caffeine-associated death and five separate cases of seizures associated with consumption of energy/power drinks. Other reports included: (1) an otherwise healthy 28-year-old man who suffered a cardiac arrest after a day of motocross racing; (2) a healthy 18-year-old man who died playing basketball after drinking two cans of Red Bull; and (3) four cases of mania experienced by individuals known to have bipolar disorder.

Noting that teens and young adults are consuming energy drinks “at an alarming rate,” the study authors said it was important to determine whether long-term use of these beverages “will translate into deleterious effects later,” such as liver and cardiovascular disease, insulin resistance and diabetes.

Currently, the drinks are labeled as “dietary supplements,” which exempts them from regulations governing sodas and juices and allows manufacturers to make “ “structure and function” claims, like “enhances athletic performance” and “increases caloric burn and mental sharpness.”

The American Beverage Association says most mainstream energy drink brands voluntarily put statements on their containers, including advisories about use by people sensitive to caffeine, and many also list the amount of caffeine on their product labels or have provided caffeine content information through their Web sites and consumer hot lines.

But the study authors worry that some athletes who exercise intensively are substituting energy drinks for sport drinks (which only contain sugar and electrolytes). They say the high doses of sugar in energy drinks can impair absorption of fluids and result in dehydration, noting that a 16-ounce can of an energy drink may contain 13 teaspoons of sugar and the amount of caffeine found in four or more colas.

Source: The New York Times

You can view an abstract of the study published in the Mayo Clinic Proceedings here.

In response to the increase of smoke-free air laws, one of the nation’s biggest cigarette makers started test marketing flavored tobacco pellets in parts of the country. Although the new product by R.J. Reynolds Tobacco, called Camel Orbs, is marketed for adults and packaged in child-resistant containers, critics think it “closely resembles Tic Tac breath mints,” and creates appeal for teenagers, reports Duff Wilson of the New York Times.

According to Wilson, in a study published in the April issue of the Pediatrics journal, researchers say that Camel Orbs and other dissolvable tobacco products are “packed with nicotine and can poison children and lure young people to start using tobacco.” These smokeless products are appealing to teenagers because of their “candy-like appearance, added flavors, and easily concealable size,” says Dr. Laurence Deyton of the FDA in a commentary in the same issue of the Journal. In fact, a group of teenagers were seen sharing Camel Orbs.

Not only do these pellets increase the likelihood of more teenagers becoming addicted to tobacco, their dissolvability and high level of absorbable nicotine also pose health hazards to younger children: children who ingest tobacco products suffer nausea and vomiting.

To combat the emergence of these new products, Congress passed legislation last year to require Reynolds to produce research results and other materials about the dissolvable tobacco products. The FDA is also required under the legislation to study the products within two years; and “depending on the outcome of that review, the agency could ban them or require product changes,” writes Duff Wilson.

Caffeine is technically a drug, although it's hard to think of it like that.

But some experts are saying that, because caffeinated energy drinks promise some of the same effects as prescription drugs, they should be labeled so kids know that anything that produces those effects has to be treated with caution:

Because energy drinks are touted as performance enhancers and stimulants, Dr. Roland R. Griffiths explained in an interview with Reuters Health, kids who use them for these reasons will likely be more open to trying prescription drugs that promise the same effects.

"It seems like it's a pretty easy threshold to step over, but as a society we want to make this a bright line," Griffiths said in an interview.

In their report on the marketing, regulation and health effects of caffeinated energy drinks published this month in the journal Drug and Alcohol Dependence, Griffiths and his colleagues at The Johns Hopkins University School of Medicine call for regulations requiring energy drink makers to list the caffeine content of their products on their labels, and warn of the potential for caffeine intoxication.

The whole article merits reading as it contains a lot of little-known information about energy drinks and how they are manufactured and what they contain.

New research from the Harvard School of Public Health shows that tobacco companies have been deliberately varying levels of menthol in their cigarettes, marketing cigarettes with lower levels of menthol to younger smokers and then increasing the level of menthol with the age of the target demographic. From the article:

One document from R.J. Reynolds noted that all three major menthol brands "built their franchise with YAS (younger adult smokers) ... using a low-menthol product strategy. However, as smokers acclimate to menthol, their demand for menthol increases over time."

In 1987, R.J. Reynolds marketed low-level menthol varieties to persuade consumers to switch from regular brands and to recruit new, young smokers, noting: "First-time smoker reaction is generally negative. ... Initial negatives can be alleviated with a low level of menthol."

This new research serves as a reminder that, despite famous regulations about where and how Joe Camel can be displayed, tobacco companies continue to market deadly products to very young people.

Recently, there was an outcry about new recommendations from the American Academy of Pediatrics that suggest giving kids as young as 8 years old cholesterol-reducing statin drugs.

Tara Parker-Pope discusses the controversy in a recent column. Those who object to the new recommendations worry about the drugs' long-term consequences, the AAP's financial relationships with drug companies and the possibility that the new guidelines will lead to overuse of the drugs. The defenders argue that the guidelines specify that only a very small group of children--those with strong genetic and lifestyle risk factors--would even be considered for statin therapy. Parker-Pope's whole article is worth reading, as it discusses both the financial and the medical aspects to this debate.

One problem here is widespread throughout medicine: what some have called "indication sprawl." Once a drug or treatment is recommended for one narrow category of patients, it tends to get indicated for more and more categories with less and less testing and justification for the new categories. But more profit for the drug makers.

A smoking cessation program involving four computerized sessions is effective for teens, new research indicates. From the article:

Fritz studied 128 teenagers, 14-19 years old, divided in half for control and experimental groups. The experimental group completed four CASCP computer sessions as well as questionnaires and post-intervention testing. Not only did the experimental group report more quit attempts than the control group subjects, who did not participate in the computer sessions, but 23% of the teens actually quit smoking.