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No Evidence Supports Previously Held Link Between Vaccines and Autism
Laurie Barclay, MD
from Medscape
February 9, 2009 — There is no cause for parental concern that childhood immunization might cause autism, according to the results of a new review that shows no link between vaccines and autism. The review is published in the February 15 issue of Clinical Infectious Diseases.
“Vaccines don’t cause autism — 20 studies now show no link between vaccines and autism,” senior author Paul A. Offit, MD, chief of infectious diseases, The Children’s Hospital of Philadelphia in Pennsylvania, told Medscape Infectious Diseases. “I think that many people are reassured by these studies, although there are still a group of parents who hold that vaccines cause autism, much as some people hold a religious belief. To those people, it really doesn’t matter how many studies you do, it’s not going to change their minds.”
More education is needed to prevent further disease resurgence among children whose parents have refused vaccination based on this unfounded fear, he added.
Three Theoretical Links
Three specific hypotheses have been offered to suggest a theoretical link between vaccines and autism. The review describes how each of these theories originated and summarizes the pertinent epidemiological data, which refute the 3 hypotheses.
“The first theory concerned the Measles-Mumps-Rubella (MMR) vaccine; the second, that it wasn’t the MMR vaccine specifically but a mercury-containing preservative, thimerosal; and the third, that the simultaneous administration of many vaccines is just too much for a young child’s immune system,” Bryan H. King, MD, co-chair, American Academy of Child and Adolescent Psychiatry Autism and Intellectual Disabilities Committee, told Medscape Infectious Diseases when asked for independent comment.
The first hypothesis is that the combination MMR vaccine damages the gastrointestinal lining, thereby permitting the entrance of encephalopathic proteins and causing autism. After publication of a 1998 study in The Lancet suggesting an association between MMR vaccine and autism, 13 subsequent studies performed in 5 different countries showed no such link. The reviewers concluded that no data supported any causal connection between the MMR vaccine and autism, and that any apparent association was coincidental, because the MMR vaccine is typically administered at the age when symptoms of autism first emerge.
“While rates of immunization have been constant or declined, the incidence of autism has increased, and the rate of autism in vaccinated and unvaccinated children is the same,” said Dr. King, who is professor and vice chair of Psychiatry and Behavioral Sciences and director of Child and Adolescent Psychiatry at University of Washington and Seattle Children’s Hospital. “Neither the timing of onset, nor the severity of autism, differ whether or when a child gets immunized,”
The second hypothesis is that thimerosal, an ethyl mercury–containing preservative used for more than 50 years in some vaccines, causes central nervous system toxicity. However, the review describes 7 studies from 5 countries demonstrating that autism rates were not affected by the presence or absence of thimerosal in vaccines.
These 20 epidemiologic studies showing that neither thimerosal nor MMR vaccine causes autism were conducted by many different investigators, using a variety of epidemiologic and statistical methods.
“Even very rare associations, if they existed, would have been detectable given the large size of studied populations,” Dr. King said. “Studies on the causes of autism should focus on more promising leads.”
The third hypothesis is that giving multiple vaccines simultaneously overwhelms or weakens the immune system. In rebuttal, the review authors point out that the immune system in childhood routinely processes far more antigenic material than the relatively small amount contained in vaccines, and that it is biologically implausible that vaccines overwhelm a child’s immune system, even if the system is still immature.
“The challenge to the immune system from modern vaccines — even in multiple combinations — is actually significantly less than was given routinely to children back in 1980 (long before the autism epidemic),” Dr. King said.
Finally, the review authors note that autism is not triggered by an immune response, and they suggest that future research on the biological basis of autism should prove or refute alternative, more plausible hypotheses.
While the risks of vaccination concerning autism are theoretical and shown not to be valid, the risks of not being vaccinated are real and sometimes fatal.
“We’ve already seen the outcomes of choosing not to comply — over the last 10 years or so, we’ve had outbreaks of pertussis among a relatively unvaccinated population of children,” Dr. Offit said. “We had a measles outbreak in this country that was bigger than anything we’ve had in a decade. Now we have a cluster of cases of Haemophilus Influenzae meningitis where 3 parents chose not to have their child vaccinated; all 3 children got meningitis, and all 3 of them died.”
Dr. Offit noted, “The question becomes, ultimately, when do we reach the tipping point? When do we say that exempting from vaccines is creating a problem not only for those children whose parents choose not to vaccinate but for those children in the community?”
Education of the lay public, as well as the healthcare community, is needed if unfounded fears of vaccination are to be dispelled.
The “Right to Catch and Transmit Potentially Fatal Infection”
“Public health officials and the academic community are really trying to communicate this science to the public, but it’s a real challenge,” Dr. Offit said. “Is it your right to catch and transmit a potentially fatal infection? Right now, the answer to that question is yes, but we’ll see how long it takes before the answer to that question is no.”
He added that it would be unethical to do a prospective study in which some children were not vaccinated, given the known harms of failure to vaccinate, and that retrospective studies would have methodological issues because the groups would differ in characteristics other than their vaccination status.
“Focusing our precious research time and talent on questions that have been asked and answered not only contributes to ongoing confusion — for example, about whether or not to be immunized — but also will delay us from finding real answers to this critical problem,” Dr. King concluded. “Parents and clinicians should have candid discussions about the risks and benefits of vaccination including the avoidance of potentially catastrophic diseases. It will be hard not to mention autism in this context, as it may give the impression that doctors are trying to hide something, and parents should feel empowered to ask these and any other questions of their clinicians, but on the other hand, constantly linking autism and vaccines in the same sentence may continue to suggest that a relationship exists when there is no evidence to support it.”
From Medscape
News Author: Laurie Barclay, MD
CME Author: Penny Murata, MD
October 14, 2008 — The American Academy of Pediatrics (AAP) has issued updated guidelines for routine use of influenza vaccine in children and adolescents in the 2008 to 2009 influenza season, according to a statement reported in the October 1 Early Release issue of Pediatrics. This update revises guidelines originally published in a comprehensive format in Pediatrics in April 2008.
The AAP recommends annual influenza immunization for all children aged 6 months through 18 years, including those who are healthy and those who have high-risk conditions; for household contacts and out-of-home care providers of children with high-risk conditions or of healthy children younger than 5 years; for any woman who will be pregnant during influenza season; and for healthcare professionals.
Since the April 2008 guidelines, the recommended age range of children for annual influenza immunization has been expanded in these updated guidelines to include all children aged 6 months through 18 years.
“This expansion targets all school-aged children, the population that bears the greatest disease burden and is at significantly higher risk of needing influenza-related medical care compared with healthy adults,” write AAP chairperson Joseph A. Bocchini, Jr, MD, and colleagues. “In addition, reducing influenza transmission among school-aged children will, in turn, reduce transmission of influenza to household contacts and community members.”
This expanded indication now means that the following groups should be vaccinated:
Household members and out-of-home care providers of all children at high risk and adolescents and all healthy children younger than 5 years should also receive influenza vaccine annually to lower the risk for exposure to influenza for these young children, who are at serious risk for influenza infection, hospitalization, and sequelae. In healthy children younger than 24 months, the risk for influenza-associated hospitalization is at least as great as the risk in previously recognized high-risk groups. Furthermore, children aged 24 through 59 months have greater morbidity and higher rates of outpatient visits and antibiotic use related to influenza illness.
Influenza vaccine has not been approved for use in infants younger than 6 months. Clinicians should identify all children aged 6 months through 18 years, especially those at increased risk for complications related to influenza, and should inform their parents when annual influenza immunization is due.
All 3 strains in the 2008 to 2009 influenza vaccines are different from the 2007 to 2008 vaccine strains on the basis of global surveillance of circulating influenza strains.
Healthy children aged 2 through 18 years can receive either trivalent inactivated influenza vaccine (TIV) or live-attenuated influenza vaccine (LAIV).
Age determines the number of influenza vaccine dose(s) to be administered, as follows:
For the 2008 to 2009 influenza season, oseltamivir or zanamivir are still the antiviral medications recommended for chemoprophylaxis or treatment. Because of widespread resistance among some circulating influenza A virus strains, and lack of efficacy against influenza B strains, amantadine or rimantadine should not be prescribed for treatment or chemoprophylaxis of influenza. Oseltamivir resistance has been reported but it is still very limited, so current antiviral treatment recommendations have not changed.
As soon as the influenza vaccine is available, it should be offered to all children, and immunization efforts should continue throughout the entire influenza season, even after influenza activity has been documented in a community. There may be more than 1 peak of activity during the same influenza season, which often extends into March and beyond. Immunization through May 1 can still protect vaccinees during that season and facilitates administration of a second dose of vaccine to children who require 2 doses during that season.
“Health care professionals, influenza campaign organizers, and public health agencies should cooperate to develop plans for expanding outreach and infrastructure to achieve the target immunization of all children 6 months through 18 years of age, beginning no later than the 2009-2010 influenza season,” the guidelines authors conclude. “Concerted effort among the aforementioned groups, plus vaccine manufacturers, distributors, and payers, also is necessary to appropriately prioritize administration of influenza vaccine whenever vaccine supplies are delayed or limited.”
Pediatrics. Published online October 1, 2008.
U.S. Measles Outbreak Hits 127 People in 15 States
from Medscape
By Will Dunham
WASHINGTON (Reuters) Jul 10 – The biggest U.S. outbreak of measles since 1997 has affected 127 people in 15 states, most of whom were not vaccinated, federal health officials said on Wednesday.
The outbreak was driven by travelers who became infected overseas — 10 countries are implicated — then returned to the United States ill and infected others, according to the U.S. Centers for Disease Control and Prevention.
Public health officials have been stressing the importance of immunizing children amid increasingly vocal vaccine opponents who object to them for religious or other reasons or because they fear the shots may cause autism or other harm.
British health officials said last month that measles had again become endemic in that country for the first time since the mid-1990s due to parents declining to get their children vaccinated.
“The primary reason for lack of vaccination is personal belief exemptions,” the CDC’s Dr. Larry Pickering told a news conference arranged by the National Foundation for Infectious Diseases.
“Until better global control is achieved, cases will continue to be imported into the United States and outbreaks will persist as long as there are communities of unvaccinated people,” Dr. Pickering said.
The CDC first gave details about the current outbreak in May when there were 72 affected people in 10 states. At that time, it was the most cases since 116 in 2001.
With the total number of cases now at 127, this is the most since 138 people in 1997 and 508 in 1996, the CDC said.
The last serious U.S. outbreak occurred from 1989 to 1991, when 55,000 people got measles and 123 died.
No deaths have been reported in the current outbreak.
States with measles cases, the CDC said, include Arizona, Arkansas, California, Georgia, Hawaii, Illinois, Louisiana, Michigan, Missouri, New York, New Mexico, Pennsylvania, Virginia, Wisconsin and Washington state, as well as Washington, D.C.
Travelers became infected in Switzerland, Israel, Belgium, Italy, India, Germany, China, Pakistan, Russia and the Philippines, the CDC said.
Landmark “Pediatric Allergies in America” Survey Uncovered Negative Impact of Allergy Symptoms on Children
from the ACAAI
PHILADELPHIA, Penn.—March 17, 2008—Data from the largest survey of its kind suggested there’s a silent epidemic among our nation’s children. U.S. children are suffering with allergies and not getting the treatment they need, according to the Pediatric Allergies in America survey, which is the largest and most comprehensive national survey of parents of children under the age of 18 who suffer from allergic rhinitis. The survey results were presented today at the American Academy of Allergy, Asthma and Immunology 2008 Annual Meeting in Philadelphia. More than 500 parents who had a child with allergies were interviewed about severity and effects of allergies on their child’s life, and their responses were compared to more than 500 parents of children without allergies.
“We have known anecdotally that children are affected by allergy symptoms similarly to adults, but Pediatric Allergies in America offers the first data quantifying the scope of how allergies interrupt a child’s productivity, sleep cycle, and daily functioning,” said Jay M. Portnoy, MD, President of the American College of Allergy, Asthma and Immunology.
Quality of Life Findings
More than three quarters of parents (76 percent) reported Spring to be the worst time of year for their children’s nasal allergies. Allergy symptoms cause children to feel tired, miserable and irritable. Many children with allergies reported experiencing symptoms every day this time of year. Key findings included:
Allergy symptoms are interfering with children’s sleep. Forty percent of parents indicated that their child’s allergies interfere a lot or somewhat with their sleep. Only eight percent of parents of children without allergies indicated their child’s health interferes with their sleep.
Allergy symptoms are limiting children’s activities. Twice as many parents (21 percent) said allergies limit their children’s activities, compared with only 11 percent of parents whose child did not suffer from allergies.
Allergy symptoms interfere with children’s education. Forty percent of parents of children with allergic rhinitis report their condition interferes with their performance at school compared to only 10 percent of parents of children without allergic rhinitis who attribute lower performance at school to health issues.
Although the most bothersome symptom is a stuffed up nose (27 percent), almost half (46 percent) of parents of children with allergic rhinitis reported serious symptoms – such as headache and ear and facial pain.
Treatment Experience Findings
The survey found that there is room for improvement in the management of allergic rhinitis and that new therapies could help fill some of the current treatment needs. Healthcare professionals overestimate their patients’ satisfaction with allergy medicines.
“Similar to what we have learned about adults, many children with nasal allergies are not satisfied with current treatments. This dissatisfaction is one reason why nasal allergy sufferers sometimes discontinue or switch medications,” said Michael Blaiss, MD, Clinical Professor of Pediatrics and Medicine at the University of Tennessee. “We have information that tells us how, in fact, children suffer with this condition, how it truly affects their quality of life and that there is a need out there for better treatments to control allergies in the pediatric population.”
Nearly half (48 percent) of the children in the study are currently using prescription medication to treat their nasal allergy symptoms; but of those, more than half (57 percent) have changed their medication, with parents citing the medication was not effective enough as the number one reason for the switch. Patients’ dissatisfaction with effectiveness of nasal allergy medicines caused them to ask their doctor to change medication (26 percent) or to simply stop taking them (15 percent).
Bothersome side effects of prescription nasal allergy sprays were a key reason reported when parents were asked why their child is not satisfied with their medication. Cited most often are products dripping down the throat and bad taste, which were also seen as most bothersome when compared to other side effects including burning (15 percent), drying feeling (14 percent), and headaches (13 percent).
Allergic Rhinitis
Allergic rhinitis is a chronic inflammatory disease of the nasal mucosa causing sneezing, itching, nasal congestion and discharge. Some patients with allergic rhinitis have systemic symptoms, including malaise, irritability, fatigue, difficulty concentrating and decreased appetite.
Allergic rhinitis is the most common allergic disease in the U.S. affecting about 40 million people, specifically 10 percent to 30 percent of adults and up to 40 percent of children. It is associated with direct costs of about $4.5 billion annually and indirect costs that reflect approximately four million days of lost time and productivity at work and school.
Seasonal allergic rhinitis is caused by substances typically outdoors (i.e., pollen) that set off allergies and is sometimes referred to as “hay fever.” Symptoms may vary in occurrence and intensity during the day or from season to season. Symptoms are often worse in the morning even when the exposure occurred on the previous day.
Perennial allergic rhinitis is a chronic condition caused by triggers such as pet dander and dust. Symptoms of perennial allergic rhinitis are very similar to those of seasonal allergic rhinitis, yet perennial is persistent and chronic.
About the Survey
A national probability sample of 500 adults, aged 18 and older, who had at least one child who had been diagnosed with allergic rhinitis, nasal allergies or hay fever, and who had nasal allergy symptoms or had taken prescription medicine for allergies in the past 12 months, were interviewed by telephone about their condition and treatment.
More than 35,000 households in the United States were screened to identify nasal allergy sufferers between ages 4 and 17. Individual screening was conducted with a parent in the household to confirm that their child had been diagnosed with nasal allergies and suffered from them or been treated for them in the past 12 months. Parents of children without allergies (N=504) were also interviewed as a comparison group. A third parallel survey was conducted among 501 healthcare practitioners, including a national sample of 401 doctors in direct patient care in outpatient settings: 100 in family practice specialties, 101 allergists, 100 otolaryngologists, and 100 pediatricians. In addition, 50 nurse practitioners and 50 physician assistants were interviewed as part of the survey.
The survey was conducted by the national public opinion research organization, Schulman, Ronca and Bucuvalas, Inc. (SRBI) and made public by Sepracor Inc, a leading manufacturer and distributor of respiratory pharmaceutical products.
PUBLIC HEALTH RISK SEEN AS PARENTS REJECT VACCINES
article by JENNIFER STEINHAUER
New York Times
Published: March 21, 2008
SAN DIEGO — In a highly unusual outbreak of measles here last month, 12 children fell ill; nine of them had not been inoculated against the virus because their parents objected, and the other three were too young to receive vaccines.
The parents who objected to their children being inoculated are among a small but growing number of vaccine skeptics in California and other states who take advantage of exemptions to laws requiring vaccinations for school-age children.
The exemptions have been growing since the early 1990s at a rate that many epidemiologists, public health officials and physicians find disturbing.
Children who are not vaccinated are unnecessarily susceptible to serious illnesses, they say, but also present a danger to children who have had their shots — the measles vaccine, for instance, is only 95 percent effective — and to those children too young to receive certain vaccines.
Measles, almost wholly eradicated in the United States through vaccines, can cause pneumonia and brain swelling, which in rare cases can lead to death. The measles outbreak here alarmed public health officials, sickened babies and sent one child to the hospital.
Every state allows medical exemptions, and most permit exemptions based on religious practices. But an increasing number of the vaccine skeptics belong to a different group — those who object to the inoculations because of their personal beliefs, often related to an unproven notion that vaccines are linked to autism and other disorders.
Twenty states, including California, Ohio and Texas, allow some kind of personal exemption, according to a tally by the Johns Hopkins University.
“I refuse to sacrifice my children for the greater good,” said Sybil Carlson, whose 6-year-old son goes to school with several of the children hit by the measles outbreak here. The boy is immunized against some diseases but not measles, Ms. Carlson said, while his 3-year-old brother has had just one shot, protecting him against meningitis.
“When I began to read about vaccines and how they work,” she said, “I saw medical studies, not given to use by the mainstream media, connecting them with neurological disorders, asthma and immunology.”
Ms. Carlson said she understood what was at stake. “I cannot deny that my child can put someone else at risk,” she said.
In 1991, less than 1 percent of children in the states with personal-belief exemptions went without vaccines based on the exemption; by 2004, the most recent year for which data are available, the percentage had increased to 2.54 percent, said Saad B. Omer, an assistant scientist at the Johns Hopkins Bloomberg School of Public Health.
While nationwide over 90 percent of children old enough to receive vaccines get them, the number of exemptions worries many health officials and experts. They say that vaccines have saved countless lives, and that personal-belief exemptions are potentially dangerous and bad public policy because they are not based on sound science.
“If you have clusters of exemptions, you increase the risk of exposing everyone in the community,” said Dr. Omer, who has extensively studied disease outbreaks and vaccines.
It is the absence, or close to it, of some illnesses in the United States that keep some parents from opting for the shots. Worldwide, 242,000 children a year die from measles, but it used to be near one million. The deaths have dropped because of vaccination, a 68 percent decrease from 2000 to 2006.
“The very success of immunizations has turned out to be an Achilles’ heel,” said Dr. Mark Sawyer, a pediatrician and infectious disease specialist at Rady Children’s Hospital in San Diego. “Most of these parents have never seen measles, and don’t realize it could be a bad disease so they turn their concerns to unfounded risks. They do not perceive risk of the disease but perceive risk of the vaccine.”
Dr. Sawyer and the vast majority of pediatricians believe strongly that vaccinations are the cornerstone of sound public health. Many doctors view the so-called exempters as parasites, of a sort, benefiting from the otherwise inoculated majority.
Most children get immunized to measles from a combined measles, mumps and rubella vaccine, a live virus.
While the picture of an unvaccinated child was once that of the offspring of poor and uneducated parents, “exempters” are often well educated and financially stable, and hold a host of like-minded child-rearing beliefs.
Vaccine skeptics provide differing explanations for their belief that vaccines may cause various illnesses and disorders, including autism.
Recent news that a federal vaccine court agreed to pay the family of an autistic child in Georgia who had an underlying mitochondrial disorder has led some skeptics to speculate that vaccines may worsen such conditions. Again, researchers say there is no evidence to support this thesis.
Alexandra Stewart, director of the Epidemiology of U.S. Immunization Law project at George Washington University, said many of these parents are influenced by misinformation obtained from Web sites that oppose vaccination.
“The autism debate has convinced these parents to refuse vaccines to the detriment of their own children as well as the community,” Ms. Stewart said.
While many parents meet deep resistance and even hostility from pediatricians when they choose to delay, space or reject vaccines, they are often able to find doctors who support their choice.
“I do think vaccines help with the public health and helping prevent the occasional fatality,” said Dr. Bob Sears, the son of the well-known child-care author by the same name, who practices pediatrics in San Clemente. Roughly 20 percent of his patients do not vaccinate, Dr. Sears said, and another 20 percent partially vaccinate.
“I don’t think it is such a critical public health issue that we should force parents into it,” Dr. Sears said. “I don’t lecture the parents or try to change their mind; if they flat out tell me they understand the risks I feel that I should be very respectful of their decision.”
Some parents of unvaccinated children go to great lengths to expose their children to childhood diseases to help them build natural immunities.
In the wake of last month’s outbreak, Linda Palmer considered sending her son to a measles party to contract the virus. Several years ago, the boy, now 12, contracted chicken pox when Ms. Palmer had him attend a gathering of children with that virus.
“It is a very common thing in the natural-health oriented world,” Ms. Palmer said of the parties.
She ultimately decided against the measles party for fear of having her son ostracized if he became ill.
In the late 1960s and 1970s, measles outbreaks in Alaska and California triggered strong enforcement of vaccine mandates by states, and exemption laws followed.
While the laws vary from state to state, most allow children to attend school if their parents agree to keep them home during any outbreak of illnesses prevented by vaccines. The easier it is to get an exemption — some states require barely any paperwork — the more people opt for them, according to Dr. Omer’s research, supported by other vaccine experts.
There are differences within states, too. There tend to be geographic clusters of “exempters” in certain counties or even neighborhoods or schools. According to a 2006 article in The Journal of The American Medical Association, exemption rates of 15 percent to 18 percent have been found in Ashland, Ore., and Vashon, Wash. In California, where the statewide rate is about 1.5 percent, some counties were as high as 10 percent to 19 percent of kindergartners.
In the San Diego measles outbreak, four of the cases, including the first one, came from a single charter school, and 17 children stayed home during the outbreak to avoid contracting the illness.
There is substantial evidence that communities with pools of unvaccinated clusters risk infecting a broad community that includes people who have been inoculated.
For instance, in a 2006 mumps outbreak in Iowa that infected 219 people, the majority of those sickened had been vaccinated. In a 2005 measles outbreak in Indiana, there were 34 cases, including six people who had been vaccinated.
Here in California, six pertussis outbreaks infected 24 people in 2007; only 2 of 24 were documented as having been appropriately immunized.
A surveillance program in the mid ’90s in Canada of infants and preschoolers found that cases of Hib fell to between 8 and 10 cases a year from 550 a year after a vaccine program was begun, and roughly half of those cases were among children whose vaccine failed.
Gardiner Harris contributed reporting from Washington.
Video: How Physicians View Parents Who Refuse to Vaccinate a Child
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I thought I’d get a jump on National Poison Prevention Week which is from March 18 to 24 this year. I had dinner recently with a neurotoxicologist friend who told me the sad story of a child who died from drinking silver cleaner which had been left out when his mom was interrupted while doing chores.
We are so paranoid about child seats and bike helmets, but sometimes we forget the dangers that are in our own closets.
Here are some important prevention tips from the National Capital Poison Center
Facts On Poison Exposures:
• On average, poison centers handle one poison exposure every 14 seconds.
• Over two million poison exposures were reported to local poison centers in
2000.
• Most poisonings involve everyday household items such as cleaning supplies,
medicines, cosmetics and personal care items.
• 89 percent of all poison exposures occur in the home.
• 92 percent of exposures involve only one poisonous substance.
• 86.7 percent of poison exposures are unintentional.
• 75 percent of poison exposures involve ingestion of a poisonous substance.
Other causes include breathing in poison gas, getting foreign substances in
the eyes or on the skin, and bites and stings.
• 77 percent of all exposures are treated on the site where they occurred,
generally the patient’s home with phone advice and assistance from local
poison control experts.
Children and Poison:
• 53 percent of poison exposures occur in children under the age of six.
• The most common forms of poison exposure for children under the age of six
are cosmetics and personal care products (13.3%), cleaning substances
(10.7%), analgesics (7.6%) and plants (6.9%).
The Most Dangerous Poisons for Children
The most dangerous poisons for children include the following. Be sure to check the poison prevention tips to protect your loved ones.
Medicines: these are OK in the right amount for the right person. They can be dangerous for children who take the wrong medicine or swallow too much.
Iron pills: adult-strength iron pills are very dangerous for children to swallow. Children can start throwing up blood or having bloody diarrhea in less than an hour.
Cleaning products that cause chemical burns: these can be just as bad as burns from fire. Products that cause chemical burns include include drain openers, toilet bowl cleaners, rust removers, and oven cleaners.
Nail glue remover and nail primer: some products used for artificial nails can be poisonous in surprising ways. Some nail glue removers have caused cyanide poisoning when swallowed by children. Some nail primers have caused burns to the skin and mouth of children who tried to drink them.
Hydrocarbons: this is a broad category that includes gasoline, kerosene, lamp oil, motor oil, lighter fluid, furniture polish, and paint thinner. These liquids are easy to choke on if someone tries to swallow them. If that happens, they can go down the wrong way, into the lungs instead of the stomach. If they get into someone’s lungs, they make it hard to breathe. They can also cause lung inflammation (like pneumonia). Hydrocarbons are among the leading causes of poisoning death in children.
Pesticides: chemicals to kill bugs and other pests must be used carefully to keep from harming humans. Many pesticides can be absorbed through skin. Many can also enter the body by breathing in the fumes. Some can affect the nervous system and can make it hard to breathe.
Windshield washer solution and antifreeze: Small amounts of these liquids are poisonous to humans and pets. Windshield washer solution can cause blindness and death if swallowed. Antifreeze can cause kidney failure and death if swallowed.
Wild mushrooms: many types of mushrooms grow in many areas of the country. Some are deadly to eat. Only experts in mushroom identification can tell the difference between poisonous mushrooms and safe mushrooms.
Alcohol: when children swallow alcohol, they can have seizures, go into a coma, or even die. This is true no matter where the alcohol comes from. Mouthwash, facial cleaners, and hair tonics can have as much alcohol in them as alcoholic beverages.
Household Poisons
The Yukkiest Poisons
These are especially hazardous household items. Buy small quantities. Discard unneeded extras. Make sure they are always out of a child’s reach.
-
antifreeze
windshield washer solutions
drain cleaners
toilet bowl cleaners
insecticides
artificial nail removers
topical anesthetics (i.e. Products that may be used for sunburn pain)
medicines, medicines, medicines.
Did you know that even these common household items can poison little children?
detergents
automatic dishwasher detergents
furniture polish
perfume & aftershave
mouthwash
gasoline, kerosene, and lamp oil
paint and paint thinner
mothballs
alcoholic beverages
miniature batteries
flaking paint
cigarettes, tobacco products
rat and mouse poison
Pet Poison Prevention Tips:
Your pets can be poisoned too. Follow the same poison prevention tips given for children to protect you animals. The following are some additional poison prevention tips specifically for your pet:
-Never give your pet any medications unless specifically instructed to do so by a veterinarian. Many human medications can have dire consequences to animals, even in small amounts.
-Never give your dog chocolate. Dogs are particularly sensitive to chocolate, and it is considered extremely poisonous for dogs.
-Be aware of you houseplants. Many common household plants can cause kidney damage to your pets if ingested.
Keep all medications out of an animals reach, even they can get into a closed medicine bottle.
-Keep hydrogen peroxide available in case you need to make your animal vomit due to a poisoning. Do not give the peroxide unless instructed to do so by a veterinarian or a Poison Center.
-When treating you animal for ticks and fleas, read all product labels before you begin. Follow the safety recommendations given for you and for the animal.
-Hose-down areas in your driveway or garage in which chemicals have been drained or leaked. A small amount of many chemicals can be fatal to an animal.
-Be aware of neighborhood poisons that may be lurking for your pet.
slug or snail baits put out in gardens
yards and gardens recently treated with insecticides
mushrooms and outdoor plants
rat and mouse poisons
snakes and frogs (frogs may be very poisonous if eaten by a pet)
Finally, Act Fast
What to do if a poisoning occurs:
1. Remain calm
2. Call 911 if you have a poison emergency and the victim has collapsed or is not breathing. If the victim is awake and alert, dial 1-800-222-1222. Try to have this information ready:
-the victim’s age and weight
-the container or bottle of the poison if available
the time of the poison exposure
-the address where the poisoning occurred
3.Stay on the phone and follow the instructions from the emergency operator or poison control center.
P.S.DON’T FORGET TO VISIT BLOG MD FOR PEDIATRIC GRAND ROUNDS 1:24
Good evening all, and welcome to the Red Carpet PGR!
Tonight we will be encountering many interesting posts from all over the pediatric blogosphere, dressed in their red carpet best.
However, unlike the Oscars, no actual awards will be given due to the recent report from Stanford psychologist Carol Dweck and colleagues cited in New York Magazine and featured in Treatmentonline.com that certain types of praise can be harmful. Apparently, praising a child for being “smart” or “intelligent” may raise their self-esteem, but makes them hesitant to try new tasks or fail because they are afraid of not being perceived as “smart/ intelligent”. Instead, we should be praising them for trying, for a job well done and for doing specific tasks and developing specific skills. Yikes! have we turned the next generation into “praise junkies”?
Next on the red carpet, we have the dashing Dr. Clark Bartram of Unintelligent Design and the always lovely NICU nurse Judy, from Tiggers Don’t Jump who both had bad experiences with ALTE’s. That’s “Apparent Life Threatening Events” for those of you “not in the know”. Treatment and evaluation of these episodes seem to require some basic equipment: a working brain and a good dose of common sense, both of which Dr. Bartram and Nurse Judy have in abundance.
Speaking of babies with life threatening problems, we have grrlscientist from Scientist, Interrupted with a post about Viagra being used in Newcastle, England to improve circulation in a premature baby, thus saving the child’s life. Leave it to the Brits to find a new market for Viagra. Another example of ingenuity comes from the suave Scot Trauma Queen who tells the tale of a wee lad with a Lego up his noggin.
And what’s a PGR without vaccines? Dr. Sidharth Sethi from Pediatricsinfo online tells us about the cost-effectiveness of pneumococcal vaccines in developing countries. Regarding the reports of intususception associated with the new rotavirus vaccination, we have not one, but two rants from our friends Dr. Sam Blackman at Blog MD and the prolific Dr. Flea. Flea also weighed in on Merck’s recent decision to cease and desist its lobbying for mandatory HPV vaccination of adolescent girls. Nurse Marcia of Ants Marching also objected to Merck’s campaign, which turned what should be a medical/ preventive health issue into a political one.
This might be “so last year” (actually, 6 months ago), but the IOM Report on the future of Emergency Care, pointed out the lack of adequate trained personnel, facilities, resources, and disaster preparedness for pediatric emergency care in this country, has there been any progress since the report came out? Methinks we should continue talking about it till we see some. Docwhisperer just whispered in my ear that in addition to these issues, there is a growing rift in the ER community between the “career” ER physicians and the residency trained docs.
Dr. Sam Blackman of Blog MD deserves an award (although we’re not handing out any), not only for having 2 posts in this edition of PGR, and for riding in the PanMassachusetts Challenge, a 192 mile bike ride to raise money for the Dana Farber Institute, but also for evangelizing and exhorting others to join the good fight versus pediatric cancer. Thanks to Shinga too for introducing me to Lucia, a plucky 17 year old on a soapbox. In this edition, she talks about JimmyTeensTV.com, a videoproject by teens for teens to help them deal with cancer. To complete the triangle, we also hear from Cancer Dad who shares some of the difficult decisions involved in parenting a seriously ill child.
Illness is difficult enough even when parents and physicians agree on treatment, complications multiply exponentially when they don’t. Dr. Steven Novella of Neurologica Blog points out the ethical and legal issues involved when parents and physicians disagree on the therapeutic plan, particularly when unproven or controversial procedures (like psychic healing) are being used.
Preemies have been in the spotlight lately. Aside from the aforementioned Viagra baby, there is Amilla Sonja Taylor, the earliest surviving preemie, born at 22 weeks gestation. NICU Nurse Laura from Adventures in Juggling weighs in on the realities and costs of caring for very early preemies and The Preemie Experiment discusses the ambivalent emotions many parents have and asks whether they are given sufficient information and counseling in making these difficult choices. Tales from the Womb also shares new information on the psychological and neurodevelopmental outlook for these kids.
Since this is a blog dedicated to allergies and asthma, we need at least one post on that topic. My thanks to Shinga from BreathSpa for Kids for submitting an excellent post debunking the increasingly common (and immensely profitable) use of IgG levels to “diagnose” food intolerance or allergy. Brava! You can also check the Food Allergy page on this blog for more information. I’d also like to thank Shinga for trolling the blogosphere and helping me find many of the excellent blogs featured today.
Wait! The orchestra’s starting to play and I haven’t thanked my agent yet! Since it is Oscars night, I’d like to plug three excellent films this year involving children (although not necessarily suitable for children), namely Pan’s Labyrinth, Little Children, and Little Miss Sunshine.
I’m also taking the liberty of pushing my current favorite children’s book: The Secret Science Project That almost Ate the School (click to download the podcast)
I’d also like to thank everyone who contributed to this PGR, and to anonymous black puppy in the cooler, I couldn’t have done it without you!
Darn! There’s that music again, no, wait it’s my current favorite children’s Indie rock band, the Sippy Cups! Before we rock out, don’t forget next PGR is at Blog, MD on March 11, 2007.
Ladies and Gentlemen, the Sippy Cups!
Inhaled Steroid Monotherapy Seen Best for Mild-Moderate Pediatric Asthma
The following abstract reiterates what is already known and considered the standard of care, which is the use of inhaled corticosteroids for mild- moderate asthma. I was not surprised by the superiority of the inhaled steroid alone and inhaled steroid/ salmeterol arms over the montelukast arm, but what I found interesting is the finding that double dose inhaled steroid was superior to inhaled steroid/ salmeterol combo in terms of FEV1/FVC and other markers such as exhaled nitric oxide and maximum bronchodilator response. But what does this mean clinically? If these children are followed longitudinally, which I’m sure they will be, it would give us important information on the long-term relevance of these markers and give us further guidance on the use of higher dose ICS vs. ICS plus long acting beta-agonists.
Sorkness CA, Lemanske RF Jr, Mauger DT, Boehmer SJ, Chinchilli VM, Martinez FD, Strunk RC, Szefler SJ, Zeiger RS, Bacharier LB, Bloomberg GR, Covar RA, Guilbert TW, Heldt G, Larsen G, Mellon MH, Morgan WJ, Moss MH, Spahn JD, Taussig LM; for the Childhood Asthma Research and Education Network of the National Heart, Lung, and Blood Institute.
Clinical Science Center, University of Wisconsin, Madison.
BACKGROUND: More evidence is needed on which to base recommendations for treatment of mild-moderate persistent asthma in school-aged children.
OBJECTIVE: The Pediatric Asthma Controller Trial (PACT) compared the effectiveness of 3 regimens in achieving asthma control.
METHODS: A total of 285 children (ages 6-14 years) with mild-moderate persistent asthma on the basis of symptoms, and with FEV(1) >/= 80% predicted and methacholine FEV(1) PC(20) RESULTS: Fluticasone monotherapy and PACT combination were comparable in many patient-measured outcomes, including percent of asthma control days, but fluticasone monotherapy was superior for clinic-measured FEV(1)/forced vital capacity (P = .015), maximum bronchodilator response (P = .009), exhaled nitric oxide
CONCLUSION:Both fluticasone monotherapy and PACT combination achieved greater improvements in asthma control days than montelukast. However, fluticasone monotherapy was superior to PACT combination in achieving other dimensions of asthma control. Growth was similar in all groups.
CLINICAL IMPLICATIONS: Therefore, of the regimens tested, the PACT study findings favor fluticasone monotherapy in treating children with mild-moderate persistent asthma with FEV(1) >/= 80% predicted, confirming current guideline recommendations.
J Allergy Clin Immunol. 2007 Jan;119(1):64-72. Epub 2006 Nov 30
Read Pediatric Grand Rounds 1:21 at Dr.Bartram’s Unintelligent Design
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