The rise in exposure to prescription products has been so striking that the Centers for Disease Control and Prevention has established the PROTECT Initiative, intended to prevent unintended medication overdoses in children. According to the CDC, more than 70,000 emergency visits each year result from unintentional overdoses among children under the age of 18.

Dr. Randall Bond, an emergency medicine physician at Cincinnati Children’s Hospital Medical Center, presented his study on children and pharmaceutical poisonings at a recent PROTECT Initiative meeting in Atlanta. The study was published in September in the Journal of Pediatrics.

“The problem of pediatric medication poisoning is getting worse, not better,” says Dr. Bond, who also is medical director of the Drug and Poison Information Center at Cincinnati Children’s, in a news release. “More children are exposed, more are seen in emergency departments, more are admitted to hospitals, and more are harmed each year.”

Bond found that exposure to prescription products accounted for most of the emergency visits (55 percent), admissions (76 percent) and significant harm (71 percent). Levels of ingestion of opioids, most often prescribed to treat pain; sedatives-hypnotics, frequently prescribed as sleep aids; and cardiovascular medications were particularly high.

“Prevention efforts at home have been insufficient,” Bond said. “We need to improve storage devices and child-resistant closures and perhaps require mechanical barriers, such as blister packs. Our efforts can’t ignore society’s problem with opioid and sedative abuse or misuse.”

Bond studied patient records from 2001 to 2008 in the National Poison Data system – an electronic database of all calls to members of the American Association of Poison Control Centers. Bond studied children 5 years old and younger exposed to a potentially toxic dose of a single pharmaceutical agent, either prescription or over-the-counter. A total of 453,559 children were included in the study.

The largest part of increasing admissions, injuries and death was due to children finding and ingesting medication on their own. Therapeutic errors at home were uncommon and increased only minimally.

The most likely explanation for these trends is a rise in the number of medications around small children, he says. A 1998-99 survey found that half of adults had taken at least one prescription medication in the preceding week and 7 percent had taken five or more. In 2006, the same surveyors found that 55 percent had taken at least one prescription medication in the preceding week and 11 percent had taken five or more.

There are 57 poison control centers in the United States. Together they provide free, 24-hour poison expertise and treatment advice by phone. All poison centers can be reached by calling the same telephone number 1-800-222-1222. Poison centers are staffed by pharmacists, physicians, nurses and poison information providers who are toxicology specialists.

For more on child medical safety issues, see the library of articles by Daytona Beach child injury attorney.

The new mandatory crib standards, approved unanimously on Dec. 15, 2010, are the most stringent crib safety standards in the world. As of  June 28, 2011, all importers, distributors, manufacturers, and retailers must offer only cribs that meet the CPSC’s new and improved full-size and non-full-size crib standards.

Federal mandatory crib standards had not been updated in nearly 30 years and the new rule will usher in a safer generation of cribs, which will mean a safer sleep for babies across the country. These mandatory standards will:

• Stop the manufacture and sale of dangerous, traditional drop-side cribs
• Make mattress supports stronger
• Improve slat strength
• Make crib hardware more durable
• Make safety testing more rigorous

“A safe crib is the safest place for a baby to sleep. It is for this reason that I am so pleased that parents, grandparents and caregivers now can shop with confidence and purchase cribs that meet the most stringent crib standards in the world,” said CPSC Chairman Inez Tenenbaum in a news releasea. “From the start, our goal has been to prevent deaths and injuries to babies in cribs, and now the day has come where only stronger and safer cribs are available for consumers to purchase.”

CPSC has recalled more than 11 million dangerous cribs since 2007. Drop-side cribs with detaching side rails were associated with at least 32 infant suffocation and strangulation deaths since 2000. Additional deaths have occurred due to faulty or defective crib hardware. The new standards aim to prevent these tragedies and keep children safer in their cribs.

Starting on December 28, 2012, child care facilities, including family child care homes and infant Head Start centers, as well as places of public accommodation, such as hotels and motels, and rental companies must use only cribs that comply with the new crib standards.

To learn more about crib safety, visit CPSC’s crib information center at: www.cpsc.gov/cribs

For more on child safety issues, see the library of articles by Daytona Beach child injury attorney.

The study, involving 257 students, highlights that a higher degree of pain was experienced with the use of gaming devices compared to mobile phones. Pain reported by children using Xbox and Gameboy was statistically higher than pain reported for the iPhone.

Importantly, the length of time spent on the devices heightened the pain suffered, as the data demonstrated that length of time was independently associated with the pain reported, with the odds of reporting pain increasing by two for every one hour of play.

“Our study has shown the negative impact that playing computer games and using mobile phones can have on the joints of young children, raising concerns about the health impact of modern technology later in life,” said Professor Yusuf Yazici, Rheumatology, NYU Hospital for Joint Diseases, New York. “We hope that further research in this area will shed light on what could be a serious health concern for today’s gaming children, in later life.”

The study also investigated pain attributed to mobile phone usage for the sending of text messages, the number of texts sent, the use of abbreviations, and the type of keyboard used, according to age and gender.

The results indicated that female students reported twice as much pain as male students respectively, measured using the 10cm Visual Analogue Scale (VAS, a pain measurement scale) and gender was the only independent variable associated with pain.

The study involved 257, nine to 15 year old students from two schools in St Louis. They were administered with a questionnaire to aid researchers in determining the possible association device type, age of children and hours played may have on wrist and finger pain.

A multivariable generalised linear model examined whether reported pain was associated with game device usage adjusting for age, gender, school and duration of game play per game device.

The study results were presented last week during the European League Against Rheumatism 2011 Annual Congress.

For more on medical issues, see the library of articles by Daytona Beach child injury attorney.

Only one of the 29 infants who received human milk developed the dangerous intestinal condition necrotizing enterocolitis (NEC) and recovered without surgery, compared with five out of the 24 babies on formula, four of whom required surgery. The findings, say the researchers at Johns Hopkins Chidren’s Center, justify a move toward a “human milk only” diet in extremely premature babies — those born weighing less than 1,500 grams, or 3.3 pounds.

“The stark differences in the risk of NEC, its complications and the need for surgery between babies who receive human donor milk and those who get formula signal the need for a change in feeding practices across neonatal intensive care units,” said lead investigator Dr. Elizabeth Cristofalo, a neonatologist at Hopkins Children’s, in a press release.

Moreover, babies who got human milk tolerated feeding better, allowing them to be taken off supplemental IV nutrition much sooner — after 27 days on average — than the group who received cow’s milk formula.

Those babies spent an average of 36 days on IV nutrition, largely because their intestinal tracts were not adapting to food as well, the researchers say. IV nutrition, used temporarily in all premature babies to supplement feeding, carries risks, the most serious of which is liver damage.

“Although we didn’t look specifically at liver function, we know from experience and from previous research that prolonged IV nutrition can harm a premature baby’s liver,” Cristofalo said. “Using human milk cuts that risk by allowing us to wean babies off IV nutrition sooner.”

Necrotizing enterocolitis is marked by tissue damage to the baby’s bowel. Because up to 40 percent of babies who develop NEC die, the condition is considered an emergency. Some cases of NEC can be treated with antibiotics and by temporarily withholding of food, but some babies require surgery to remove the dead portions of the intestines. The remaining intestine, however, can develop scarring that leads to poor absorption of nutrients, growth problems and the need for more surgery down the road.

The health advantages of mother’s milk have been well established, but some concerns about donor milk have lingered, including how it compares to mother’s milk and whether it is, indeed, superior to cow milk formula. The new findings should resolve any residual doubts about the risks and clarify the benefits of human donor milk, the investigators said.

The multi-center study is the first trial of its kind to compare the risk for NEC and NEC surgery between premature infants fed human donor milk and those fed preterm baby formula. An earlier study by the same team showed that babies who get their own mother’s milk fortified with the standard cow milk protein are more prone to NEC than babies given a combination of their mothers’ milk fortified with human donor milk.

Other hospitals participating in the study included Cohen Children’s Medical Center of New York, University of Texas, University of Florida-Gainesville, Innsbruck Medical University in Austria, Baylor College of Medicine and Children’s Hospital and Research Center, Oakland, Ca.

For more on child medical issues, see the library of articles by Daytona Beach child injury attorney.

The most common reason mothers fed supplements and teas to their infants were to help with fussiness, digestion, colic and relaxation.

Although these parents fed their infants the products as a remedy, the products have not been evaluated by FDA to treat, cure, or prevent any disease.

“Our study is the first to examine the prevalence of dietary botanical supplement and tea use among a sample of U.S. infants,” wrote the study’s authors. “The wide variety of dietary botanical supplements and teas given to infants increases the likelihood that some are unsafe.”

Results of the study are published online May 2 in Pediatrics. The report is scheduled to appear in the June print version of the journal.

Dietary botanical supplements and herbal teas don’t receive the same scrutiny that pharmaceutical products do, according to background information in the study. Use of such products can cause adverse reactions with other medications, and these products may be inherently unsafe themselves.

The study drew on surveys of 2,653 healthy mothers with term or near-term infants between 2005 and 2007.

The study found mothers who fed their infants dietary botanical supplements and teas were more likely to have used such products themselves, and were more likely to breastfeed.

Hispanic mothers were more likely to give infants these products than white mothers. Many of the supplements and teas were marketed and sold specifically for infants.

Some supplements may contain heavy metals or other contaminants, and infants are more susceptible to such toxins, according to the study. In addition, some dietary supplements have caused seizures and even death in previously healthy infants. One dietary supplement was recalled in 2007 because of microbiological contamination.

The most commonly used products were gripe water, chamomile, teething tablets and unspecified tea, according to the study. The most common reasons for giving these products were fussiness, digestion problems, colic and relaxation.

When asked whom they talked to for information about such products, only 27 percent said they talked to a health-care professional. Almost 28 percent  got their information from the media, and 30 percent talked to friends and family about botanical supplements and teas for their babies.

During the first four to six months of life, child health experts recommend that babies only be fed human breast milk or infant formula, according to the study.

For more on child health issues, see the library of articles by Daytona Beach child injury attorney.

A new, small study of parents in Colorado reveals another potential roadblock to child passenger safety: youngsters unbuckling themselves while the vehicle is moving.

Such incidents are alarming as restraining children inappropriately in a vehicle more than triples their risk for serious injury in a collision.

While previous studies have looked at potential obstacles to getting a child restrained safely, none has assessed how frequently youngsters unbuckle themselves, or the age at which children are able to do so.

In this study, researchers led by Dr. Lilia B. Reyes, clinical fellow in the Department of Pediatrics at Yale School of Medicine, surveyed parents with children younger than 6 years to find out the age at which children begin to unbuckle themselves from vehicle restraints and how frequently this occurs while the car is moving.

Parents at five urban and suburban pediatric offices also were asked to describe what they do if their child unbuckles.

Results from 378 parents showed that 51 percent reported that at least one of their children self-unbuckled. In addition, 75 percent of children who unbuckled themselves were 3 years of age or younger, and unbuckling was reported as early as 12 months of age. More boys unbuckled themselves than girls (59 percent vs. 42 percent, respectively).

Of the children who unbuckled themselves, 43 percent did so when the car was moving. The majority of parents reported that when this happens, they pull the car over, reprimand the child and re-buckle him or her.

“This pilot study elucidates another potential safety hazard in child motor vehicle restraint that needs to be addressed,” Dr. Reyes said. “Most importantly, it makes parents aware of the fact that their child may have the motor capability of self-unbuckling without having the full cognitive understanding of the consequences of this behavior.”

Future research should look at which restraint devices would be safer, Dr. Reyes concluded. “Keeping precious cargo safe is our duty.”

For more on child safety issues, see the library of articles by Daytona Beach child injury attorney.

Of more concern was the finding that the youngest children had the greatest chance of receiving an overdose, according to lead researcher Dr. William T. Basco Jr., associate professor and director of the Division of General Pediatrics at the Medical University of South Carolina.

“Our goal was to determine the magnitude of overdosing for this high-risk drug class in a high-risk population, and these results are concerning,” Dr. Basco said in a press release.

Narcotics such as codeine and hydrocodone can be dangerous for infants and children because of their sedative effects.

Researchers from South Carolina identified the top 19 narcotic-containing drugs prescribed to children ages 0-36 months who were enrolled in the Medicaid program from 2000-2006.

For each of 50,462 outpatient prescriptions, they calculated the expected daily dose of the narcotic based on an estimate of the child’s weight, age and gender. Then they compared that dosage with the actual amount of painkiller dispensed by the pharmacy.

About 40 percent of children younger than 2 months of age received an overdose amount compared to 3 percent of children older than 1 year. For the average child who had an overdose quantity dispensed, the amount of narcotic drug dispensed was 42 percent greater than would have been expected.

“Almost one in 10 of the youngest infants ages 0-2 months received more than twice the dose that they should have received based on their age, gender and a conservative estimate of their weight,” Dr. Basco said.

“Since we know that parents have difficulty measuring doses of liquid medication accurately,” Dr. Basco concluded, “it is critical to strive for accurate narcotic prescribing by providers and dispensing by pharmacies.”

For more on child medical safety issues, see the library of articles by Daytona Beach child injury attorney.

Since the Toxic Substance Control Act (TSCA) was passed in 1976, tens of thousands of new chemicals have been developed for widespread use with little oversight or testing and the law itself has never been really updated, the pediatricians claim in a new position paper for the AAP.

“It is widely recognized to have been ineffective in protecting children, pregnant women, and the general population from hazardous chemicals in the marketplace. It does not take into account the special vulnerabilities of children in attempting to protect the population from chemical hazards,” write the authors.

It is because of the inadequacies of the TSCA that parents and pediatricians have been subjected to multiple high-profile media blitzes about specific chemicals, such as phthalates in toys and bisphenol A in infant bottles, that create anxiety without solving the problems of risky chemical exposures

Under the TSCA, companies must disclose any known hazards of chemicals used to make consumer products, but unlike drug companies, they are not required to perform pre-market testing, or even post-market followup. Pediatricians say the system works as a disincentive for companies to learn more about the chemicals because any problems found would need to be remedied at a company’s expense.

Among the changes called for by the AAP:

• Manufacturers should be responsible for developing information about chemicals before marketing.
• The U.S. Environmental Protection Agency (EPA) should have the authority to demand additional safety data about a chemical and to limit or stop its marketing when a high degree of suspicion about safety exists.
• The federal government should provide funding to evaluate the effects of chemicals on children’s health. Research should include effects on reproduction and development.

The EPA has implemented several voluntary programs in attempts to compensate for inadequacies of the TSCA. These programs include the Endocrine Disruptor Screening Program, the Voluntary Children’s Chemical Evaluation Program, and the Chemical Assessment and Management Program.

Because these programs are voluntary, the EPA cannot require companies to produce information about the health and safety risks of these chemicals. Each of these programs has produced few data over long periods of time, and none has led to any significant regulatory changes.

Under the EPA Inventory Update Reporting program, the chemical-manufacturing industry estimated that approximately 27 trillion pounds of chemicals were produced in or imported into the United States per year in the early part of this decade, which is the equivalent of approximately 74 billion pounds a day (nearly 250 pounds per person) and does not include fuels, pesticides, pharmaceuticals, or food products. Yet, in the past 35 years, the TSCA has been used to regulate only five chemicals.

“The current policy really is virtually useless,” said Dr. Jerome Paulson, the paper’s author and medical director of the Child Health Advocacy Institute at Children’s National Medical Center in Washington, D.C., in a press release. “In the last couple of years we’ve had a ‘toxicant of the month’ situation. Why aren’t these chemicals tested before they’re in the market so we . . . can know if they’re unlikely to do harm to the environment or to human beings?”

For more on medical safety issues, see the library of articles by Daytona Beach medical malpractice attorney.

Gastroenterologists from the Pediatric Inflammatory Bowel Disease Center at Johns Hopkins Children’s in Baltimore say that many of the hundreds of children they see were referred to them only after months of repeated visits to their primary-care physicians for symptoms mistakenly attributed to common GI ailments like viral gastritis.

“Inflammatory bowel disease is still considered an adult condition and is rarely on pediatricians’ radars,” says Dr. Maria Oliva-Hemker, chief of the Gastroenterology & Nutrition division at Hopkins Children’s and director of the comprehensive IBD center there, in a press release. “Fifty years ago, IBD was almost exclusively diagnosed in adults. These days, treating children with IBD is business as usual in our clinics.”

More than 100,000 children in the United States have IBD, according to the Crohn’s & Colitis Foundation of America. A 2003 study published in The Journal of Pediatrics reported a surprisingly high rate of IBD among children in Wisconsin — the highest in the world at that point — 7.5 cases per 100 000, with a CD rate of 4.56 and a UC rate of 2.14.

Scientists believe that IBD is triggered by an overactive immune system that mistakenly attacks the colon and small intestine. The reasons driving the rise of childhood IBD remain unclear, but genetic and environmental factors are clearly at play, experts say.

Because genetic makeup does not change drastically in populations over short periods of time, it is more likely that changing environmental factors are triggering new cases in genetically predisposed children, the researchers say.

The two main forms of IBD are Crohn’s disease (CD) and ulcerative colitis (UC). For unknown reasons, Crohn’s disease seems to be rising more rapidly in children than ulcerative colitis, Oliva-Hemker says.

Children with CD also tend to be diagnosed later than those with ulcerative colitis because the most common symptom is vague abdominal pain rather than the more suggestive bloody stools seen in ulcerative colitis, she notes.

Delays in treatment can make IBD worse and lead to severe anemia from gastrointestinal bleeding, poor food absorption, malnutrition and stunted growth. In advanced cases, IBD can cause serious damage to the colon and small intestine that requires surgery.
To prevent dangerous delays in diagnosis and treatment,  Oliva-Hemker says the following symptoms — especially if they keep coming back or never fully go away — should prompt a visit to a specialist:

• abdominal pain
• bloody stools
• diarrhea
• nausea and/or vomiting
• poor appetite and weight loss
• poor growth, especially in younger children
• pale skin, rapid heartbeat, fatigue and dizziness, all of which could indicate chronic anemia from GI bleeding
• a family history of IBD —  up to 30 percent of childhood cases have genetic roots

Oliva-Hemker advises pediatricians who suspect IBD to obtain routine blood tests to check for anemia and inflammation markers like elevated sedimentation rate and C-reactive protein. The diagnosis can usually be confirmed with an endoscopy and colonoscopy.

IBD is most commonly diagnosed in school-age children and teens, but gastroenterologists say that they have seen the disease in a growing number of children younger than 5 years of age.

For more on children’s medical issues, see the library of articles by Daytona Beach child injury attorney.

These findings raise safety concerns, note the researchers. They point out the paucity of evidence supporting the efficacy of these medications to treat young children, their known adverse metabolic effects, and unknown long-term effects on the developing brain.

The rate of antipsychotic drug treatment among privately insured children, aged 2-5 years, rose from 0.78 to 1.59 per 1,000 children during the study period, and increased more for girls (148 percent) than for boys (94 percent).

Treatment with antipsychotic drugs rose significantly for children diagnosed with pervasive developmental delay/mental retardation (57 percent), disruptive behavior disorders (54 percent), and attention deficit/hyperactivity disorder (70 percent).

Antipsychotic drug treatment for children without a diagnosed mental disorder increased by 65 percent, although the rate per 1,000 children remained low. Over the same time period, the rate of nondrug interventions decreased or remained unchanged. The rate of mental health assessments for children treated with antipsychotic drugs remained essentially unchanged from 1999-2001 (40 percent) to 2007 (almost 41 percent).

While 50 percent of children treated with antipsychotic drugs in 1999-2001 had at least one psychotherapy session during a treatment year, this rate fell to slightly more than 41 percent by 2007.

These findings were based on analysis of service and pharmacy claims from the MarketScan Research Databases on privately insured individuals and their families from 150 United States employers. The study was funded in part by the Agency for Healthcare Research and Quality (AHRQ) to the Center for Education and Research on Mental Health Therapeutics at Rutgers University.

Despite increasing rates of antipsychotic use by very young children, provision of formal mental health services remains sparse, the authors note. These service patterns highlight a critical need to improve the availability of specialized and well integrated mental health care for very young children with serious mental health problems.

For more on child heath issues, see the library of articles by Daytona Beach child injury lawyer.