Autism, Poison Safety, ADHD Meds – PediaCast 344

Posted by Dr. Mike on April 18, 2016

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Show Notes

Description

Dr Lara McKenzie visits the PediaCast Studio to talk about poison safety. Pediatric news this week covers autism & eye gazing, exercise in the womb and declining rates of ear infections. We also answer a listener question regarding ADHD medication dosing. We’d love to have you join us!

Topics

Autism & Eye Gaze
Exercise in the Womb
Declining Ear Infections
Poison & Toxic Substance Safety
ADHD Medication Dosing

Guest

Dr Lara McKenzie
Principal Investigator
Center for Injury Research and Policy
Nationwide Children’s Hospital

Transcription

Announcer 1: This is PediaCast.

[Music]

Announcer 2: Welcome to PediaCast, a pediatric podcast for parents. And now, direct from the campus of Nationwide Children’s, here is your host, Dr. Mike.

Dr. Mike Patrick: Hello everyone, and welcome once again to PediaCast. It’s a pediatric podcast for moms and dads. This is Dr. Mike, coming to you from the campus of Nationwide Children’s Hospital. We’re on Columbus, Ohio.

It is Episode 344 for April 18th, 2016. We’re calling this one “Autism, Poison Safety and ADHD Meds”. I want to welcome everyone to the program.

We have lots coming your way this week with more news parents can use and interview with the pediatric expert and another answer to a listener question. I’ll get to the complete rundown in a moment, because in our usual fashion, we’ll be covering more topics than the title would suggest.

First, though, I want to remind you, we are coming up on a decade of PediaCast episodes. So I launched the show — not really sure how long it would last or how far it would go — back in 2006, the same year that Facebook and Twitter came into being. And here we are, close to ten years later with millions of downloads, listeners in all 50 US states and over 100 countries around the globe.

We routinely get listener questions from close to home here in Columbus, Ohio. Also, from California, Colorado, Texas, New York, Florida, and as far as away as the United Kingdom, France, Israel, Germany, Australia, New Zealand to name a few.

We’re hosted by America’s largest children’s hospital and finest pediatric research institute, in my opinion, at Nationwide Children’s.

0:02:05

In fact, they’re moving us into a brand new state-of-the-art sound studio next month. So there’s that.

We’ve also launched the companion podcast for providers over at PediaCastCME.org. CME stands for Continuing Medical Education. That’s where we turn up the science a couple of notches and provide free Category 1 Continuing Medical Education for listeners.

Because of the success of PediaCast, I’ll be in Baltimore in just a few days teaching other pediatricians sub-specialists, and researchers how to engage in social media and make a global impact. We’ll be talking about those things at the annual meeting of the Pediatric Academic Society. Which, by the way, if you are a pediatrician, sub-specialist and/or researcher, I’d love to see you at the meeting, drop me a line.

Probably the easiest way to get in touch with me is over at PediaCast.org or PediaCastCME.org. Just click on the Contact page and send me a note because I would love to meet up with you face to face at the meeting — that would be fabulous — later this month in Baltimore at the annual meeting of the Pediatric Academic Society.

So, all sorts of amazing feats in the life of this program, but the truth is that none of this would be possible without you, the PediaCast audience. And so I truly do want to thank you for listening, for your loyalty over the years, for sharing the show with others, for participating on the show with your questions and comments and providing truthful and mostly fabulous reviews of the show in iTunes and other places in and around the Internet. You’re a great bunch, and as we approach ten years of shows, here’s to another ten years down the road.

Having said all that, we are going to be on a bit of a hiatus during the month of May. As I attend the conference at the beginning of the month, I’ll be attending my daughter’s college graduation a little later in May. So that’s exciting, and we’ll be taking a long and much needed family vacation in the middle part of the month.

0:04:10

It’s been a rough six months, I’m going to tell you. I’ve had three — yes count them — three eye surgeries for glaucoma. That’s been a struggle, as many of you know. But my eye is finally healing well. My pressure is great. My vision is excellent, so I’m very thankful for that.

Still, as you can imagine, and then of course, flu season in the winter and being busy seeing patients, a nice long family vacation is in order. You all know how I feel about spending quality time with loved ones. So that’s mid to late May.

And then, late May, we’ll be physically moving the studio to its new location. Much more on that as we make the transition and I’ll be sure to get photos on the website and social media.

So a bit of a hiatus in May, but then back in June, with more news parents can use, interviews with pediatric experts and answers to listener questions, which as it turns out is exactly what we’re doing today.

So let’s quickly run through the line-up for you. In our news parents can use segment, first up, it will be autism and eye gazing. Autism spectrum disorder is a clinical diagnosis. There’s no autism test, which is frustrating for parents because they want to know for sure. While researchers are working on more objective tests. They’re not a hundred percent, at least not yet. But they can help with the diagnosis, and one of these tests comes from an unexpected source — the way in which children gaze at pictures and videos. So I’ll fill you in on the details of that.

And then, exercise in the womb, this is a really interesting story. Could activity level by mom during pregnancy affect how active her baby is as a child and even as an adult? And could it be that a subsequent family lifestyle and activity levels are not the reason for this observation? Could it be simply be due to being active during pregnancy, and how exactly do you design a study that eliminates those other factors like family lifestyle and activity levels? Or even the genetic predisposition to being active, how do you eliminate those as variables and just say, you know, it really was the activity during pregnancy that did it? How do you design a study that looks at that?

0:06:20

So, we’ll explore those details. It’s a pretty interesting study. And then, a decline in ear infections, compared to the 1980s and the 1990s, ear infection rates are down. So we’ll look at the reasons why and see if there’s anything that you can do now to lessen the risk of your young child having an ear infection.

And then, in our interview segment, poison safety. Dr. Lara McKenzie visits the PediaCast studio to talk more about the Make Safe Happen Campaign, their website and their mobile app. She’s going to fill us in on five poison and toxin risks that you might not think about in your home but you should. So stick around and we’ll add to your poison watch list and talk about ways to protect your family from poison and toxin risks in and around the home.

And then, finally, we’re going to answer a listener question concerning ADHD medication dosing. And I know, we’ve talked about ADHD a number of times lately. But hey, these are your questions. If you want answers to different questions, be sure to ask them, by using the contact page at the website, PediaCast.org, and we’ll try to get your question on the show.

In the meantime, we’ll answer Faith’s question from Colorado concerning ADHD medications and dosing. It’s a good one. And I think it’s probably going to address in some way or another questions that a lot of parents have about ADHD medications and like how long they last, what are the side effects, how do they work, how do you know if you got the right combination of medicine and dosing?

So stick around for that, especially if your child has ADHD or you suspect he or she may have it. Or maybe someone you know has a kid with ADHD, and they’re struggling with finding the right medication or dose. You may be able to share some nuggets of wisdom– hopefully, it’s wisdom — with your friend after listening to that portion of today’s program. You can be the expert on ADHD medication and dosing.

0:08:12

All right, so lots to cover before we take our May break, so let’s get right to it.

Don’t forget, the information presented in every episode of this podcast is for general educational purposes only. We do not diagnose medical conditions or formulate treatment plans for specific individuals. So if you do have a concern about your child’s health, make sure you call your doctor and arrange a face-to-face interview and hands-on physical examination.

Also, your use of this audio program is subject to the PediaCast Terms of Use Agreement which you can find at PediaCast.org.

So, let’s take a quick break and I will be back with news parents can use, an interview on poison safety and answers regarding ADHD medication dosing. That’s all coming your way right after this.

[Music]

Dr. Mike Patrick: The evaluation of a child’s eye gaze may help clinicians differentiate children with autism spectrum disorder from children without autism, but with other developmental problems. This, according to researchers at the Cleveland Clinic and recently reported in the Journal of the American Academy of Child and Adolescent Psychiatry.

Presently, autism spectrum disorder is identified using subjective methods such as parent report, interviews, and clinician observations. Having an objective marker of autism could substantially increase the accuracy of clinical diagnosis. In addition, parents are often wary of believing a diagnosis based solely on clinical impression. So an objective measurement may also help moms and dads accept the diagnosis.

Researchers used two samples of at-risk patients and presented each child with still pictures and dynamic videos. These pictures and videos contained social and non-social elements. Then, as each child viewed the pictures and videos, their eye movements were tracked to determine which elements, social or non-social, attracted their gaze.

0:10:39

The children in both samples were between the age of three and eight years, and results of the gaze test were compared with each child’s eventual diagnosis of autism spectrum disorder or another non-autism developmental problem.

Dr. Thomas Frazier, lead investigator for the project, hypothesized that more time spent gazing at social targets and less time spent gazing at non-social targets could be combined into a single “Autism Risk Index”, which could then be used to identify children with autism spectrum disorder.

So how did the gaze test fare? Well, the resulting Autism Risk Index correctly predicted an eventual diagnosis of autism in 80% of the children, and this percentage held true in both samples of children. So it wasn’t perfect, but there was some positive correlation which may give clinicians another data point in making the diagnosis.

Another interesting finding, the gaze test performed very well in predicting autism severity and its ability to do so was not influenced by language level or behavioral patterns.

Dr. Frazier says, “Identifying children with autism early is critical to getting them appropriate interventions that will make their lives better. The lack of objective methods for identifying children with autism can be a major impediment to early diagnosis. Remote eye tracking is easy to use with young children and our study shows that it has excellent potential to enhance identification. And because it’s objective, may increase parents’ acceptance of the diagnosis, allowing their children to get interventions faster.”

0:12:15

The authors concluded that eye gaze tracking may be an easy, inexpensive, and effective method to help clinicians make the diagnosis of autism. They say the growing prevalence of autism spectrum disorder, which is now 1 in 68 children in the United States, and the lack of objective markers means the use of eye gaze tracking as an objective measure of autism could help with early identification and lead to more rapid treatment.

Researchers add that eye gaze tracking also has the potential to monitor treatment progress, although their study did not evaluate changes in the Autism Risk Index over time, something that future studies will likely evaluate. If the test can mark progress, investigator say it could enhance the knowledge of effective treatments and reduce the time to discovery of new interventions for autism.

The team admits that additional research in larger samples is necessary to confirm these findings and to further develop remote eye tracking as a clinical tool. If validated and scaled for routine use, eye gaze tracking has the potential to dramatically advance our ability to identify and assist individuals with autism.

So interesting stuff. We’ll be sure to keep you updated on the progress of eye gaze tracking as an objective measure of autism and let you know if the method is validated and if and when it becomes a useful tool in routine practice.

Our next story is a really good one. Researchers at Baylor College of Medicine had discovered that female mice who voluntarily exercise during pregnancy have offsprings that are more physically active as adults.
This according to a recent report in The Journal of the Federation of American Societies for Experimental Biology.

Dr. Robert Waterland, associate professor of pediatrics, nutrition and molecular and human genetics at Baylor and Texas Children’s Hospital and senior author of the study, says, “Several human studies have reported results consistent with ours.”

0:14:13

For example, observational studies have found that women who are physically active when they’re pregnant have children who tend to be more physically active. But these results could be attributed to the mothers’ influence on the children after they’re born. Or, perhaps, mothers could pass to their offspring a genetic predisposition to being physically active.

However, Dr. Waterland adds, “Our study in a mouse model is important because we can take all those effects out of the equation. We studied genetically identical mice and carefully controlled the amount of physical activity of the mothers before and during pregnancy.” The Baylor team began with female mice who enjoyed running. Then, they divided them into two groups. Mice in one group were allowed access to running wheels before and during pregnancy. All mice in the other group were not.

During early pregnancy, the females with running wheels ran an average of 10 kilometers every night. That’s a lot of running for a little mouse. They ran less as pregnancy progressed, but even by the beginning of the third trimester they ran or walked about three kilometers each night on their running wheel.

Researchers found that the mice born to mothers that exercised during pregnancy were about 50% more physically active than those born to mothers who did not exercise. Importantly, their increased activity persisted into later adulthood, and even improved their ability to lose fat during a three-week voluntary exercise program.

This study supports the idea that movement during pregnancy influences fetal brain development, making the offspring tend to be more physically active throughout their life. Dr. Waterland says, “Although most people assume that an individual’s tendency to be physically active is determined by genetics, our results clearly show that the environment can play an important role during fetal development.”

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If a similar effect can be confirmed in people, it could represent an effective strategy to counteract the current worldwide epidemic of physical inactivity and obesity. Increasing physical activity has major health implications. According to the World Health Organization, insufficient physical activity is one of the ten leading risk factors for death worldwide.

Several expert groups including the American College of Obstetricians and Gynecologists already recommend that, in the absence of complications, pregnant women should get 30 minutes or more of moderate exercise each day. Dr. Waterland says, “I think our results offer a very positive message. If expectant mothers know that exercise is not only good for them but also may offer lifelong benefits for their babies, I think more expected mothers would be motivated to get moving.”

We have good news to report from the University of Texas Medical Branch at Gavelstone. Investigators there say that the rate of ear infections during a baby’s first year has declined. And they suggest the reason for this observation may be due to higher rates of breastfeeding, increased use of immunizations and smoking cessation. This according to the report in the journal, Pediatrics.

Dr. Tasnee Chonmaitree, professor of pediatrics and lead author of the study, says the incidence of ear infection in the first year of life has dropped significantly since the late 1980s and 1990s, which is the last time that similar studies were completed. Investigators found the rates of ear infection dropped from 18% to 6% by three months of age, from 39% to 23% by six month of age, and from 62% to 46% by 12 months of age.

The team followed 367 babies, all between 1 and 12 months of age from October 2008 until March 2014. They gathered information on family history of ear infections, cigarette smoke exposure and breast versus bottle feeding. They also collected nose and throat mucus samples throughout the study to seek out and identify infections.

0:18:10

Parents notified the study team whenever their baby had any signs of an ear infection or viral upper respiratory infection. And one of the study physician would see and examine the baby within five days.

Dr. Chonmaitree says, “We clearly showed that frequent upper respiratory infections, carriage of bacteria in the nose, and lack of breastfeeding are major risk factors for ear infections. Prolonged breastfeeding was associated with significant reductions in both colds and ear infections, which is a common complication of the cold. It is likely that medical interventions in the past few decades, such as the use of pneumococcal and flu vaccines and decreased smoking also helped reduce the incidence of the disease.”

Also known as acute otitis media, ear infections are one of the most common childhood diseases and the leading cause of visits to the doctors by children. They’re also the most common reason children take antibiotics and undergo surgery — to have ear tubes placed, in case you’re wondering. Having ear infections as a young infants under the age of six months also increases the risk of recurrent or repeating ear infections later in life.

So it’s good to see research on ear infections again. It’s been awhile. Also good to see the rate of ear infections declining.

I would add another reason to Dr. Chonmaitree’s list. She mentioned breastfeeding, pneumococcal and flu vaccine and decreased smoking by parents and caregivers. All good things, for sure.
I would add, I think we, as providers, aren’t as quite as quick to call an ear infection an ear infection, especially in children with colds who aren’t fussy and pulling on their ears.

If they have a viral upper respiratory infection and are otherwise happy, eating well, don’t have a fever, yet their eardrum looks a little red, maybe even has a small amount of fluid behind it, are we more likely to let the illness play out, give the immune system a chance especially in older infants? I think so, in the name of antibiotic stewardship.

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So kudos all around for breastfeeding vaccines, smoking cessation and conservative use of antibiotics. We’re making a difference in the lives of our children. Now, despite best efforts, lots of kids still get ear infections. So if your child gets one or two or three, don’t feel like a failure. It still happens to the tune of nearly half of all babies by the age of 12 months according to this study.

So if you’re dealing with ear infections at home in the young child, don’t be too hard on yourself. If you can breastfeed, sure do that. Make sure your child’s fully immunized. That’s always important for multiple reasons, and if you’re smoking, please stop for you sake and the sake of your kids and get help in doing so. Because it’s very difficult to stop smoking on your own.

Aside from these suggestions, there’s not much more you can do. You can get your kid out of daycare, where they catch most of the colds, which then leads to ear infections as a complication of the viral upper respiratory infection. But that’s not very practical for most parents, and really if you shield them from viruses now, they’re only going to get them later like when they start school, right? Colds are inevitable. And for nearly half of all babies, ear infections are still inevitable, too.

[Music]

Dr. Mike Patrick: Dr. Lara McKenzie is a principle investigator with the Center for Injury Research and Policy at the Research Institute at Nationwide Children’s Hospital. She’s also an Associate Professor of Pediatrics at the Ohio State University College of Medicine and the Division of Epidemiology in the Ohio State University College of Public Health.

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Her research focuses on injury prevention and childhood safety including raising awareness among parents. And she’s been instrumental in the national Make Safe Happen campaign. She joined us on PediaCast Episode 336 to talk about fire safety. She’s back today and the topic at hand is poisoning and toxic substances in and around the home.

So let’s give another warm PediaCast welcome to Dr. Lara McKenzie. Thanks for stopping by today.

Dr. Lara McKenzie: Hi. Thanks for having me again.

Dr. Mike Patrick: Really appreciate it. Remind us what Make Safe Happen is all about. Just that program and campaign in general.

Dr. Lara McKenzie: Sure. The Make Safe Happen Program is a program at Nationwide Insurance, and we are a member-partner with them in that. We’ve created a Make Safe Happen app so that parents and caregivers can follow safety checklist in each room of their house. They can get recommended safety products to install on their home. They can set reminders for things like checking their smoke alarms and testing their carbon monoxide detectors. And all the information in the Make Safe Happen app is tailored to the age of their children, so they can really just focus in on the things that they need to do right now.

Dr. Mike Patrick: That’s great. And we’ll have a link in the Show Notes for this episode, 344, over at PediaCast.org, where folks can get a link to find the website and then, from the website, there’s links to the various apps that you have in the iOS store and Android, all that.

Dr. Lara McKenzie: Yeah, links to the apps, free download from the apps on Android and iOS and also a lot of safety information. They break it down by topic and by age, and they have got some great information on the Make Safe Happen website.

Dr. Mike Patrick: Great. That’s fantastic. So let’s talk today around the home. I know there are five toxic substances in particular that may not be at the top of parents’ lists before they heard this program, but they probably should be. What are those five things?

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Dr. Lara McKenzie: The things that we’re going to talk about today are hand sanitizer, laundry packets, medication, button batteries and e-cigarettes.

Dr. Mike Patrick: OK. So let’s start with the hand sanitizers, because most parents would think, “Hey, sand sanitizers are a great things. They’re keeping our kids from getting sick.” But, they really can cause a problem, can’t they?

Dr. Lara McKenzie: Yeah, and some of the hand sanitizers these days, they’ve got glitter, or they smell really nice. And young kids are really attracted to things that look like candy or smell like something delicious. They are really drawn to things like that.

And the thing with hand sanitizer is even a couple of squirts of hand sanitizer can be really dangerous for a child if they ingest it. The alcohol content in some hand sanitizers is actually pretty high, like 60% ethyl alcohol, and that is stronger than the concentration in most hard liquor. So that is not something you want a kid to ingest. And when it looks and smells like something interesting to a child, they may be tempted to taste it.

So hand sanitizers sort of one that maybe not on everyone’s register, that it’s something we need to keep away from kids. We encourage them to clean their hands all the time. We want them to use it. Using it is fine. You need to sort of watch them while they’re using it. And then, maybe lock it up or store it up, so that they can’t get it on their own.

Dr. Mike Patrick: Right, yeah. I mean, really, with it being 60% ethyl alcohol, just like two or three squirts is enough to cause alcohol poisoning.

Dr. Lara McKenzie: Absolutely. So some of things you want to, the symptoms or the signs of alcohol poisoning that you would want to look for if you thought your child may have ingested it, they may be can’t think clearly. They might be throwing up. They can’t stay awake. They’re breathing really slowly or irregularly. They might look blue or pale. They could be shivering.

0:26:09

Really, any of those signs, not all of those, but just any one of those things, you would want to call Poison Control or Poison Help number which is 1-800-222-1222. Call right away if you think your child has swallowed any hand sanitizer. You don’t need to wait for these symptoms to develop to call.

Dr. Mike Patrick: Yeah, absolutely. Now, parents out there may be thinking OK, really, how often does this happen? But actually each year poison centers manage over 17,000 hand sanitizer exposures in kids that are less than 12 years old. So this really does happen. You have to be careful.

Dr. Lara McKenzie: Yeah, this is a real problem. You know, I bet the numbers are even higher because that’s just calls that are handled by poison centers. So there’s probably a lot of kids that ingest, they might go to their doctor, their primary care. They might go right to the emergency room.

Again, this is a product everybody has that we actually encourage kids to use. We want them to have clean hands because, let’s face it, they are dirty little people all the time, right? The dirt and mulch and whatever they’re playing in, we want them to have clean hands. And this is one of the ways we encourage them to do it. They do this at schools, the day cares, at home. So kids really use this product a lot. We encourage them to use it, but we need to make sure they do it safely and they don’t get tempted to try to taste it.

Dr. Mike Patrick: Yeah. And supervision is the biggest prevention really and to keep it up and away when you’re not supervising their use of it so they don’t get into it. They even put glitter in some of it. So it just look so inviting. It’s crazy.

Dr. Lara McKenzie: I mean, I don’t blame them. It looks like it would taste good and they smell good, too.

Dr. Mike Patrick: Yeah, exactly. Now, the next item on our list, I think that we’re doing a little bit of a better job with this one. I think there’s a bit more awareness about it. But, of course, it’s still very dangerous or has the potential to be dangerous, and that’s laundry packets. Tell us about that.

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Dr. Lara McKenzie: Sure. So laundry packets, like hand sanitizer, we’ve kind of got the same issue here. And that it’s their pretty colors or their shapes are interesting to kids. But the laundry packets are very dangerous for young children. They’re really popular and a lot of parents think that they’re convenient for doing laundry, but they’re really more toxic than liquid and powder detergent, and they pose this poisoning risk to little kids because they can look like candy or toys to a young child.

So the idea with the laundry packets is to keep them away from your kids is keep them lock up if you do have them. Now, some people recommend not using these kind of laundry packets when you have children under five, for some of the reasons that I just mentioned, that they looked like something else to a young child. They can’t read. They don’t know what that something is. They might think it’s a teething toy or something they can put in their mouth. And because they’re so concentrated, they can be really dangerous. And they’re made to dissolve when they get wet.

So the kid has sticky hands, wet hands. They could dissolve if they put it in their mouth. They can give them a huge dose of detergent that we don’t want them to have. So for kids under five, we say maybe we don’t want to use this product yet. Or if you choose to use it, that you’re going to keep it up on a high shelf and in a locked cabinet so that they can’t get it. Another recommendation is to really do that kind of laundry when the kids are napping or they’re doing something else, so that the kids aren’t involved with the packets at all.

Dr. Mike Patrick: So they don’t see them. They don’t even know that they exist.

Dr. Lara McKenzie: They don’t see them, they don’t… Yeah.

Dr. Mike Patrick: That’s great. They could look like a teething ring, too. They look like something a kid should put in their mouth.

Dr. Lara McKenzie: Some of them can look really close in color and some of the shapes to pacifiers. And to a kid who can’t read who doesn’t know what that is, it may look just like a candy that you want to put in your mouth.

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Dr. Mike Patrick: Right, yeah. I would assume it’s more dangerous than powders and liquids because of just the concentration, because it’s so much detergent in such a small package.

Dr. Lara McKenzie: That’s exactly it. So you would think about the relative size of how much you would use… Let’s say if you’re washing clothes, you might fill a cup of liquid or powder detergent, and for the packet, you’re just popping in one small packet. And that is going to wash the same amount of clothes. So it’s just a higher concentrated dose of it.

Dr. Mike Patrick: You mentioned even the sticky finger, this can dissolve the outer layer. And if they get the detergent on their skin, that could be an issue too, isn’t it?

Dr. Lara McKenzie: Absolutely. Could squirt on their eyes, on their skin, on their mouth.

Dr. Mike Patrick: And their fingers go in their mouth.

Dr. Lara McKenzie: And their fingers go in their mouth. The package actually can pop pretty easily. So even if your hands aren’t wet and they don’t dissolve the outer coating, if you squeeze it, even a little bit, it will pop. So that stuff can just go right in their face or in their eyes.

Dr. Mike Patrick: Yeah, yeah, that’s definitely a danger. And then, that’s going to irritate the inside of the mouth, their esophagus.

Dr. Lara McKenzie: Oh, yeah, absolutely.

Dr. Mike Patrick: It can really cause big, big problems. What kind of symptoms would you anticipate with that, if they have exposure?

Dr. Lara McKenzie: If a child comes in contact with a laundry packet, his or her symptoms could include things like mild stomach ache, vomiting, coughing, choking, wheezing or gasping. They may have eye pain or irritation if that product gets in their eyes. They might have some drowsiness. So if they’re having trouble breathing or unconscious, having seizures, anything, you want to call 911. But if you suspect that they’ve gotten into a laundry packet, or you’ve seen that they’ve got into one, you want to call the Poison Help number.

Dr. Mike Patrick: And again, 1-800-222-1222.

Dr. Lara McKenzie: We’re going to have it memorized by the end of this.

Dr. Mike Patrick: There’s a jingle. You don’t want me to break out in song.

[Laughter]

0:32:05

Dr. Mike Patrick: I think we’ve actually played that on PediaCast in the past.

Dr. Lara McKenzie: Yeah. I think that’s how a lot of parents remember it.

So, one thing we should add about the Poison Help number is to put it on your phone, in your smartphone because a lot of people used to have a sticker for this number next to their landline, and nobody has landline. Or, if you do, nobody answers it or your phone’s not charged. I don’t know, this happens in our house too. We sort of don’t even know where the landline phone is right now. But I always know where my cellphone is.
.
Dr. Mike Patrick: Yeah, that’s a great idea.

Dr. Lara McKenzie: I want to have that number right there.

Dr. Mike Patrick: So 1-800-222-1222. And that’s a national number but it will link up wherever you are to your local poison center.

Dr. Lara McKenzie: To your regional poison center, exactly, yup.

Dr. Mike Patrick: And then, with that phone number in particular, it’s staffed 24 hours a day, 7 days a week, 365 days a year. There is always going to be someone who is knowledgeable about exposures and poisoning and can let you know, “Hey, is this dangerous, not dangerous. You need to go to the emergency room,” that kind of thing.

Dr. Lara McKenzie: Exactly. So this is something, we don’t want to see people Googling ‘my kid just ingested something’. We want to call the Poison Help number. They will tell you better than you could find yourself information on what to do. So they may say, “This is OK, we need to just watch them.” Or, “You know what, you need to take your child to the emergency room right now.”

And the other thing the Poison Help Number and the regional poison centers do is that they follow back with you. So, you’re in really good hands if you call them.

Dr. Mike Patrick: That’s a great point. The phone number in case you missed it, we’re going to put it in the Show Notes for Episode 344. So if you go to PediaCast.org, you can find it easily. And again put that number in your phone contacts so you can find it easily, 1-800-222-1222. But again, if your child’s unconscious, not breathing, having seizures, call 911. Get help right away.

Dr. Lara McKenzie: There are a couple more things about laundry packets that I wanted to mention that I kind of forgot about, that I think are really important for parents. So, the laundry packets usually come in packages that are really easy for kids to open. So this is another reason why we want to keep them, not just because they’re attractive and they could look like other things but the containers that they come in, sometime they’re in those resealable bags. That is a lot like a snack bag that we do put kids’ snacks in.

0:34:20

So if you’re a child who can’t read and you’re now seeing something attractive in a container that you can open, another reason to keep it locked up or stored.

And then, we don’t want to take laundry packets and put them in other containers like a Tupperware container, for example, again because it’s going to be easy for kids to open those. And they may think it is a snack because it’s in may be a food container.

Dr. Mike Patrick: Yeah, excellent points all around. With these laundry packets in terms of the scope of the problem, from a poison center standpoint, each year, nearly 12,000 children, 5 and under are harmed by laundry packets which that works out to more than one child every hour in the United States.

All right, well, let’s move on to the most common cause of childhood poisoning, over the counter and prescription medications. It’s really important to keep those away from kids, right?

Dr. Lara McKenzie: Yeah, absolutely. So again, this is starting to sound similar to the other two — the hand sanitizer and the laundry packets — medications and especially some of the over-the-counter stuff can look like candy to a child. So, vitamins come in gummy forms now. Pills can be sugar coated. And syrups, they come in different ice pop flavors. Stuff is attractive to kids when it looks like that.

So it’s really important that all medications and over-the-counter stuff, too, needs to be locked up in a cabinet and secured.

Dr. Mike Patrick: Yeah, absolutely. Not only the child’s own medicine and the parents’ medicine but also even pet medicine can also be an issue.

Dr. Lara McKenzie: Absolutely. I think it’s something we don’t typically think of when we think of medicine. What comes to mind is like what’s in a prescription medicine bottle. We don’t think of all these other things — the over the counters, the pet meds that you may have. This could be their flea and tick medicine. This could be their heartworm medicine. This could be some kind of ointment that you need to give your cat or your dog or your turtle, I don’t know.

Dr. Mike Patrick: Yeah, great, great.

0:36:25

Dr. Lara McKenzie: But people don’t always keep that medicine with the adult and the human medicine, so it needs to be locked up and stored the same way that you store human medicine. I guess another thing with pet medicine is that you want to watch out when you’re giving those pets their medicine, that the kids aren’t around to either touch that cream or ointment or pick up that pill that maybe the dog didn’t swallow.

Dr. Mike Patrick: Right, right.

Dr. Lara McKenzie: So there is another risk there that when you’re administering some of these pet medications. But for the most part, we’re talking about human meds and kids getting into that stuff.

Dr. Mike Patrick: Also, if you have visitors over and grandma for instance, and her purse can be on the floor, and if there’s medicine in there, a toddler can get in to grandma’s purse pretty easily.

Dr. Lara McKenzie: Absolutely. You’ve seen it when people have the days-of-the-week pill containers where it may sort their medicine. Or maybe they’re visiting for a long weekend, or they’re there just like you said, they bring their stuff over. It’s in their purse, and the purse just gets dropped by the front door. Kids are really curious. They will get into stuff, and that stuff’s going to look like candy to them.

Dr. Mike Patrick: Yeah, and it’s so easy to get into those Monday to Friday… You know what I’m talking about, the daily medicine cases.

Dr. Lara McKenzie: I think my kids would think, “Oh, just little snacks, here you go, in a little cute container.”

[Laughter]

Dr. Mike Patrick: Something too, a lot of times, I’ll hear parents present the medicine as candy. You know, like “Hey, take this. It’s just a little bit of candy.” They try to encourage them to take their medicine that may not taste the best. That’s probably not a good idea.

Dr. Lara McKenzie: Yeah, I would tend to not try to tell them it’s candy or that it tastes like candy, but that it is medicine, and it’s something totally different than candy.

0:38:05

Dr. Mike Patrick: In terms of the scope of this problem, every year, more than 64,000 children go to ERs for medicine poisoning. So that works out the one child every eight minutes. So this really is a big issue and something that’s totally preventable.

Dr. Lara McKenzie: Really, it is. Because keeping stuff locked up. So child-resistant containers are great but they’re not child-proof. Kids, given enough time and will, will be able to open some of those things. So just keeping it in child-resistant container is not the highest level of security. It’s really going to be keeping it locked up.

Dr. Mike Patrick: What’s best practice for getting rid of medicines that you’re not taking anymore? Do you throw it in the trash? Do you flush it down the toilet, down the drain? What are you supposed to do?

Dr. Lara McKenzie: I think it depends on the type of medicine but getting rid of unused or expired medicine, you can see if your community has a take-back program. And some communities do, where you can just drop medications off and they will safely dispose of it. To do it yourself, you need to take the medicine out of its packaging and put it not a sealable plastic bag.

And if you’re throwing out pills, you can add water that would dissolve them. You can also mix any of these medicines in cat litter or saw dust or used coffee ground and then toss it in the garbage.

With a lot of prescription medicines, you don’t want to flush those down the sink and the toilet, unless they tell you to do that. And again, I think you could call the Poison Help number for this kind of information on safe medication disposal.

Dr. Mike Patrick: That’s great, 1-800-222-1222. If your child does take something, do you want to make them vomit?

Dr. Lara McKenzie: Not necessarily, because depending on what it is, that could be just as bad to come back up again, so you want to call. This is again, don’t Google what they just swallowed. I would call Poison Help right away. They will tell you the best information, the most accurate and then you won’t have to worry about finding that right information.

Dr. Mike Patrick: We used to, this is a long time ago, we would give out parents a packet that had poison safety tips and little bottle of Ipecac with it.

0:40:06

Dr. Lara McKenzie: Ipecac, yeah.

Dr. Mike Patrick: But we don’t really recommend that unless someone tells you to do it. Don’t do it on your own. Same thing with charcoal, some folks buy that and have in their house. Don’t give them anything. Call Poison Control.

Dr. Lara McKenzie: Yes, so I wouldn’t give them anything. It’s OK to have those two things, but again, those are things you also keep locked up. You can’t leave the Ipecac on the counter because if the kids comes and gets into that, they will obviously throw up. That makes you vomit.

So keeping those — I don’t know if I call them remedies — but those assistant’s tools or whatever if somebody gets into something, it’s OK to have them, but you also have to keep those stored.

Dr. Mike Patrick: Yeah, makes sense. Moving on to button batteries, these are quite a problem.

Dr. Lara McKenzie: So button batteries are really interesting because they can look like coins to kids. They can be really small and shiny and that’s attractive to children, and they’re in everything. They’re just in stuff now that we didn’t used to have. So they’re in remotes. They’re in key fobs for your car. They’re in greeting cards. They’re in a lot of toys and a lot of little gadgety things around the house.

Dr. Mike Patrick: Thermometers, calculators.

Dr. Lara McKenzie: Just more and more surprised as in my own home how many of these things seem to turn up. So it’s something that most people aren’t really tuned into as something that is a risk. And we’ve sort of talked about it as a poisoning risk, because it’s typically something that’s ingested, but the mechanism and why these are so harmful is that they, once swallowed, can burn kids from the inside. And they can be really, really dangerous and they can be deadly.

Dr. Mike Patrick: This is an important point. So if they got stuck in the GI track and that caustic chemical is leaking out, that just can eat through the intestine or the stomach and then cause infection. Because the contents inside the GI tract has a lot of bacteria, and then which then goes into the body cavity. So that can be really, really serious.

0:42:08

Dr. Lara McKenzie: Yeah, the thing that scares me, personally, about button batteries is that the symptoms, when you ingest the button battery look like the flu. It can look like a stomach ache. It can look like vomiting, things that little kids really have all the time.

Dr. Mike Patrick: Just subtle symptoms.

Dr. Lara McKenzie: Yeah, and some of the deaths from these button batteries that have been in the news. They talked about child who that is what they died from, but what the parents thought was that the child had a flu or was sick for awhile, couple of weeks even, where this process was happening and this thing was burning them and making them so ill that they eventually died. So if you suspect your child has ingested one of these, you want to get help right away.

There’s a couple of ways that we would recommend doing it. So, for this one, you want to call the National Battery Ingestion Hotline, which is a different number than Poison Help. And that number for the National Battery Ingestion Hotline is 202-625-3333. But if you know that your child has ingested one, you might want to get help right away.

Dr. Mike Patrick: Yeah, just go to an emergency room.

Dr. Lara McKenzie: Go to an emergency room. I think some other people have suggested that you want to make sure that someone doesn’t think it’s a coin that they swallowed. Because on an X-ray, this button battery can resemble a coin. The remedy for swallowing a coin in most cases is to let it pass. You don’t want to do that with a button battery. This is something that needs to come out right away.

Dr. Mike Patrick: And that phone number for the National Battery Ingestion Hotline, we’ll put that in the Show Notes as well over at PediaCast.org for Episode 344.

That is a really good point. So on X-ray, especially those larger button batteries could like a nickel or a quarter. So, you really have to have a high index of suspicion that this is what’s going on.

Dr. Lara McKenzie: Yes.

Dr. Mike Patrick:: Yeah, good point.

0:44:06

All, right, what about e-cigarettes. Those are out there more and more and folks think this is a safer way to take my nicotine, right? But it’s dangerous for kids.

Dr. Lara McKenzie: Yeah, the jury may still be on whether it’s really a safer form of nicotine intake than not. But that’s not what we’re talking about here. Today, we’re talking about the vaping and the accessories that go with it and how those can be dangerous to children.

So like the other products we’ve talked about today, the refills, the nicotine refills for e-cigarettes are often flavored and they have different scents — rootbeer, bubble gum, other sweetly flavored refills. They’re just really popular. And even though they’re tobacco-free, you’d still want to avoid using these things around kids. If kids see you putting this in your mouth and that it smells good, they might want to try to taste it.

Dr. Mike Patrick: Especially when you have flavors like rootbeer and bubblegum, it really does smell like it’s something that you’d want to put in your mouth.

Dr. Lara McKenzie: Absolutely. Because, again, the refills are highly concentrated, even getting a little bit on your hands isn’t good. Then, getting it in your mouth or swallowing a whole bunch of it can make you really, really, really sick or in some cases, you could die from this.

Dr. Mike Patrick: In addition to the refill cartridges being toxic, there’s also small pieces parts of the e-cigarette that kids can choke on, probably not something you want to have just sitting around even if the nicotine stuff is put away.

What are some of the symptoms of nicotine poisoning?

Dr. Lara McKenzie: Well, you know, it starts to sound similar to some of these other things but vomiting or difficulty breathing would be signs that they might have come in contact with e-nicotine. Some other things are faster heartbeat, feeling jittery or unsteady, increased saliva.

0:46:13

But again, if you suspect that your child has come in contact with e-nicotine, you don’t need to force them to throw up. Just call Poison Help number and they will tell you what to do. But if they’re unconscious or not breathing or having seizure, you want to call 911.

Dr. Mike Patrick: Poison Help line, 1-800-222-1222. Put it in your cellphone, and again call 911 if your child’s having a serious problem, unconscious, difficulty breathing, seizures, that sort of thing.

So, great points all around and things that I think aren’t necessarily always on the top of parents’ watch list but they should think about them. What’s the best way to just in general poison-proof a home?

Dr. Lara McKenzie: So I would go room to room. This is just the way I think about my own house. Because it’s hard to think about all the cleaners that I have unless I’m standing in the room because I keep things in different places in different parts of my house. So I go room to room.

You don’t have to lock every single cabinet. You can try to consolidate the cleaners or the medicines to one cab and in each room so that I have one place that’s secure, that’s lock and I can store these things in this room. Then, I’ll go to the next room and I think, “Oh, I didn’t realize we had this on the mantle, or, “We keep this in the other room now.” I need to kind of just bring all the things back to that locked space or that designated place. So room to room is what I like to do.

Finding that designated space to keep things lock and secure, returning those items to that place after each use — now, this is something that all parents will think is a huge pain, but this the only way. There’s no other way to do this. You got to just take that item when you’re done using it and put it back in that place so that kids don’t get in to it.

0:48:09

When we have really young children, they don’t know how to read, they don’t know what things are. They don’t know that they’re dangerous. We’ve talked about how almost all these products today have some flavoring or smell or some attraction that’s going to draw a child to it. They can’t figure out on their own that these things are going to be harmful. So it’s our job to keep them safe from these products.

Another things is, when kids are a little bit older, and they are able to access certain things, they may have… So I’m thinking of a situation where we got an older sibling and a younger sibling who comes along after. So, older sibling is reaching for the cookies and opens a cabinet. That’s where you keep the cleaners or the medicines. And a younger kids comes along because that cabinet hasn’t been secured or locked up and then they’re able to access it. They see what the older kids do and get in to those spaces.

Dr. Mike Patrick: And it’s not just inside of the house that we should be kind of taking the inventory and looking around. What are some other places around the home that…

Dr. Lara McKenzie: So I think a lot of people think of the kitchen and the bathroom as sort of main places where you keep medicines and cleaners and stuff like that. So we need to also think, like I said, every room in the house and sort of in and around the house, too. So you want to think about the garage. You want to think about the basement or the laundry area if that’s different, the shed or if you’ve got a detached garage or a attached garage, wherever you keep some of these things that maybe you don’t get in to all the time — cleaners or pesticides or fertilizers.

Dr. Mike Patrick: Even gasoline for the mower.

Dr. Lara McKenzie: Gasoline for the mower, yeah. This is stuff, in the summer, a lot of people are using that all the time, but sometimes, it’s just stored on a shelf, in a pantry, in a laundry room, in a shed.

Dr. Mike Patrick: What about plants? Can plants be poisonous to kids, too?

Dr. Lara McKenzie: Yeah, some plants can be poisonous to kids. I don’t know all the types that are, but…

0:50:00

Dr. Mike Patrick: Berries, you want to avoid the berries, right?

[Laughter[

Dr. Lara McKenzie: Yeah. Poinsettias, I think maybe. So it just depends what you have in your house.

Dr. Mike Patrick: That’s when you can Google, right?

Dr. Lara McKenzie: Yeah, I think, fake plants are really good too for those of us without a green thumb and also who have young children.

Dr. Mike Patrick: Yes, absolutely.

All right, well, we really do appreciate you stopping by and talking with us again today about safety. And again, the Make Safe Happen website and app, fantastic resources for parents, we’ll put links to those resources in the Show Notes as well as the National Battery Ingestion Hotline number, Poison Help number, 1-800-222-1222.

I’ll also put a link to PediaCast 336 when you’re on to talk about fire safety around the home. Then, we’ll have you back at some point here to talk about more safety stuff.

Dr. Lara McKenzie: Thanks. Yeah, that’ll be great.

Dr. Mike Patrick: Before your run, one of things that I like to kind of advocate for parents is just to play games together. So what are some of your family’s favorite games to play?

Dr. Lara McKenzie: My kids are four and a half now. They will be five in July, and they’re really competitive when we play board games and stuff. So we’ve started playing some of these cooperative games. I don’t if you’ve played some of these. They’re just a board game where everybody is moving one piece together and sort of the collective group has to achieve something to win. So that’s really good for four-and-a-half year olds, too. Like, “I want to win,” and, “I want to do this.”

So we’ve tried a couple of those games and they really like that. But they’re into everything, they just like playing together, you know.

Dr. Mike Patrick: Yeah, that sounds fun. We got a game for Christmas called Caverna, which is a pretty complicated game. But if you have older kids and teenagers, it’s really fun. Basically, you’re a cave farmer. So you have to kind of build the rooms in your cave and you have to farm and have fields and livestocks.

It’s pretty involved and lots of little parts that is not a good… It’s definitely a choking hazard. But if you have older kids, Caverna, The Cave Farmers, we got a lot to play out of that, especially on a rainy day. But it’s long. It takes about half an hour per player. So if you get a family of four together, it’s a two-hour game. But the parts are so cute, like little sheep and donkeys and cows.

0:52:25

Anyway, that would be one I would give a try if you have older kids.

All right, well, Dr. Lara McKenzie, principal investigator with the Center for Injury and Research and Policy at Nationwide Children’s, thanks again for stopping by.

Dr. Lara McKenzie: Thank you.

[Music]

Dr. Mike Patrick: We have a listener question today from Faith in Colorado. It’s on ADHD medication dosing, and I know we’ve talked about ADHD quite a bit in recent weeks, but hey, you guys keep bringing it up. And I want to get your questions answered. And I know for every parent that asks a question, there are many, many more of you out there who have the same question. ADHD, it affects so many families that I think it’s an important one to consider, even though we have considered it before. But this one, with a slightly different angle.

So Faith in Colorado says, “Hello, Dr. Mike, my daughter has recently been diagnosed with ADD. After discussing several treatment options, my husband and I agreed to start out daughter on Vyvanse. She started out at 10 milligrams then went to 20 milligrams. At 20 milligrams, she seem to be having intense emotional outbursts. My husband called her doctor, relayed this information and now, she’s back down to 10 milligrams.

“While this has been helping her immensely during the day at school, the mornings and evenings are difficult to say the least. When she arrives home after school, she is intensely active, running and jumping around the house uncontrollably. And when we try to calm her down, she fights back physically. Is the intense activity at the end of the day a result of the medicine? She’s on such a low dose, but could this be?