Safe Medication Practices

by Kala Rorbaugh with contributions by Jeni Burgess, Kelly Steidl and Margaret Anderson of Upstate Golisano Children’s Hosptial Peds Pharmacy Service

A sick child can put quite a bit of stress on a family and the added stress of several medicines creates an opportunity for medication errors to occur.  A medication error is an error that can happen at any point in the treatment pathway, starting when a clinician prescribes a medicine and ends when the patient receives the medicine.  Certain patients are at a higher risk for medication errors, including children, elderly patients, and those who take more than three medicines.  Knowing how to safely store, administer, and dispose of your child’s medicines can help prevent medication errors. 

Don’t Store Medicines in the Medicine Cabinet?

Medicines are often sensitive to changes in things like temperature, humidity, and light to name a few.  If a medicine is not stored in the right place it may make the medicine not work correctly.  It is important to check the labeling of a medicine for directions on how to store it properly.  If the label is unclear your pharmacist would be more than happy to help you. 

While the medicine cabinet’s name would suggest it would be a great place to store medicines, it actually is not!  The humidity in the bathroom from hot showers and baths can actually alter the medicine.  A cabinet in a kitchen or a hallway closet may be preferred if the temperature changes less often.  Some medicines need to be kept in the refrigerator; place these medicines in a safe place inside the refrigerator so they cannot be easily confused as a treat to children who are able to open the door.

 It is important to monitor the expiration date on a medicine.  While it may seem like a good idea to keep the leftover antibiotic “just in case,” it can be dangerous to take an expired medicine or to attempt to treat something with the wrong medicine

 Lastly, all medications should be kept out the reach of children!   Tell anyone at a house your children may be staying at to please do the same, Grandma and Grandpa may have some medications that can be potentially dangerous to children.  Remember to keep your meds high and dry and closed up tight!  

Not All Spoons Are Created Equal!

Administration of a medicine involves several pieces: giving the right amount, of the right medicine, at the right time, by the right route, to the right patient.  The best way to do this is to create a Medication Administration Record or MAR for short.  This is a schedule for medicines and it will say what amount of what medicine to give at what time by which route.  Once the medicine is given, the spot on the MAR can be marked as complete.  There is an example at the end of this section.

The Right Amount

There are usually liquid preparations available for medicines that children take.  The label from the pharmacy will usually say how many milliliters or mLs to administer.  Never use a household spoon to measure how much medicine to give, they vary in size from house to house and you could end up giving your child either way too much, or way too little of their medication.  The best things are oral syringes and medicine cups that can be used to appropriately measure the medicine.  Syringes are more accurate and give you more control when administering medicines to a squirmy child than medicine cups do, but older children may prefer the cup over the syringe.  These are usually for sale at the pharmacy and sometimes if you ask the pharmacist they can just give you one!  Your pharmacist can also show you how to use the syringe correctly to make sure you get the right amount of medicine.

 The Right Medicine

When a child is taking several different medicines it is important to read the labels closely before giving a medicine.  Bleary-eyed parents have been known to grab the wrong medication when their child gets sick in the middle of the night so use caution!  Sometimes pharmacies will pour liquid medicines into amber-colored bottles that protect the drug from light; however they all look the same and can put you at risk for medication errors!  You can always use a marker to mark the lid to look different or put stickers on the bottle to help you distinguish medicines from one another.

The Right Time

Medicines can be given once a day, twice a day or more and many of them are different. So it is important to know how many times a day a medicine is to be given. Using the MAR from the example below is a great way to ensure that you are giving the medicine at the right time.  It is also a great way to make sure that you don’t give the same medicine twice by accident and helps you remember that you actually DID give the medication.  You may also wish to keep a medicine box that allows you to keep all of the tablets and capsules for the day in one handy place.

The Right Route

Before giving a medicine read the label and make sure you are certain where the medicine is going.  For example, is this a liquid medicine to be given by mouth? Is this a suppository to be given rectally?  Or is this a topical medicine to be applied to the skin?  If you are ever unsure about how or where to administer a medicine, your doctor, nurse, or pharmacist should be able to help you.  Also, whenever a new medicine is prescribed you should ask your doctor, nurse, or pharmacist how you should give the medicine.

The Right Patient

Sometimes more than one family member is sick, ensuring that you are about to give a medicine to the right patient is important.  If a younger, smaller sibling gets the older, bigger sibling’s medicine it could result in an overdose and possible harm.  Getting the child involved in their own care can help, asking questions like, “Are you Jimmy?” before giving a medicine can help prevent giving the wrong patient the wrong medicine.  Use these suggests for  your child might sound like this story. Jimmy has an ear infection that is being treated with amoxicillin two times daily.  To make sure that he is getting his treatment safely his mom creates a MAR.  Mom notices that it is 8:00AM and the MAR says it is time to give Jimmy his amoxicillin.  First, she pulls the amoxicillin out of the refrigerator.  She knows it is the amoxicillin because she drew a purple dot on the top of the lid and she read the label that says, “amoxicillin 10mL by mouth twice daily.” Next, Mom uses an oral syringe to draw up 10mL of amoxicillin out of the bottle and then she double checks the label and the syringe to make sure she has drawn up the correct amount.  Next, she asks, “Are you Jimmy?” Jimmy laughs and says, “Yes Mommy! I’m Jimmy!” Now that Mom knows she has the right dose of the right medicine for the right patient at the right time, she double checks that this medicine is given by mouth and asks Jimmy to open wide.  Finally, so that she and dad both know that Jimmy got his dose at 8:00AM she marks an “X” in the column for 8:00AM. 

Figure 1: MAR Example
Medicine

8:00AM

8:00PM

Amoxicillin 10mL by

X

 

 

Following the five rights before giving your child a medicine can help you ensure the safety of your child!

 

 

 

 

Medication Disposal

What happens when your child has finished the prescription but there is still medicine left?  What happens if a dose is changed and there is left over, expired medicine?  What happens to that medicine?  Leftover medicine should never be kept “just in case”.

Medicine that comes as pills or tablets should never be just thrown into the trash without first making the medicine undesirable to anyone who may stumble upon the trash.  This can be done by mixing the pills or tablets with used coffee grounds or kitty litter.  This is also an option for small amounts of liquid medication (just make sure it does not get too soupy).

Medicine that comes as a patch should always be place inside something before throwing it into the trash.  It can be put inside a laundry detergent bottle or something similar.  Again, our goal is to make it difficult to accidentally obtain.

Some medicines can be flushed down the toilet, a list of these medicines is available on the FDA website, an excellent sources of information on the disposal of medications. http://www.fda.gov/Drugs/ResourcesForYou/Consumers/BuyingUsingMedicineSafely/EnsuringSafeUseofMedicine/SafeDisposalofMedicines/ucm186187.htm

The last option, and the safest option, is to check with your local pharmacy and police station.  Sometimes these locations have Drug Take-Back Events.  Check you local paper’s webpage for dates and locations.

Before throwing out any empty bottles or other medicine packaging make sure to scratch our or blacken with a marker any patient information like name, date of birth, address, medicine name, and doctor so that no one else can access the information. Proper disposal of medicines can help keep not just your child, but other children and pets safe!

 

 

 

 

 

 

 

 

http://www.fda.gov/Drugs/ResourcesForYou/Consumers/BuyingUsingMedicineSafely/EnsuringSafeUseofMedicine/SafeDisposalofMedicines/ucm186187.htm (Really great disposal website)

               

 

Fun in the Sun – Sun Safety

By Kala R. Rorabaugh PharmD Pediatric Pharmacy Resident

Winter is finally over and it is time to go out to enjoy the sunshine!  But before you reach for those flip flops and beach ball you should make sure you and your children are protected against the harmful rays of the sun

 

UV or ultraviolet rays are the harmful rays of light that cause skin irritations like sunburn and skin cancer.  Fortunately, it is easy to protect yourself from these rays.  Sunscreen is the easiest way to protect your skin.  It is important to buy sunscreen that is at least SPF 30, but don’t be fooled!  An SPF greater than 50 does not mean better protection, stick to sunscreens with an SPF of 30-50.  Also make sure your sunscreen says “broad spectrum”, this means it protects against both UVA and UVB light.  It is also useful to get water resistant sunscreen so skin is still protected in the pool, lake, or ocean.  This information is usually available right on the front label of the sunscreen.  Most adults need about one ounce of sunscreen to cover their exposed skin, make sure you are applying enough sunscreen on your kids.  And don’t forget their face, neck, and ears!  There is lip balm with SPF protection as well.

  Sunscreen should be applied heavily approximately 15 minutes prior to sun exposure and repeated every 2 hours.  Apply more often if the skin becomes wet such as in swimming, vigorous activity or excessive sweating.

Keep infants under 6 months out of direct sunlight.  If shade is not an option, consult your doctor about using sunscreen.  The American Academy of Pediatrics recommends using small amounts of zinc or titanium based sunscreen as a last resort for infants.

Sunglasses and hats are not just great fashion accessories!  They’re also great ways to protect yourself from the sun.  Sunglasses protect the UVA and UVB rays from damaging eyes.  Hats help to protect any area shaded by the outline of the hat, for example a big sombrero will protect more than a baseball cap, but both are important for shielding your face from the sun!

When playing outside it is important to drink lot of water.  Children can easily become dehydrated while playing in the hot sun, even while swimming!  It is also important to avoid being out in the sun during the peak hours of sunlight, usually 10AM to 3PM, when the harmful rays are the most exposed.  If you must be outside, try to stay in a shaded area.

Even on a cloudy day the dangerous rays can cause skin damage, so even if it doesn’t look sunny you should still use sunscreen, wear sunglasses and hats, drink plenty of water, and keep out of the sun.  Practicing these sun safety tips can help you enjoy summer safely!

 

Helpful Websites:

http://www.skincancer.org/prevention

http://kidshealth.org/parent/firstaid_safe/outdoor/sun_safety.html

Let’s Not Meet By Accident during 100 Deadliest Days for Teen Drivers

By Kim Nasby, Upstate Trauma Center’s injury prevention coordinator and Let’s Not Meet By Accident instructor And Arielle Spears Marketing intern

 The Let’s Not Meet By Accident program of Upstate Medical University’s Trauma Center is offering easy tips for teen drivers during what the AAA Foundation for Traffic Safety deemed the “100 Deadliest Days for Teens.”

Upstate’s tips include how teen passengers can also help teen drivers stay focused on the road as well as tips for parents.

Despite progress in car safety regulations and new technology, motor vehicle accidents remain the leading cause of death for drivers ages 15 to 19. We at Upstate want to ensure that teens, their parents and the other drivers are properly prepared for the coming months, as well as encourage everyone to start practicing safe habits every day.

Tips for teen drivers and their teen passengers :

The most common distractions for teen drivers include cell phone use and texting, driving under influence of alcohol/drugs, talking with passengers, and the car radio.

Avoid distractions by:

Turning your cell phone off while driving. If not possible, put the phone on safe mode or download one of the many apps that prevents phone use while driving. Some apps offer settings that automatically reply to text messages. Passengers can hold the teen driver’s phone and respond to calls or texts for them. If the cell phone must be used by the driver, pull off the road at a safe distance before using the phone.

Have a back-up plan to avoid driving, or riding with someone under the influence of alcohol or drugs. Underage drinking and/or drug use while driving is illegal, dangerous and is proven to be deadly. Teen passengers should refuse to ride in a car with a teen driver who is under the influence. Remember, parents or other caregivers would much prefer a phone call for a pick up than a teen driving under the influence of drugs.

Limiting your vehicle to one passenger. Also, there is plenty of time to socialize after the ride, so teen passengers should reduce conversation and movement while on the road with teen drivers. Also, respect the teen driver and do not encourage negative behavior, such as speeding.

Finding your preferred radio station or playlist before you start the car and sticking with it until you reach your destination. Keep music at a low level and save the dancing for home.

Review maps and directions before leaving for an unfamiliar destination. GPSs should be placed in appropriate places that do not obstruct the driver’s view. If a GPS or map needs to be consulted, pull over at a safe distance. Teen drivers and teen passengers should also prepare for travel by checking the weather each day.

Keeping sunglasses in the car. The sun may also be an outside distraction for teen drivers. When buying sunglasses teens should opt for sunglasses labeled ‘UV 40’ or polarized lenses, to reduce glare from reflective surfaces like glass or polished metal.

Remember, all drivers, not only teens, should signal when changing lanes, wear a seatbelt, turn on headlights at night and during bad weather and always obey the speed limit. It takes only seconds to lose control of the car so don’t feel pressured by the flow of traffic to speed. Maintain a larger buffer zone with faster speeds.

Teen passengers should politely remind teen drivers to adhere to traffic rules if violated. Also, be on the lookout for pedestrians who may be difficult to see, especially at night and during bad weather.

Parents can also be of vital importance when protecting teen drivers and passenger.

Parents can:

Lead by example. Don’t text and drive, make sure all occupants in the car have their seat belt on and follow traffic laws.

Look into apps that monitor a teen’s texting and phone calls while they are driving.

Explain the dangers of driving under the influence and assure teen drivers, as well as teen passengers, that driving impaired is intolerable.

Consider a no passenger policy for their teen drivers until the teens have had more experience driving.

Stay informed on tips for safe driving for teens and review the information with their teen driver or teen passenger.

Let’s Not Meet By Accident is a free interactive injury prevention program designed by Trauma Services at Upstate Medical University to enlighten young drivers about the harsh realities of bad decision making behind the wheel. The program is offered once a month for up to 150 students from various schools throughout Central New York. The program services more than forty area high schools.

For more information, contact Let’s Not Meet By Accident at 315-464-4779 http://www.upstate.edu/surgery/healthcare/trauma/accident.php

 

LEON Day features Upstate specialists aimed at keeping kids safe

By Elle Spears

Upstate is inviting kids and families to a free giant holiday party June 25 at Onondaga Lake Park in Liverpool.  It’s called LEON Day (that’s NOEL spelled backwards) and celebrates the half-way mark to the December holidays, the end of school and a kickoff to summer fun. The event takes place from 5 to 10 p.m.

“We at Upstate are taking this opportunity to educate families about summer injury prevention,” said Tamer Ahmed, M.D., medical director of Upstate Golisano Children’s Hospital’s Pediatric Trauma Program. “In the summer, parents and children are more active, which increases the risk of injuries. We want to ensure that everyone is safe and well prepared for the coming months, as well as highlight the outstanding child-focused groups at Upstate and in our community.”

Upstate will distribute 1,000 free children’s helmets that will be fitted by the Upstate’s Pediatric Trauma team, and provide summer tips to parents on ways to keep their children safe. Other health information on topics ranging from proper sleep hygiene to the warning signs of diabetes will be available. Upstate will also oversee a special “hometown hero” section where medical helicopters, fire trucks, police cars and more will be on display.

Other highlights include: a balloon walk, where children can explore the inside of an inflated hot air balloon, bounce houses, human foosball, a dunk tank, face painting, photo booths, magicians and more.

The event will conclude with the dropping of an Orange ball signifying the halfway point to Dec. 25, followed by fireworks. Various displays from Lights on the Lake will be set up and Lights on the Lake holiday characters will interact with children at the festival.

A special feature of the event is a concert by the Kidz Bop, the national singing sensation that has kids and parents alike dancing and singing along to today’s hit music.

Don’t Believe Everything You Read!

Part One : Why You Should Be a Skeptical Reader?

By Amy E. Caruso Brown, MD, MSc, MSCS

This is the first entry in a new occasional series, Don’t Believe Everything You Read!, that will help families read reports about child health and wellness more critically and better understand the science and research methods behind claims that appear in the popular news media.

 If you’ve glanced at a newspaper or turned on the evening news in the last few months, you’ve probably heard statements like these:

“No correlation between time spent with mom and overall success, study says” http://www.ksl.com/?nid=1009&sid=34056890

“Toddler sleep problems tied to behavior issues later” http://www.foxnews.com/health/2015/04/13/toddlers-sleep-problems-tied-to-behavior-issues-later/

“Breastfeeding May Cut Breast Cancer Recurrence Risk” http://well.blogs.nytimes.com/2015/05/13/breast-feeding-may-cut-breast-cancer-recurrence-risk/?ref=health

“Bleach could be making your kids sick with respiratory infections”  http://www.theglobeandmail.com/life/health-and-fitness/health/bleach-could-be-making-your-kids-sick/article24045387/   In fact, Lee Livermore,Public Education Coordinator, Upstate New York Poison Center, wrote about that last one on this blog a few weeks ago.) http://blogs.upstate.edu/pedstoparents/2015/04/21/the-dangers-of-cleaning-with-bleach-in-the-news

After reading these headlines, you’ve probably also contemplated whether you should be making changes in your own life.  You might have rushed home and swapped out all your plastic cups and bottles for BPA-free glass and metal containers, or maybe you just spent the drive home after work feeling guilty for not having sleep-trained your one-year-old yet.

Confession: I’m writing this as I drink my fourth cup of coffee today, a quantity I adopted as a regular habit after reading the torrent of journal articles – and, yes, newspaper headlines – about the health benefits of coffee. We are all – doctors, nurses, psychologists, scientists, and others – just as eager as anyone not working in science and medicine to discover practical ways to improve our health and well-being.

But as a physician-researcher (I specialize in taking care of children with cancer, many of whom are enrolled on clinical trials, and in bioethics), what stands out to me is how confidently journalists and reporters, at even nationally renowned publications, repeat these statements. If you haven’t read a medical journal lately, you might be surprised to learn that the researchers themselves are almost never so confident in the original scientific papers. In fact, the “Discussion” section of most research papers – the section where the authors explain what they think the study proved and why anyone would care – almost always has a paragraph or two on the limitations of the study. Simply put, these are “reasons you shouldn’t completely trust what we say.” These can be related to how the study was set up in the first place, how it was conducted, or how the data was analyzed. Very often, the researchers make a tentative conclusion or recommendation but then add that they also think another study needs to be done before they can be certain of that conclusion.

Over the course of this series, we’ll talk a lot more about the idea “limitations” in research, because those “limitations” often disappear when medical research is translated into national news. We’ll use current headlines related to hot topics in child health to help you understand the science and medicine behind the headlines.

We’ll answer questions like these:

  • Who decides what research gets done and what questions get asked?
  • What kinds of questions can research studies answer? Why can’t we answer everything we want to know?
  • How does research happen, and how long does it take to complete a research study and publish the results?
  • What’s the difference between the data or results of the study and the conclusions of the study?
  • What are some of the problems – practical, scientific, ethical – that doctors and scientists run into when designing research studies?
  • Who pays for medical research?
  • How many people are involved in a research study and what are their roles?
  • How are people or patients recruited to enroll in research?
  • Where can you find more information about participating in research studies?
  • Where can you find original research publications to read yourself?
  • How should you read an original research paper? (hint: not from beginning to end!)
  • When should you be especially skeptical of a research claim?

Author Biography: Amy Caruso Brown is an assistant professor of bioethics and humanities and pediatrics at SUNY Upstate Medical University. Her research interests include the teaching of ethics and professionalism in medical education, the impact of social media on medical practice, provider-family communication, and medical decision making.


 

“Cured” of Autism – What Does It Mean?

By Margaret Ninno, M.S. Margaret L. Williams Developmental Evaluation Center

One in 68 children in the United States have been identified as having an Autism Spectrum Disorder (ASD) according to the Center for Disease Control. ASD is usually considered a lifelong condition. However, a recent study, When an Early Diagnosis of Autism Spectrum Disorder Resolves, What Remains?, looked at 569 children who had been diagnosed with ASD at around 2.6 years old. They did a follow-up study 4 years later and found that 38, or 7%, the previously diagnosed children no longer met criteria for ASD when re-evaluated. All of these children were enrolled in an intervention program in the Bronx, and they came from diverse racial, ethnic and socioeconomic backgrounds. Does this mean they were free of any developmental problems? Not necessarily.

After reviewing the data, researchers found that 92% of these 38 “cured” children continued to experience different degrees of residual impairment and behavior issues. More than half of them had some type of language or learning disability. Almost half of them appeared to have attention-deficit hyperactivity disorder (ADHD). Most of the children who lost the Autism diagnosis continued to need some type of educational support in school.

It is important for children with ASD to receive the supports and services they need as early and as intensively as possible in order for them to be the most successful at home, at school and in the community. Intense early intervention is the only consistently validated strategy to improve a child’s developmental outcome. Providing these services and supports can make a world of difference for these children. The children can develop skills and abilities that overcome many of the classic symptoms of autism, but, most continue to have some learning and behavioral challenges as this research indicates.

Margaret L. Williams Developmental Evaluation Center at http://developmentalevaluationcenter.com/

Two articles discussing the study:

http://aapnews.aappublications.org/content/early/2015/04/26/aapnews.20150426-2

http://www.medicalnewstoday.com/articles/293079.php

To view the study abstract, “When an Early Diagnosis of Autism Spectrum Disorder Resolves, What Remains?” go to http://www.abstracts2view.com/pas/view.php?nu=PAS15L1_2750.2.

 

Center for Disease Control at http://www.cdc.gov/ncbddd/autism/data.html

Viral Croup 101

by Jennifer A. Nead, MD Pediatric Hospitalist and Assistant Professor of Pediatrics

Croup is a common childhood illness and can sound very scary.  Children with more severe croup sometimes need to be treated in the emergency department and admitted to the hospital.  Here is some information on viral croup and what to expect if your child is evaluated at our hospital.

Viral croup commonly occurs in children 6 months-3 years (peak around 2 years) during the fall to early winter months.  At the beginning of the illness, children may have non-specific common cold symptoms such as runny nose, congestion, cough, sore throat and fever.  Eventually, irritation and swelling develop in the upper airway.  As a result, classic croup symptoms develop, including hoarse voice, dog or seal-like cough and stridor (high-pitched, noisy breathing heard during inspiration).  Some children will have high fevers.

Since viruses cause viral croup, antibiotics are not prescribed.   The best medicine is time and eventually, symptoms go away.   Children with more severe croup develop respiratory distress and struggle to breathe. Often, these children receive a breathing treatment called racemic epinephrine and a dose of steroids.  Both of these medications decrease upper airway swelling, making it easier to breathe.  Racemic epinephrine reduces swelling within minutes, but only lasts about 2 hours.  Steroids last much longer, but take up to 1-2 hours to effectively decrease airway swelling.   This is why children with more severe croup get both treatments.  The most commonly used steroid is dexamethasone because it is cheap and lasts in the body for up to 2.5 days.  Doctors prefer to give oral (by mouth) steroids.   Sometimes, doctors give steroids through an IV or IM route (which is a shot) because children are vomiting or are in too much respiratory distress and it’s unsafe to give them oral medication.  Usually, children who receive two or more doses of racemic epinephrine will be admitted to the hospital for observation.  In these cases, the doctors want to make sure their breathing remains comfortable.  Occasionally, these children require repeat racemic epinephrine treatments. At this time, research studies have not found humidified air, including steam or cool air, to be helpful in treating patients with croup.  This is why hospitalized children don’t get these treatments and why you will not see croup tents.   Since a dose of dexamethasone lasts for several days, a repeat steroid dose is not typically required.

We know that viruses cause croup, but doctors don’t routinely test children because the virus test is expensive and the result usually doesn’t change treatment.   If your child is tested, parainfluenza virus is the most common virus that causes croup.  However, it is important to realize that numerous other viruses also cause croup.   In order for children admitted with croup to go home, doctors want to see children breathing comfortably and drinking fluids well.  At the time of discharge, some children will have mild stridor, especially with activity.  As long as these children are breathing comfortably, they are safe to go home.  After discharge, children should see their primary care physician in 1-2 days for a follow-up appointment.  At home, parents should make sure their children get plenty of rest and fluids.   Children should start to get better in 2-3 days and as in the case of any virus, it may take 1-2 weeks for symptoms to completely resolve.

For more information see: https://www.healthychildren.org/English/health-issues/conditions/chest-lungs/Pages/Croup-Treatment.aspx

 

Keep Your Children Lead Safe Outdoors

by Dr. Howard L. Weinberger, Central New York/Eastern New York Lead Poision Resource Center, Professor of Family Medicine, Emeritus Professor of Pediatrics

Many parents are surprised to learn that childhood lead poisoning remains an issue for young children.  In New York State and around the U.S., exposure to lead and the developmental and learning disabilities that may follow, continues because of the high percentage of old homes containing leaded paint. 

The spring time brings warm weather and sunshine and the chance for the kids to play outdoors. In many neighborhoods, this brings the possibility that young children will accidentally be exposed to additional lead sources.

 

How does this happen?  Lead can be in the dirt outside in many ways:

For many years, cars used leaded gasoline and the residue from that old gasoline remains in the soil, especially in driveways or other places where cars were parked. Houses near highways that have been used for more than 30 years may also have leaded gasoline in the soil.

Any home built before 1979 may have lead in the house paint.  As the paint begins to chip and flake off the outside of the house, the particles land in the dirt.  Lead breaks down very slowly and can be found in the dirt around a house for many years. The spots most likely to have leaded dirt are an area 3 feet wide circling the house. This is called the “drip line” because rain and snow melt and drip down the sides of the house, carrying the old paint chips to the ground.  Over time, the paint breaks down into very tiny particles that are difficult to see in the dirt.

Small children often put their hands in their mouth and if they play in the dirt, it sticks to their fingers. When they put their fingers in their mouth, the lead is absorbed into their bodies.

How can you protect your child from outdoor lead poisoning?

Keep your children from playing in the dirt.  If there is grass in the yard, have them play in the grass.

 

All kids love to dig in the dirt- instead of dirt, buy them a small sand box and fill it with clean sand from the store.

If there is a neighborhood playground nearby, walk there to play and enjoy some outdoor fun!

Wash your children’s hands frequently, especially if they are little enough to have their fingers in their mouth often. You can carry wet paper towels in a plastic bag to clean their hands without needing to go into the house.

What should you do if you think your child has been exposed to lead, indoors or outdoors?

The best way to know if your child has too much lead is to have a blood test done.

Call your doctor’s office to find out how to have a blood lead test ordered.

You can also call the local Childhood Lead Poisoning Program.  You can find the phone number on line or in the telephone directory.

Keep your children lead safe for a healthy future!

 

Central/Eastern New York Lead Poisoning Resource Center

University Hospital, 750 East Adams Street, Syracuse, NY 13210
Phone: 315 464-7584

http://www.upstate.edu/gch/services/lead_poisoning/

 

 

 

Corporal Punishment: Lessons Learned

By Ann S. Botash, MD

“This is lesson number two, this is what you should not do.” The Bike Lesson, by Stan and Jan Berenstain

When Papa Bear shows Brother Bear the rules of the road in this 1964 book from the Berenstain Bear series, he inevitably ends up with a twisted bike in a comical mess. Although the story is about a bike lesson, I have often thought that the real lesson for parents reading this book to their children is that children learn from their parents’ actions – even “what they should not do.”  I loved this book as a child and now find it makes a useful point to help understand the issues related to corporal punishment.

Corporal punishment is defined as the use of physical force with the intent to cause physical pain but not physical injury, for the purpose of correction or control of the child’s behavior. Methods include the use of an open hand, hitting with an implement and/or enforced standing, starvation, cold bathing, etc.

 

USA Today just reported that Adrian Peterson has been reinstated to the NFL (April 16, 2015). The highly publicized whipping of his 4 year old son and subsequent child abuse charges caused a national outrage as the Vikings lost sponsors when they allowed him to play. The graphic images of his son’s injuries, classic findings of excessive corporal punishment, were posted in news articles on the internet.  The public and the media were divided in their support of him and his actions. Adrian Peterson’s mother was quoted as saying, “It is about love, it’s not about abuse, it’s about love.” Corporal punishment is a risk factor for escalation to physical abuse and severe injuries, such as those observed in Peterson’s son. Research shows that corporal punishment has no benefits over spanking and that other means of discipline are more effective.

Surveys show that many Americans do spank their children. In New York State, corporal punishment is allowed in the home, but may be considered abuse, neglect or assault. It prohibited in day care, alternate care, and public schools. It is allowed in private schools, although usually requires consent.  The American Academy of Pediatrics recommends that parents not spank their children. There are more effective methods to teach children right from wrong without hitting them. We want to guide children to make appropriate decisions, be safe, and grow up to have good self-esteem. We want to do this all while also modeling good behavior.

Positive discipline is an approach to teaching that helps children to succeed, gives them information and supports their growth. It brings together what we know about children’s healthy development, research on effective parenting and children’s rights principles. It is a set of principles that can be applied in a wide range of situations. In fact it can help guide all parents’ interactions with their children, not just those that are challenging.  Methods for positive parenting are based on principles that are:

  •  Non-violent
  •  Solution focused
  •  Respectful
  • Based on child development

The first of ten principles of positive parenting, recommended by Dr. Katharine C. Kersey Ed.D, 2006, is called the “Demonstrate Respect Principle.” This principle encourages caregivers to treat children the same way that they treat other important people in their lives. Some people would refer to this as the Golden Rule –treat people the way that you would want to be treated.  If you treat children the way you would want to be treated, they will learn to do the same. This is not only the first principle, but I would consider it to be lesson number one! For more information on the other 9 principles of positive parenting, click on the Health Link-on-Air links below to hear Dr. Alicia Pekarsky.

What do children learn if we use physical discipline to correct their mistakes?  The research on corporal punishment is clear. Spanking children is linked to poor behavioral and cognitive outcomes. That is, children who are hit do not learn “love” but learn to be more aggressive and do not learn as well.   Using forms of discipline that utilize threats and corporal punishment can lead to bullying behaviors in older children. Studies have shown increased medical problems, depression, poorer parent-child relationships, increased delinquent behavior, poorer mental health and later physical abuse of a grown child’s own children or spouse.

 This is what we should not do, this is lesson number two: Don’t hit your children!

For additional information:

American Academy of Pediatrics Committee on Psychosocial Aspects of Child and Family Health Policy Statement: Guidance for Effective Discipline. Pediatrics 1998 Aug;101;723-728. http://pediatrics.aappublications.org/content/101/4/723.full.pdf+html

Bell  J. USA Today, Sports. http://www.usatoday.com/story/sports/nfl/vikings/2015/04/16/adrian-peterson-return-should-lead-to-record-season/25899397/

Botash AS. Bullies, Victims and Bystanders. http://blogs.upstate.edu/pedstoparents/2015/04/13/bullies-victims-and-bystanders/

Gershoff ET. Report on physical punishment in the United States: What research tells us about its effects on children. Phoenix Children’s Hospital, Child Abuse Prevention. 2008 http://www.phoenixchildrens.org/sites/default/files/PDFs/Report_on_physical_punishment_exec_summary.pdf

Kersey, K. The 101 Principles of Positive Discipline. http://teachtrainlove.com/the-heart-of-positive-discipline/

Pekarsky A. Parenting in a positive way. http://blogs.upstate.edu/healthlinkonair/2014/12/03/parenting-in-a-positive-way/

Pekarsky A. Part II. Parenting without mistreatment. http://blogs.upstate.edu/healthlinkonair/2015/03/19/positive-parenting-part-two-discipline-without-mistreatment/

Sege, R.  Is Spanking Your Child Ever Okay? http://radiomd.com/show/healthy-children/item/23214-disciplining-your-child-is-spanking-ever-ok .

Staying Positive While Parenting Tips http://champprogram.com/pdf/Staying-Positive-While-Parenting-pamphlet-cny.pdf

Strauss MA, Steward JH. Corporal punishment by American parents: National data on prevalence, chronicity, severity, and duration, in relation to child and family characteristics. Clinical Child and Family Psych Rev. 1999; 2(2): 55-70. http://pubpages.unh.edu/~mas2/CP36.pdf

 

 

 

The Dangers of Cleaning with Bleach in the News

By Lee Livermore, Public Education Coordinator, Upstate New York Poison Center

Recently a news story was circulating amongst the news media stating “cleaning with bleach may lead to childhood infections”. The stories stated that “a splash of bleach can kill germs on a counter, but it may also cause health problems in children, a new study finds”.

While there is some truth to the stories, it is important to explore the facts. Chemical exposures can be toxic, even when they are household chemicals. Household bleach refers to a number of chemicals which remove color, whiten, or disinfects, often by oxidation. Chlorine is the bases of most common household bleach, which is about 93 percent water and less than 10 percent Chlorine.

According to The American Cleaning Institute (ACI) response to the study,” bleach is a relatively inexpensive and highly effective disinfectant. It not only cleans up dirt and mold, but also kills some of the most dangerous bacteria, including staphylococcus, streptococcus, E. coli and salmonella as well as viruses like the flu and the common cold”.

Back to the headlines, does cleaning with bleach lead to an increase in childhood infections? The answer, it depends. The study, entitled Domestic Use of Bleach and Infections in Children: a multicentre cross sectional study published April 2, 2015 in Occupational & Environmental Medicine Journal, suggested that, “passive exposure to cleaning bleach in the home may have adverse effects on school-aged children.” However, consistent exposure to most any chemical product may be harmful over time.

A different point to consider is, there is a theory in medicine; the hygiene hypothesis is a hypothesis that states that a lack of early childhood exposure to infectious agents might suppress the natural development of the immune system. What this theory is suggesting is some homes might be too clean and that some exposure to bacteria allows the body to learn to build up an immunity to fight off harmful bacteria.

Another point to consider is the exposure to bleach and other antibacterial products. The Upstate New York Poison Center recommends that when using cleaning products they should be out of the reach and exposure of children. An unintentional exposure happen when the product is breathed in, sprayed or splashed on the skin or in the eyes, or is ingested. Bleach might cause breathing problems if ingested or breathed in.

The Poison Center recommends to:

  • Always read the label, for ingredients and proper usage
  • Avoid over use
  • Limit exposure by diluting the product and use in an open ventilation
  • If you think some has been exposed to a toxic chemical call the Poison Center at 1-800-222-1222

Upstate Poison Control Center  http://www.upstate.edu/poison/

Link to study Domestic use of bleach and infections in Children http://oem.bmj.com/content/early/2015/02/20/oemed-2014-102701.full

Link to primary source use and defintion of hygiene hypothesis http://medical-dictionary.thefreedictionary.com/hygiene+hypothesis

Link to The American Cleaning Institute (ACI) response, http://www.cleaninginstitute.org/aci_responds_to_study_on_household_use_of_bleach

Link to local news coverage http://www.localsyr.com/story/d/story/study-cleaning-with-bleach-linked-to-child-illness/36895/X6nysRsFCUa3uG9Ktl89Nw