Tag Archive for: Health

THE RISING RATE OF PEDIATRIC OPIOID POISONING

When little Enora Lavenir’s parents put her down for a nap during a family vacation they never could have imagined it would result in her death. Vacationing in a Florida Airbnb, the couple didn’t know that the rental home had been a “party house” where the illicit drug Fentanyl had likely been used. Yet, confirmed by autopsy, Enora’s death was due to acute Fentanyl toxicity.

Until now, our perception of the opioid crisis has largely been viewed as an adult problem. However, there is stunning and alarming evidence that infants and children are more likely to die from an opioid overdose than from any other toxic substance.

According to findings published in the journal Pediatrics about 52% of poisoning deaths in children under 5 years of age are due to opioids. “In fact, the number has doubled since 2005, when 24% of poisonings were attributable to opioids” said lead researcher Dr. Christopher Gaw, a pediatric emergency physician at Childrens Hospital of Philadelphia.

Dr. Gaw and colleagues reviewed child death data from the U.S. National Center for Fatality Review and Prevention. Between 2005-2018, 731 poisoning deaths in children aged 5 and younger were reported to the center. Overall, infants, under the age of 1 accounted for 2/5 (40%) of poisoning deaths. During this period opioids were involved in 47% of these deaths. The next leading cause of drug related deaths occurred from over the counter pain & cold medications (15%).

Five years later, the numbers are rising.

Even a small dose of a prescription opioid can put an infant or toddler’s life at risk. This is particularly true of synthetic opioids such as Fentanyl which is 50-100 times more potent than morphine. 

Where are these overdose deaths occurring?

Nearly 2/3 of these poisoning deaths occur in the infant or child’s home.  Roughly 1/3 of these occurred when a child was supervised by someone other than their parents. The data clearly shows that the vast majority of these poisonings were accidental.  Dr. Gaw added “Kids are curious, active and we know from experience and other studies that often kids are exposed accidentally.  They are just exploring their environment when they find an opioid and end up ingesting it.  A lot of these are what we call exploratory ingestions.”

Dr. Sam Wang, a pediatric toxicologist with Childrens Hospital Colorado in Aurora noted ”even legitimate opioids that are not properly stored and kept out of reach of a child can cause a death if a child would get into them.”  On the other hand, illicit drugs are particularly risky in homes where supervision of children is usually not as good.  This type of event is considered drug endangerment.  Our readers need to understand that, even when properly prescribed opioids are in the home, they must be stored safely  –  away from little ones.  

Shows a baby's hands on top of various pill packets

SIGNS OF AN OPIATE OVERDOSE:

  • Very lethargic, hard to arouse
  • Shallow, slower breathing
  • “Pinpoint” pupils

If any of these occur call 9-1-1 immediately and if breathing stops, initiate CPR immediately

Our Pediatric CPR & Family Safety Class begins with a focus on prevention of most household injuries & accidents.  

When it comes to storing any potentially dangerous drugs we emphasize:

  • storing all medication (prescription or otherwise) out of the reach of children
  • keeping opioid drugs under lock and key, if possible
  • that medications of this type be kept in child resistant containers

Consider asking you M.D. for a prescription for Naloxone, the proven life-saving antidote to all opiate drugs.

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LET’S TALK ABOUT SEIZURES AND HOW TO RESPOND TO THEM

If you’ve ever witnessed a person having a seizure, it’s likely that you’ve responded with fear or even revulsion. Or maybe you’ve simply felt helpless not knowing what to do.

So what do you do?

Film or TV portrayals of someone having a seizure might misinform you as to what the proper response actually is, and viewing seizures as evidence of demonic possession, while historical, is also likely to be misleading.

Let’s take a look at some basic facts.

Throughout the body there are electrical currents that facilitate many functions. This is especially true of the heart and brain. Sometimes an incident may occur where the current is short-circuited resulting in a seizure. The seizure itself is not the cause but the result of something, an event brought on by one of many possible causes.

Some possible causes are:

  • Use of alcohol and/or drugs
  • Flashing lights (like a strobe light)
  • Not taking medication prescribed to prevent seizures
  • Head injury where the brain is affected
  • Rapidly rising high fever in some babies and small children
  • A significant drop or rise in blood sugar levels
  • A brain tumor

DIFFERENT FORMS OF SEIZURES

Some seizures are short in duration while others last several minutes or longer.

A seizure may exhibit as rapid blinking or staring off into space.  Historically, these types of seizures have been called “petit mal” which are a less serious form.

When a seizure involves the whole body, causing shaking and altered consciousness, it is often referred to as “grand mal.”  

Some seizures only involve certain parts of the body causing involuntary twitching, confusion, and the inability to respond to someone.  

Keep in mind that having a seizure does not mean that a child has epilepsy.

Seizures resulting from rapidly rising, high fevers are the most common seizures seen in the pediatric population. These are referred to as febrile seizures. If you are a parent with infants, toddlers and/or small children it is important that you speak with your pediatrician about fever so you can learn how to treat it.  

ARE ALL SEIZURES A MEDICAL EMERGENCY?  

The short answer is NO. In relation to some of the causes listed above, however, some seizures may require a paramedic response.

For example, when…

  • seizures last more than 5 minutes
  • someone is injured during a seizure
  • a person is experiencing their first seizure
  • someone has breathing problems or the inability to walk normally after a seizure
  • the seizures don’t stop
  • they occur in water

FIRST AID RESPONSES TO A SEIZURE

Shows a young boy lying on the floor in the aftermath of a seizure. A woman's hand resting on her leg can be seen to the left of him.

While someone is having a seizure…

  • do not try to restrain or hold them down during a seizure
  • do not put anything in their mouth
  • expect short periods of absent breathing, changes in skin color
  • do not start CPR or give rescue breaths
  • avoid giving the victim food or water

When someone is convulsing it is common for them to bite their tongue, cheek or lips, and bleeding can occur.  Do not panic if you see this.  Seizure victims DO NOT swallow their tongues.  

Stay with the victim until the seizure ends and the person fully awake is able to communicate normally. Many people will be confused afterward.

Speak softly to the victim.

Once a seizure begins to ease off, it is ok to carefully turn the person on their side.

 

SMALL CHILDREN AND PETS

Staying home during this pandemic has both good and, on occasion, not-so-good implications from an injury standpoint.

There has been a recent surge in dog and cat bites, especially where children are concerned. Let’s face it, small children and pets can be a volatile mix.

Dog bites alone account for tens of millions of injuries annually. A great number of these bites are provoked by toddlers and children. If a dog is frightened, experiences pain or is approached while eating the risk of a bite is greater. Dogs that are ill or older have a lower tolerance and may bite when younger dogs might not.

Dog bites can be minor or severe in nature. Many of them can be treated at home with basic first aid, but others may require a scary visit to the emergency department. Canines have very strong jaws and can exert up to 200 pounds of pressure per square inch while larger dogs are capable of twice that much.

The most common bites are to the hands and arms. These can be very serious due to the pain inflicted and because of the risk of infection. Dog mouths have as many as 64 types of bacteria including staph and strep microbes.

As a community we have done well by adopting dogs of every shape and size. The vast majority of these animals are welcomed into our homes and become our loving pets. All the same, you should be aware of the dog’s history and if that history includes aggression and/or unprovoked biting.

One of your best resources is your own veterinarian. Make sure that you discuss issues of safety if a dog has come from unsafe circumstances.

 

THE #1 PANDEMIC VIRUS THAT COULD AFFECT YOUR FAMILY

Hype or hyperbole? Headlines scare people, for sure. The number of coronavirus comments, articles and statistics can make you shudder. You might even purchase protective masks or simply stay home in fear.

Americans, much like many others, are actually at much greater risk from a virus which is here, now. This season, influenza (the Flu), has already claimed the lives of at least 40 children and it remains a far greater health concern for your family than any other communicable disease.

According to the Centers for Disease Control & Prevention (CDC) the flu has sickened 13 million Americans this winter, putting 120,000 of them in the hospital and has already taken 6,600 lives. The flu season has not yet peaked and when all data is in the flu may take as many as 61,000 American lives.

Protection from the flu takes a number of forms. Although imperfect due to the changing nature of viral illnesses, the flu vaccine is still your best hedge against this awful disease. According to the CDC, fewer than half of American adults got a flu shot last season. For children, who are more vulnerable to the respiratory effects of the flu, only 62% received the vaccine last year.

Dr. Paul Offit, director of the Vaccine Education Center at Children’s Hospital of Philadelphia believes that because the exotic viruses from foreign lands have such different and scary names (Ebola, Zika, Wuhan, etc.) we fear them even more than our generic annual flu strains. When the SARS virus caught our attention, causing a global panic, the U.S. “dodged a bullet” according to the CDC with only 8 Americans becoming infected. There were no deaths from SARS in the U.S. Yet, it caused panic on a global scale.

Children are most often hit the hardest with the flu and statistics reveal that most kids who die from the flu virus have not been immunized against it. Many of these children were previously healthy.

Protection from the flu not only includes getting vaccinated. If you or a family member develops a fever, body aches, headache and/or cough they should be seen by the family physician and screened as early as possible for the flu. Early detection is essential as there are anti-viral medications that can be prescribed to lessen the negative impact.

Other simple methods of disease prevention include keeping sick individuals at home, frequent hand washing and covering ones mouth when coughing.

8 WAYS TO REDUCE A CHILD’S RISK OF CHOKING

In the 20 years that I have been teaching for Save A Little Life™  I have heard countless stories from parents regarding choking or near-choking events with their infants and/or children. These reports stick with me and I try to learn something from each parent who experiences them.

In our CPR and First-aid classes we always discuss the realistic chances of an infant or child choking. It remains one of the top causes of accidental death and the risks vary depending on the age of the infant or child. What has become clear, however, are the circumstances and conditions that either increase or decrease these incidents.

Human beings are born with good reflexes (gagging, coughing, vomiting) that most often reject items that threaten the airway. Parents will readily tell me about these episodes and most have learned how to prevent a choking episode.

Prior to eating semi-solids and solid foods infants thrive on breast milk and other fluids. Parents observe gagging episodes and almost always find ways to reduce (or at least panic less) these. Once we begin more solid foods there is a palpable increase in parental concern. This is understandable and we never minimize those concerns.

So, what can any parent, family member or care provider do to lessen the choking risk? Here are the most effective measures you can take to lessen the risk:

  • Infants & children need to be seated in an appropriate highchair or booster seat when eating. No exceptions
  • A responsible adult needs to be present during all feeding times
  • Try and avoid doing other activities during feeding because a choking person makes no sound!
  • Once an infant or child is able to crawl or walk they should have no food in their mouths or hand(s). The risk of choking elevates when these activities coincide.
  • During family activities, vacations and/or parties (birthday’s, etc.) there should be no letdown of your focus.
  • Pay close attention to toddlers who, when self-feeding, attempt to put too much food in their mouths at once. You have control of this!
  • Never allow infants or children to eat in the vehicle…especially during the first 2 years when they are seated facing rear.
  • Make sure that any family members, care providers or friends who assist during feeding understand these risks and observe the same precautions

There is always the possibility that, even when safe eating practices are used, some little ones will choke. Most people have about 30 seconds of consciousness once their airway is completely blocked. There is no reason to (initially) call 9-1-1 for a choking person since effective removal of an obstruction is done by those present. Paramedics are anywhere from 4-10 minutes away.

During the Save A Little Life™ class we prepare all in attendance to be able to identify a blocked airway and to remove it by safe and established emergency guidelines.

Prevention is the key to reducing risk for all health emergencies. It is woven into the fabric of our daily lives. We are always living with risk but with the proper understanding and consistent practice these risks can be lowered.

DO INFANT SLEEP PATTERNS AFFECT NORMAL GROWTH AND DEVELOPMENT?

This study, recently published in the Journal Pediatrics, attempted to examine the relationship between length of infant sleep and expected levels of growth and development in various aged infants and children. The phrase “sleeping through the night” has had different meaning depending on what era and/or whose criteria one used. The most current definition is… “the longest period of uninterrupted sleep without parental intervention.”

In the past, other criteria were considered, including “total nocturnal sleep” (total of hours slept during the night) or “total sleep duration” (number of hours slept in the last 24 hour period.)

Using their criteria of 6 to 8 hours of uninterrupted sleep, the authors discovered that 27.9% to 57% of infants (6 to 12 months old) did not sleep through the night. (Our italics) In addition, this study found that 43.4% of 12 month olds did not sleep through the night as well. Using well-developed study criteria, the authors found that, despite less than “optimal” sleep, these infants had normal physical and emotional development.

Maternal mood was another important consideration of this research as well.  These assessments were done in the 3rd trimester, at 6, 12 and 36 months postnatally. Items on the scale reflect frequency of symptoms in the previous week. Given the many differences in households, the research also looked at issues of maternal education, income and socioeconomic status. Issues of maternal depression, infant gender and breastfeeding were factored in as well.

Their conclusion states: “Considering that high proportions of infants did not sleep through the night and that no associations were found between uninterrupted sleep, mental or psychomotor development, or maternal mood, expectations for early sleep consolidation could be moderated.”

As always, we want you to seek the advice of your pediatrician on all issues of pre and postnatal care…for both your baby and yourself!

WHY COVERING YOUR STROLLER WITH A BLANKET IS DANGEROUS

In the blazing summer heat with the full sun bearing down on us, countless parents and caregivers drape a blanket over the stroller to give babies shade. It turns out, while we think we are protecting our little ones from the sun, we may be putting them at risk for heatstroke and SIDS (Sudden Infant Death Syndrome).

 

Based on an interview with Stockholm pediatrician Dr. Svante Norgren about the dangers of covering a stroller, the Swedish newspaper, Svenska Dagbladet, conducted an experiment by putting a stroller out in the sun, midday, in the summer. Without a cover, the stroller was about 72 degrees Fahrenheit. After covering the stroller with a thin cover for 30 minutes, the temperature rose to 93 degrees and after an hour, 100 degrees!

Because babies sweat less, they are not able to adjust their body temperature as easily, compared to adults and older children. Their body temperatures can rise 3-5 times faster than ours. According to SIDS Australia, “Thermal stress (overheating) has been implicated in Sudden Infant Death Syndrome (SIDS) for many years and avoiding overheating has been one of the strategies to reduce the risk of SIDS.”

So how can you keep infants cool, safely?

Staying indoors during the peak heat of the day (between 10am and 3pm) can be helpful. If you must head outdoors, use a UV cover that doesn’t enclose the stroller, like a parasol. Look for strollers with large sun canopies, ventilated or removable back panel, and no excess cushioning. Air circulation is critical. Wide-brimmed hats are also a good way to protect them from the sun. Dress children lightly, use plenty of sunscreen, and keep them well-hydrated. Sponge your child with a damp cloth to keep them comfortable. A small clip-on fan can be attached to their stroller for added circulation – just be sure to keep it out of reach.

When in their stroller, check your baby to ensure they are not overheated. An overheated baby may sleep a lot. Ensure they are not sweating or are hot to the touch and head indoors if the sun and heat get too strong.

 

Article courtesy of our friends at
Tot Squad Baby Gear Services

 

 

 

EMERGENCY CARE WITHOUT PARENTAL CONSENT

For years we have been telling parents that if someone other than you arrives with the baby or child (in your absence) that a form should accompany them. The form is known as the Parental Consent Form. This form, allows medical personnel to initiate care for your infant or child prior to your arrival at the hospital.

Examples of this potential conflict would be when a grandparent or aunt/uncle, babysitter, nanny, etc. brings the baby to the E.R. without a signed statement from the parent, allowing care to proceed until you arrive. This would provide the doctors & nursing staff with knowledge about the infant/child’s medical history (allergies, other health issues, medications). The assumption is that this information would clear the way to initiate treatment with medications, imaging studies, other necessary sedation of the baby or child for a wide variety of illnesses or injuries.

The American Academy of Pediatrics (AAP) has issued a new policy statement regarding these potential conflicts. The decision of the AAP for the revised policy on parental consent was summarized in this statement:

“Current medical ethics recommendations also appear to support the E.D./E.R. treatment of unaccompanied minors“ so the statement reads. Furthermore, the AAP statement included: “The physician should seek consensus from the patient or family as soon as possible.”

Simply put, this change suggests that preauthorization (with a note or letter, signed by the parent) is not a necessity and that proceeding with treatment of the minor will be based on a variety of factors.

When we instruct parents in our CPR and first-aid classes the issue of parental consent is always on our check-list of important things to do. We strongly suggest that all parents provide this document to those who have childcare duties, even those blood relatives who are not the parent or legal guardian of that minor.

Forms of this type are easily found on the internet and simply requesting a generic parental consent for medical treatment of a minor. Some states may have laws requiring notarization of the document. Not so in California.

NANNIES NEED A CPR AND FIRST-AID CLASS

Why Does My Nanny Need CPR and First Aid Training?

The question posed above is a good one. The answer I usually provide anyone who asks why their caregiver needs a life-saving course is: “Do we really have control over when bad events occur at home or anywhere else?” That answer suggests that parents stop and think about this issue. Their answer is usually self-evident. Of course we don’t.
Emergencies in the home have little or no warning as to when they will occur. This is why we emphasize the importance of two main areas: Prevention and, if and when needed, action.

The program offered by Save A Little Life ™ addresses and re-focuses on these two critical areas. The responsibilities we give our nannies/care-providers are awesome. They are not only your eyes and ears when parents are away from home, they really need the exact same understanding of how we prevent and, importantly when and how we act.

Simply and accurately put, they perform the most important job you will ever hire for. The vast majority of your home based help are smart, interested and utterly committed to your infant, toddler and child’s well-being. It is the parent’s job to make sure you are leaving your little ones in prepared hands.

First Aid and little ones

The first-aid component of the course is far more likely to be required. Cuts, bumps, splinters, head bonks and the like are quite common. Our experienced instructors review the most common of these incidents so that your nanny will be able to be decisive in their action. These actions may include:

* Responding to the more minor incidents noted above.
* Be able to understand when an injury, for example, needs the parent’s attention right away.
* Should be confident in explaining a situation that has occurred and do so succinctly and in a timely way.
* The competent use of first-aid supplies provided by the parent at home or elsewhere.
* Do their best to identify injuries or accidents that may require a visit to the E.R.
* Quickly identify higher risk concerns in or near your home where quick action may be needed to safeguard your small ones.

What we do

Save A Little Life ™ specializes in Pediatric CPR and First Aid for families and caregivers. Ask us about family discounts for those who have taken our class recently and need to have a caregiver trained too. Don’t wait!

Our next two certification courses are as follows:

Westside Nannies (En Espanol)
July 15, 2017
(Ask about our Special for this class, now through June 13, 2017!)
Westside Nannies (English)
July 22, 2017
Parents are welcome too, of course!

Have a safe and prosperous summer
Richard Pass, RN ,BS
Founder and Owner of Save A Little Life, inc.