Child Health ALERT

Volume 15 A Survey of Current Developments Affecting Child Health Care April 1997

Do Cold Medications Really Help Preschoolers?

It's natural for parents to want to relieve their child's symptoms when he or she has a cold, and it's been estimated that almost 40% of preschool children receive at least one over-the-counter cold medication in a month. Despite their widespread use, there's been little information published in medical journals about whether these medications really work.

To provide just this kind of information, pediatricians in Seattle, Washington, studied 59 children between the ages of 6 months and 5 years who were seen by their doctor for a common cold. Parents were then given either a typical cold medication or a placebo that looked and tasted the same. The cold medication that was studied was Dimetapp Elixir, which is avail able without a prescription and contains both an antihistamine and a decongestant. For the next two days, parents were instructed to give the cold medication when they thought it was necessary, and then two hours later they recorded certain information, such as whether the child's symptoms had improved.

When the authors compared the results from the active drug to that of the placebo, they found that the Dimetapp generally wasn't any better than placebo in reducing symptoms such as runny nose, congestion, or cough. However, almost hall me children who received Dimetapp were asleep after two hours, compared to only about one-quarter who took the placebo.

The authors conclude that because this study and some previous studies found no benefit from medications used to treat colds, "we question the appropriateness of using antihistamine-decongestant combinations for relief of symptoms of the common cold in preschool children." (Clemens CJ et al: Journal of Pediatrics, March, 1997; pp. 463-466)

COMMENT: Studies of this kind are badly needed, and it's good to see that interest is growing in learning whether various medications that are commonly used in children really do work. Two previous reports looked at whether cold medications helped after a day or a few days, but the current authors correctly point out that since the medications act quickly and are eliminated from the body quickly, any benefit they may have should be seen in a matter of a couple hours, not a day or a few days later.

Thus, based on studies available in medical journals, there's not much basis for believing that cold medications make a big improvement in symptoms among preschool children. But why, then, are the medications so popular? Doctors have used them for years, and over-the-counter medications are heavily advertized. On the other hand, this study seems to give another clue as to why parents may like these medications--compared to the placebo, children were twice as likely to be sleeping two hours after taking the active medication. Colds tend to make children uncomfortable, restless, and irritable, so parents may appreciate the fact that their child is at last sleeping.

The authors are careful to point out a number of limitations in their study, but we suspect that if this medication had any dramatic benefit on specific cold symptoms, this study would have found it. Based on the information available to us, we think parents should be aware that the main benefit of an antihistamine/decongestant cold medication may be to provide their child some sleep, and this should be kept in mind when deciding whether these products are worth using.

Clothing Drawstrings: The Hazards...

Over 25 years ago, a "new health hazard" was described- -called the "long-scarf syndrome", researchers described 11 cases of children and young adults who were injured when the long, free-flowing scarves they were wearing got caught in machinery, such as ski tows. Since then, it has become clear that various items of clothing can cause accidental strangulation of children, and in a recent report researchers analyzed 58 cases in which children in the U.S. were involved in accidents where drawstrings on their clothing became caught in other products.

The two most common accidents involved strangulation when a drawstring in a hood or neck became caught in a gap between parts of playground slides or when drawstrings in a waist or bottom became caught in a school bus handrail or door. After considering a number of approaches to the problem (such as using shorter drawstrings or "breakaway" drawstrings), the authors conclude that "the only feasible intervention is the removal of drawstrings." (Drago DA et al: Archives of Pediatric and Adolescent Medicine, January, 1997, pp. 72-77)

In another report, this time from Canada, researchers describe two children who died when drawstrings on their clothing were caught on slides. Like their U.S. counterparts, these researchers call for banning the use of drawstrings and toggles on children's clothing. (Petruk J et al: Canadian Medical Association Journal, November 15, 1997, pp. 1417-1419 )

RESOURCES

A "Healthy Start" for Spring

A few months ago, we informed readers about the first issue of a new newsletter to promote healthful nutrition for children (CHILD HEALTH ALERT, December 1996). The American Academy of Pediatrics, The American Dietetic Association, and the Food Marketing Institute have developed "Healthy Start: Food to Grow On", and the spring issue is now available. Among its features are "Great meals in minutes: Tips for quick cooking", as well as other suggestions for how to make nutritional foods and cooking attractive to children.

The newsletter is available at no cost and may be reproduced for distribution. Readers interested in obtaining the spring issue should send a stamped, self-addressed business-size envelope to: American Academy of Pediatrics, Department C-HS Spring, P.O. Box 927, Elk Grove Village, Illinois 60009-0927.

Don't Get Caught Dirty Handed!

We have regularly reported the importance of handwashing as a way to prevent the spread of infections, and we have published both a "Healthy Handwashing" Poster and Coloring Packets to help reinforce this message (see p. 6). We also wanted to bring to our readers' attention a pamphlet, called "Don't Get Caught Dirty Handed!", which describes why, when and how people should wash their hands. Included in the pamphlet is a sticker that can be put in a conspicuous location to remind everyone of the importance of "operation clean hands". The pamphlets are made available through the Bayer Corporation's Pharmaceutical Division and the American Society of Microbiology; they are available free of charge, and you can order them, in quantities up to 3,000(!), by calling (888) 972-2937.

... And Guidelines For Safety

The U.S. Consumer Product Safety Commission (CPSC) points out that since 1985, it has received reports of 19 deaths and 42 non-fatal incidents involving the entanglement of children's clothing drawstrings. In 1994, CPSC invited manufacturers and retailers of children's clothing to discuss the problem, and following the meeting 28 manufacturers and four retailers agreed to voluntarily eliminate drawstrings from the necks and hoods of their jackets and sweatshirts by the spring of 1995. By 1996, CPSC was aware of almost no children's jackets being manufactured with hood or neck drawstrings; instead, manufacturers had changed to elastic, velcro, or buttons.

Readers may be interested in the CPSC's "Guidelines for Drawstrings on Children's Clothing," which was written in 1995 to inform manufacturers, retailers, and consumers about the voluntary effort to prevent drawstring deaths. To obtain a copy of the CPSC guidelines, write: Guidelines for Drawstrings, CPSC, Washington, DC 20207, or visit CPSC's Internet Web site at http://www.cpsc.gov (go to "Consumer/CPSC Publications/ Children's Safety/Drawstrings-"). (CPSC: Consumer Product Safety Review, p. 7, Winter, 1997)

MEDICATION

Making Medication Labels Easier To Understand

As the report on page I illustrates, nonprescription medications are frequently used to treat common illnesses in children, but it often can be difficult for parents and other care providers to make sense out of -the -complicated information on the product labels. Partly for this reason, the federal government is now proposing that labels on nonprescription drugs should be simplified to help consumers better understand ingredients, uses, and warnings of these very common medications. According to the Commissioner of the U.S. Food and Drug Administration, a current typical label "reads like a legal contract" and as a result the information it provides is likely to be ignored. The new labels will list the ingredients and purpose of each medication, what it's intended to treat, simple directions, and warnings, such as side effects and advice on when to contact a doctor.

The FDA stated that if all goes as planned, the changes would take effect in about two years; in the meantime, the public is encouraged to comment to the FDA on these proposals before the end of June. The prospects for implementing these simplifications are considered good because the new labels are supported both by the FDA and manufacturers of nonprescription medications. (New York Times, February 26, 1997)

COMMENT. Nonprescription drugs have become more widely used in recent years because more of them have been approved for marketing by the FDA and more people are treating their own illnesses rather than seeing a doctor or buying prescription drugs. Making labels more "user friendly" is certainly a welcome development, and consumers will now have little excuse for not reading--and following--the label's instructions.

ENVIRONMENT

Pollution And Birth Problems

Many people are concerned that air and water pollution may increase the risk of birth problems such as prematurity and birth defects. A Swedish researcher, trying to learn more about such possible risks, took Swedish birth registry information on the pregnancy outcomes of 38,718 women, and then linked that information with measures of air and ground pollution in the areas in which the women lived. After considering prematurity, low birth weight, and serious birth defects, the author concluded that "environmental pollution in this country does not seem to be a major determinant of delivery outcome." (Landgren 0: Acta Paediatrica, 1996, pp. 1361-1364)

COMMENT: We thought readers might appreciate some good news for a change. While this analysis didn't take into account a number of important factors, the general conclusion can certainly be considered reassuring.

HEALTH ISSUES

Instant Glue For Lacerations: How Do They Look A Year Later?

It's becoming increasingly popular for surgeons and other doctors to use a special glue to treat cuts and lacerations that might otherwise require stitches. The glue is actually a form of the "instant glues" that are sold for general use by consumers, and it has been found to be easier to apply than stitches and to eliminate the need for a follow-up visit to remove the stitches. One question that hasn't been examined very closely, however, is the eventual cosmetic appearance of glue-treated lacerations.

To help answer this question, researchers followed-up patients who had earlier participated in a study that randomized children with lacerations less than 2 inches long to be treated either with glue or stitches. Two plastic surgeons evaluated the cosmetic appearance of the wounds (without knowing how they had been treated) based on photographs taken two months and one year after they were repaired. In both the short and longer follow-up' the surgeons were unable to see any differences in the appearance of the wounds treated with glue. (Simon HK et al. Pediatrics, February, 1997, pp. 193-195)

COMMENT: Children have had the benefit of some improved treatments in recent years--by using EMLA cream. physicians are able to dramatically reduce the pain from shots and minor surgical procedures (see CHILD HEALTH ALERT April,1994), and when children or adults require stitches, doctors can use tissue adhesive to reduce the pain and trauma of repairing minor lacerations. At the same time the current study indicates that the wounds, when they eventually scar over, don't look any different from those treated with stitches.

DIET & NUTRITION

Diarrhea And Iron Content Of Infant Formula

Breast feeding, has many benefits. but there has been concern for some time that infants who are breast fed do not get enough iron to prevent iron-deficiency anemia. For that reason. infant formulas frequently have iron added to them because many health experts (including the American Academy of Pediatrics) believe that if breast-fed infants are supplemented with formula, that formula should be fortified with iron to prevent iron deficiency.

However, some researchers have suggested that the iron in formula could lead to an increase in E. coli bacteria in the infant's intestines, which in turn could lead to diarrhea. This suggestion has been controversial since it is based only on theoretical and laboratory information. not on studies from infants who are actually fed iron-fortified formulas; for that reason, federal health researchers decided to compare the frequency of diarrhea among breast-fed infants given iron-fortified formula with those fed low-iron formula.

The study involved a sample of 1743 mothers who provided information on a wide variety of factors during their child's first year of life, including how they fed their infant and how often the baby had diarrhea. Among infants who received both breast milk and infant formula. the authors found no meaningful differences in rates of diarrhea for infants fed iron-fortified formula compared to those fed low-iron formula.

In their discussion, the researchers state that iron in iron-supplemented formula may change the bacterial content of an infant's intestines, but there's no evidence that this change increases the risk of diarrhea or is harmful in other ways. Indeed, "we think there is no compelling medical evidence to support the use of low-iron formula in the general population. On the other hand, there is substantial evidence that iron-fortified formula has helped to prevent iron deficiency anemia in the United States." Therefore, they believe that low-iron formulas have no place in infant feeding and that any formula given to infants should be fortified with iron. (Scariati P et al. Pediatrics, March, 1997, p. e.2 [This is the electronic version of the journal Pediatrics])

COMMENT: This is a good example of how important it is to test whether theoretical health risks really occur in real-life situations. The debate will likely continue, but it is useful to recognize that even though this study leaves a number of questions unanswered, it represents the only "real world" data on this controversy, and it does support the safety of iron-supplemented infant formulas.

PRODUCT RECALLS

Recalls: Tonka Soft Walkin' Wheels Toys

The Tonka Corporation, a division of Hasbro Inc., of Pawtucket, RI, is recalling about I million Soft Walkin' Wheels toy vehicles (model 90165) because the small wheel hubs can separate from the axle, creating a choking hazard. The toys are battery operated soft toy vehicles that are covered in brightly colored nylon fabric and are available in five styles: dump truck, school bus, airplane, train, and fire truck. The affected model has serial numbers lower than 9528 or no serial number at all. The numbers are printed in blue ink on the sewn-in label that displays the toy's cleaning instructions, brand name, and model number. They were sold in major toy stores and mass merchandise outlets nationwide for about $15, beginning in January 1994. To receive a free replacement or refund, consumers should return the toy to the store where purchased, or to receive a free replacement, call Tonka at 1-800 524-8107. Note: Other Soft Walkin' Wheels are not being recalled; these include model 90165, with serial numbers 9528 and above; the Soft Walkin' Wheels Dalmatian, Dinosaur, or Pig; Soft Walkin' Tuggers; Soft Squeeze'n Shine; and Soft Shakin'Wheels.

(Report from the U.S. Consumer Product Safety Commission, Washington, DC. 1-800 638-2772)