Child Health ALERT

Volume 16 A Survey of Current Developments Affecting Child Health Care April 1998

Caution With Pesticides And Toys

About 90% of all households in the U.S. use pesticides of one kind or another. and one of the most commonly used chemicals is called chlorpyrifos (one popular brand name is Dursban). This chemical is used for a wide variety of pests, including termites and cockroaches. Because of safety concerns, pesticides are supposed to be applied in ways that minimize the amounts that might come into contact with humans, particularly young children.

To see how much pesticide might be found in the home after it had been applied, researchers treated two sample apartments, using a pump sprayer according to label directions. They then tested for the pesticide in the air and on various surfaces and toys in the apartments. The toys had been put on the floor an hour after the insecticide was applied.

Long after the pesticide had been applied, there were still significant amounts of it on household surfaces (such as furniture) and on children's toys, even though the toys had not been in the rooms when the spraying took place. The reason for this relates to the nature of certain pesticides, which attach to surfaces during spraying, then evaporate into the air from those surfaces, and then land on other objects in the room.

The authors worry that if children handle these contaminated toys a lot, as they are likely to do, and particularly if they mouth the toys, they can become exposed to fairly large doses of pesticides. Based on a number of estimates, they believe that children could be at risk for a week after pesticides are sprayed, and they suggest that current recommendations for when it's acceptable to come back into pesticide-treated living quarters may need to be reconsidered. In particular, they suggest that household toys, pillows, and other absorbable surfaces should probably be kept out of treated areas not only while pesticides are being applied, but for some days afterward. (Gurunathan S et al. Environmental Health Perspectives, January, 1998, pp. 9-16)

COMMENT: This report provides some disturbing information. Though the researchers measured actual amounts of pesticides found on household surfaces and toys for two weeks following the spraying, their estimates of how much 3-6 year old children might absorb through their skin or by mouthing toys were based only on educated guesses.

Nevertheless, these findings reinforce how important it is to be cautious about how pesticides are applied in living areas, especially if young children are likely to be around. Furthermore, they suggest-based on reasonable evidence--that toys and other objects that children are likely to touch or put to their mouths should be kept out of the treated area not only during the spraying, but also for about a week afterwards. While the evidence in this report is focused only on Dursban, we think it would be wise to consider this problem for any pesticide that is sprayed throughout a living area or any other indoor space where children spend time.

RESOURCES

Playground Safety Materials

The various benefits of playgrounds have been appreciated for more years than we can remember, but it's only more recently that experts have pointed out how important it is to make sure playgrounds are also safe. The National Program for Playground Safety, located at the University of Northern Iowa, is a project that helps to educate parents teachers, medical personnel, and child care providers about playground safety.

The National Program for Playground Safety offers many useful and thoughtfully-written pamphlets and brochures designed to help prevent injuries. These include: A Blueprint for Increasing Playground Safety, National Action Plan for the Prevention of Playground Injuries, Planning a Play Area for Children, Inspection Guide for Parents, and Tips for Playground Fundraising. One copy of each of these is available at no cost (there is a charge, however, for additional copies). In addition, this group has two videos, "ABC's of Supervision" (for adults) and "Sammy's Playground Pointers" (for children); they cost $29.95 each.

Dr. Donna Thompson, the program director, reminds readers that National Playground Safety Day is April 30, 1998. This is a time when adults and children can evaluate their own playgrounds, and we think these materials can be particularly useful and timely for this effort.

To receive the free materials, or to order the videos, call 1800 554PLAY (7529); for additional resources, contact their web site at www.uni.edu/playground

INFECTIONS/ILLNESS

Can Diarrhea Be Treated With "Friendly" Bacteria?

Diarrhea is one of the most common infectious illnesses affecting infants and young children. Fortunately, most cases aren't very serious, but many times the fluids that children lose during their illness lead to dehydration, which can cause emergency room visits and hospital admissions. Except for making sure a child gets plenty of fluids, there isn't any specific treatment for most kinds of infectious diarrhea. Because the vast majority are caused by viruses, antibiotics won't work since they are only effective against bacterial infections.

Remarkably, researchers a few years ago found that certain bacteria, when given by mouth, might actually help treat diarrhea caused by viruses! Two very recent reports seem to add more evidence that this kind of treatment can make a difference. Both involved infants between the ages of 3 and 36 months who had mild to moderate diarrhea, and both used bacteria that are normally found in the human gastrointestinal tract.

A study from Italy involving 100 children found that giving oral doses of certain lactobacillus for up to five days reduced the length of the children's diarrhea by half (from 6 days to 3 days). In children with a particular kind of viral diarrhea (caused by rotavirus), the bacteria even seemed to reduce the amount of viruses in their intestine. (Guarino A et al: Journal of Pediatric Gastroenterology and Nutrition, 1997, pp. 516-519)

Another study, this time from Finland, used other kinds of lactobacillus bacteria to treat 66 children who had rotavirus diarrhea. They, too, were given the bacteria for up to five days, and the effect was similar--by the second day, watery diarrhea was still present in 80% of the children given placebo, but it was present in less than half the children given a large dose of the bacteria. (Shornikova A-V et al: Pediatric Infectious Disease Journal, December, 1997; pp. 1103-1107)

COMMENT: These results are fascinating. The lactobacillus bacteria appear to be safe, since they are normally found in the human intestine and they are helpful in digestion. On the other hand, no one seems to be sure how or why they might work in treating diarrhea.

Since a number of small studies have found similar benefits from using these bacteria to treat infants with infectious diarrhea, there is probably good reason for American researchers to conduct a large study in the U.S. to see whether therapy with lactobacillus and other similar bacteria can shorten the course of infectious diarrhea in North America. If they work, treatment could not only reduce the discomfort of children and their parents, but it could also reduce the spread of this common illness in child care settings.

Though lactobacillus can be purchased in health food and other stores, we think it's too early to use these bacteria as a routine treatment for diarrhea; readers should consult their health care practitioner if they want to pursue this treatment approach further.

CHILD DEVELOPMENT

Does Serious Dieting Produce A Supermodel Figure?

Supermodels have been criticized for being bad role models for young women because of their unnatural thinness, and they have even been blamed for the recent increase in eating disorders. Psychologists from England studied this issue by reviewing the measurements of 300 fashion models, 300 glamour models, and 300 normal women. They also reviewed measurements of 30 women with anorexia and another 30 with bulimia.

Though the models were significantly underweight, they were consistently heavier than anorexic women. The authors point out that "the key difference may be height, since the models, though heavier, had an hour-glass figure. ... The take home message from this study is that supermodels are both tall and curvaceous, and that dieting will not make you look like a Vogue covergirl. " (Tovee MJ et al. Lancet, November 15, 1997, pp. 1474-1475)

COMMENT: The results of this study make sense, and it may be helpful to bring this message to the attention of adolescents; because younger and younger girls are becoming very concerned about their body images, we think even preadolescents should hear this message. Serious dieting won't necessarily produce a model's figure, but it may well lead to a serious eating disorder.

CHILD SAFETY

Mary Ucci: Getting The Playground Ready For Spring

This winter has seen different kinds of weather in various parts of the country, much of which was blamed on El Nino. There were torrential rains and tornados, extreme winds and cold, and major snowfalls. It will come as no surprise that bad weather takes its toll on playgrounds, and for that reason it's important to carefully inspect playgrounds regularly--and particularly after extended periods of bad weather--to be sure they're still safe.

The following suggestions may seem simple, but the benefit children receive from playgrounds requires that these areas be safe and secure. Though this checklist focuses on what inclement weather might have done to a playground. many of the ideas can be applied on a regular basis to assure the maximum safety for children in our care:

* Check for obvious signs of damage or decay, such as loose or broken nuts and bolts or rotting wood in equipment, gates, and fences. Check painted surfaces for chipping paint which would need a coat of primer. Check for holes in fences.

* Check the swings for proper height and stability; make sure the ropes are properly attached and not frayed. Check the slides to make sure that the protective surfaces around them have enough sand or mulch. Be sure to clean off bird droppings.

* Check for natural hazards: Fallen tree limbs and branches are obvious, but also make sure there aren't any damaged limbs that could fall into the playground. Water erosion can expose rocks and other objects that may be hazardous for children, and burrowing animals ca leave behind dangerous holes. Finally, ants, spiders, and hornets may build new nests where there were none before.

* Check for human pollution: bottles, cans, pieces of glass.

* Check the sandbox: Make sure it's clean and free of debris, such as twigs and glass, also make sure it hasn't been used by cats as a litter box.

Mary Ucci, who is Educational Director of the Child Study Center of Wellesley College, writes this periodic column on various issues related to child care; she welcomes questions from readers, which she will answer as space permits. Questions should be sent to her c/o Child Health ALERT, P O Box 610228, Newton Highlands, MA 02461.

MEDICATION

Long-term Effects Of Inadequate Pain Relief

Painful medical procedures are a major source of distress for children, and for many with chronic diseases, they can be worse than the illness itself. Based on their observations of children who undergo painful procedures, experts in Connecticut wondered whether the memory of a painful experience causes anxiety about later procedures, and if that anxiety might actually influence the degree of pain the child feels.

A while ago, 21 children with serious chronic illnesses had taken part in an experiment of a new pain reliever, and they received either a powerful narcotic or no drug before a painful procedure. The researchers now studied the same children while they were again undergoing painful procedures, but this time all the children received the painkiller. The authors found that among the 13 children younger than 8 years, pain seemed to be higher for those who hadn't gotten pain relief during the earlier procedure, and lower for those whose pain during that initial procedure had been kept to a minimum. The 8 older children did not show this effect.

These researchers point out that because of the developmental level and cognitive capabilities of the younger children, they are less likely to be influenced by preparation and discussion. They also point out that these results, though limited, "argue for the importance of aggressive pain control during the initial procedures performed on children who will require multiple procedures." Finally, when medications are used for procedures that can cause serious amounts of pain, it is important that large enough doses are given to make sure that the pain is reduced as much as possible, especially in younger children. (Weisman SJ et al: Archives of Pediatric and Adolescent Medicine, February, 1998, pp. 147-149)

COMMENT: This small study reminds us not to ignore children's pain. More and more, medical care providers are realizing that pain is not something felt just by older children and adults: infants and young children do indeed feel pain and they deserve to be treated for it. What can be tricky is balancing the need to give enough medication to effectively reduce the pain without giving so much that the child could be harmed by the very medication that was intended to help. As more attention is given to these important issues, we can look forward to better and safer ways of relieving pain in young children.

PRODUCT RECALLS

Evenflo "On My Way" Infant Car Seats...

The U.S. Consumer Product Safety Commission, in conjunction with the National Highway Traffic Safety Administration, announced a recall of about 800,000 "On My Way" infant car seats/infant carriers manufactured by Evenflo Co. Inc. The seat is designed to be used both as an infant car seat and as an infant carrier. There is no problem with the device when it is used in the car. Instead, the hazard occurs when the seat is removed from its base (which is left in the car) and used as a carrier. The red push button assembly on each side of the seat that is used to latch and adjust the carrying handle can unexpectedly release and cause the seat to flip forward. There have been 176 reports where this has happened, resulting in 89 injuries to children; although many of the injuries were minor, some were serious, including skull fractures.

The seats come in two versions: a car-seat model that sells for about $6070 and a car seat/stroller combination that sells for about $150-175. Evenflo re-designed the popular car seats last summer and models now available in stores should no longer pose a safety problem. The recall affects seats/carriers made between December 15, 1995 and July 27, 1997, with model numbers "207 for car seats and "492" for the car seat/stroller combination (called the On My Way Travel System). The manufacture date and model number are located on the bottom of the seat. Consumers should call Evenflo's tollfree hotline, 1800 203-2138 to obtain a free repair kit. Until parents make the repair, Evenflo urges them to stop carrying the seat by the handle; instead, they should lift it by the "hand-holds" at the ends of the seat.

On the other hand, parents were cautioned that there is a problem only when the seat is used as an infant carrier. There is no problem when it is used properly as an infant restraint in the car, and parents should continue to make sure their infant always rides in a car with this or another approved infant car seat.

... FirstYears High Chair Gym...

The First Years company is recalling over 100,000 First Years High Chair Gym toys for repair because the clacker balls hanging from the center of the toy present a choking hazard to young children. The gym is an activity toy consisting of a metal wire frame about 7 inches high and 10.5 inches wide. It attaches to a high chair by two large red suction cups, and several brightly colored plastic toys hang from it. There are two plastic clacker balls, each one-inch in diameter, one black and one white. A yellow plastic spinning toy on one end of the frame has "The First Years" molded in one end, with a sun on the opposite end. The toys were sold in discount and toy stores nationwide from January, 1995 through November, 1997 for about $ 10. Consumers should call The First Years at 1800 533-6708 anytime for a free repair kit and installation instructions, or write The First Years, One Kiddie Drive, Avon, MA 02322-1171.

... And Fisher-Price Infant Toys

Fisher-Price, Inc. is recalling about 21,000 cookie-shaped refrigerator magnet toys and 49,000 crib mobiles. The magnet can come apart and release small plastic pieces, presenting a choking hazard to young infants; the mobile can come apart and fall into the crib, presenting an injury risk to young children.

The magnet looks like a partly-eaten chocolate cookie with colorful candy pieces on top. The bottom of the cookie is white. Only cookie-shaped magnets with date codes from 224 through 228, sold after September 1, 1997, are involved in this recall; the date code is imprinted on the back of the magnet as the first three digits of the code. It is sold as part of a three-piece Refrigerator Activity Magnet Set, Fisher-Price No. 71126. The other two magnets look like a carrot and a piece of cheese.

The crib mobile is a round, rotating mobile with a white plastic ring suspended from a plastic arm attached to a crib. The mobile, which plays music, has a mirrored center and colorful butterflies and beads that move on the ring as the mobile rotates. It is sold as the Magic Motion Mobile, Fisher-Price No. 71153.

Both items were sold in major toy and mass merchandise stores nationwide; the magnet set sold for about $6 beginning in September, 1997, and the mobile sold for about $24 beginning in June, 1997. For a free replacement cookie magnet or replacement parts for the mobile, consumers should call Fisher-Price toll-free at 1888 4076479 between 8 AM and 6 PM EST Monday through Friday.

(Reports from the U.S. Consumer Product Safety Commission, Washington, D. C.)