Child Health Alert Newsletter

Child Health ALERT

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

Should Air Bags Be Disconnected?

Starting January, 19, 1998. the National HighwaY Traffic Safety Administration (NHTSA) began permitting vehicle owners to have manual airbag on/off switches installed, as long as the owners properly complete a form stating that they've read an informational brochure and are among a small number of people potentially at risk of airbag injury. Brochures and request forms will be available at dealerships, repair shops, state motor vehicle offices, NHTSA's Internet site (www.nhtsa.dot.gov), AAA offices, and other locations. The application form must be sent to NHTSA for approval, and dealers and repair shops must notify NHTSA when a switch is installed; no work can be done without an authorization letter.

Airbag switches must be key operated to indicate when an airbag is off. Once off, they stay off until turned back on with a key--they don't automatically switch on when the ignition is turned on.

NHTSA defines four risk groups for on/off switch approvals: 1) drivers unable to sit at least 10 inches away from the steering wheel; 2) drivers who transport more children ages 1- 12 than can safely fit in back; 3) drivers who must place a rear-facing infant seat in front; and 4) people who for medical reasons are at high risk of airbag injuries.

A recent copy of the "Status Report", published by the Insurance Institute for Highway Safety, points out that airbags have been blamed for the deaths of 87 people in low severity crashes since 1990; these included 35 adult drivers and 3 adult passengers, 37 children (ages 1-9 years), and 12 infants (10 restrained in rear-facing infant seats and 2 in infant seats on adult passengers' laps). In contrast, airbags have been credited with saving 2600 lives and have prevented hundreds of thousands of serious injuries.

The report offers guidelines to consumers to help identify the few people who may be at increased risk from airbags. From the pediatric perspective, the issue centers on the passenger-side airbag, and the risk here is to infants "and the remedy is usually as simple as properly restraining kids in a back seat." A rear-facing infant restraint should never be put in the front seat if a passenger air bag is present. The report notes that "an on/off switch so you can occasionally put a baby in the front seat might seem like a good idea, but if you're in a hurry it's easy to forget about the switch." The only appropriate setting for an on/off switch is the rare instance where an infant with medical problems requires constant observation and the driver is the only other person in the vehicle."

"If there are too many infants or small children to put them all in a back seat, it's okay for an older child to ride in the front seat, even with a passenger airbag, if the vehicle seat is pushed all the way back and the child is secured in a lap/shoulder belt and sitting back in the seat." However, "if you routinely transport too many kids to put them all in the back and worry about keeping the child up front sitting back and away from the passenger airbag, you may wish to get an on/off switch. If you do get one, remember to use it correctly." (Status Report; Insurance Institute for Highway Safety, November 29, 1997)

COMMENT: With all the media hype given to deaths caused by airbags, parents and others who transport children may find it difficult to decide when it's appropriate to get an on/off switch for the passenger-side airbag. The evidence clearly favors keeping the airbags "on", but there are some situations where it may be better to have the airbag deactivated. The NHTSA and the Insurance Institute's pamphlet help identify those few situations where installation of such a switch might be appropriate.

Special Note: Because of' the importance of this decision, we are, including, in this issue of CHILD HEALTH ALERT a copy of the guidelines intended for consumers that is contained in the pamphlet. (This may be reproduced for posting on bulletin boards or for distribution to parents.) For a copy of the entire pamphlet, contact the Insurance Institute for Highway Safety at 1005 N. Glebe Rd., Arlington. VA 22201, tel. 703 247-15001, fax 703 247-1678, Internet: www.hlighwaysafety.org

INFECTIONS/ILLNESS

Managing Winter Diarrhea ...

Many of the intestinal illnesses that children acquire during the winter months are complicated by diarrhea, and if children lose too much fluid because of diarrhea, they may become dehydrated. In years past, dehydration meant sending the child to the hospital so fluids could be given intravenously. However, research over recent years has demonstrated that mild dehydration can be managed --and better yet, prevented--with special fluids that the children can drink. Unfortunately, these "oral rehydration solutions" (ORS) don't taste very good, and care-givers can have quite a problem getting children who need them to drink them.

Because of the poor taste of commercial ORS, some parents and physicians have taken to flavoring these products with a small amount of the child's favorite juice, unsweetened Kool-Aid powder, or Jell-O powder. However, no one has yet shown whether these well-intentioned efforts might dilute or otherwise change the ORS so they no longer provide the same benefit.

To see whether adding these flavorings creates potential problems, a researcher from Calgary, Canada, took Pedialyte, a popular commercial ORS, and added different amounts of unsweetened Kool-Aid, Jell-O powder, apple juice, or orange juice. When small amounts of these liquids or powders were added to relatively large amounts of Pedialyte, the chemical makeup of the Pedialyte wasn't changed by an appreciable amount, but when larger quantities were added to Pedialyte, the chemical makeup did change in a way that could produce problems. The author therefore concluded that to maintain acceptable biochemical levels, parents and other care providers should add no more than 2.5 cc (one-half teaspoon) of unsweetened Kool-Aid powder or Jell-O powder to 8 ounces of Pedialyte, and no more than one ounce of fruit juice should be added to 4 ounces of Pedialyte. (Nijssen-Jordan C. Pediatric Emergency Care, December, 1997, pp. 374-375)

COMMENT: Years ago, physicians relied on relatively "high-tech" approaches to treat children with intravenous fluids when they became dehydrated; in poor countries, where this technology was not widely available, efforts were instead focused on preventing dehydration in the first place, and it was in those settings that the "low tech" ORS was developed and proven to work. Though intravenous fluids may still be needed if dehydration is serious, children throughout the world now are less likely to develop dehydration if they are treated with the simple approach of ORS. The report above offers some guidelines for how to safely flavor ORS if the taste is just too much for a child to handle.

... And Hope For Prevention

A common cause of diarrhea during winter months is rotavirus, which tends to attack infants and toddlers. Rotavirus diarrhea is so common that it accounts for over 500,000 visits to doctors and about 50,000 hospitalizations each year for children under 5 years of age. Not surprisingly, then, a lot of work has focused on developing a vaccine against rotavirus, and in mid-December, an advisory committee to the U.S. Food and Drug Administration recommended that FDA approve a rotavirus vaccine for general use. The vaccine, which has been shown to be safe and effective, is given orally in three doses, when infants are 2, 4, and 6 months of age. (Pediatric News, December, 1997, and other sources)

COMMENT: This development is good news, and it's expected that the vaccine (called RotaShield) will become available fairly soon. The cost of the vaccine is likely to be fairly high, so it's still not clear whether experts will recommend that it be given to all infants or only those who might be particularly at risk from having rotavirus diarrhea, such as infants and children with various chronic diseases.

CHILD SAFETY

Should We Worry About Cartoon-induced Seizures?

At the end of last year, some 700 people--mostly children--were taken to hospitals throughout Japan after having been affected by flashing lights on a cartoon television show. Some had vomited, and others had seizures or lost consciousness. About 20 minutes into the show, which is particularly popular among kindergarten and primary school children, a bright red explosion filled the screen, and red- and blue, lights flashed for about five seconds. It was this climactic scene, composed of both different colored lights flashing alternately and a flash that emits a strong beam of light. that set off the convulsions and vomiting. (New York Times, Dec 18 1997)

COMMENT: This incident was widely reported and undoubtedly raised concern among parents about the health hazards posed by TV cartoons. Some experts have suggested that this "epidemic" of seizures and related problems was probably due to the unique combination of lights, colors, and flashes that triggered these events, and others have noted that the same problem is unlikely to occur in North America since the nature of TV images differs from Japan. Further, despite the years and years of cartoons that have been shown across North America, we are not aware of any episodes of seizures that have occurred here.

For these reasons, there is probably little concern about a similar phenomenon occurring. To reduce risks even further, however, specialists suggest that children sit at least 6 feet from the screen and that the room not be darkened while the TV set is on.

PARENT/CHILD

Yes, There IS Life After Colic!

Given the stress that colic puts on families in the first months of an infant's life, it came as little surprise when researchers in Finland found that families with a colicky infant had more problems with anxiety and conflicts than did families without colicky infants. Even one year later, the families of severely colicky infants still had more problems than other families,, though families of infants with moderate colic were getting closer to normal. Now these same researchers report on family life when the child reached 3 years of age.

Among the 59 families of children who had had moderate or severe colic and 58 families without a colicky child, the authors found that families with moderately and even severely colicky infants no longer differed very much from other families with respect to psychological family characteristics. (Raiha H et al: journal of Developmental & Behavioral Pediatrics, 1997, pp. 290-294)

COMMENT: Last month. we reported results of a study suggesting that small amounts of a sugar solution might relieve some of the symptoms in a child with colic. Now, the study above offers some badly needed reassurance to parents of colicky infants who are sure that life will never return to normal. While doctors have long offered families the comfort that "this will pass", it's nice to also know that the effects on the family are also likely to pass!

RESOURCES

Poison Prevention Materials

The week of March 15-21, 1998 is Poison Prevention Week, and readers may be interested in obtaining a free packet of materials that will help focus attention on how parents and others who care for children can take simple and effective steps to reduce the risk of poisonings. Included in this information packet is a catalog offering additional materials that can be ordered, much of it at no cost, such as telephone stickers and a pamphlet called "Locked Up Poisons", with safety recommendations in both English and Spanish. To obtain the introductory packet, send a postcard with your name and address to: Secretary, Poison Prevention Week Council. P.O. Box 1543. Washington. D.C. 20013.

CHILD DEVELOPMENT

Developmental Delay Among Preschoolers Who Are Born At Very Low Birth Weights

It's widely recognized that infants who are born at very low birth weight (below 3 pounds, 5 ounces) have an increased chance of having developmental disabilities; these can include problems with learning, movement (coordination), or behavior. Most specialists recognize that these problems are particularly common among certain very low birth weight babies, including those who already have obvious disabling conditions such as cerebral palsy, deafness, or blindness. However, more than half of recently born very low birth weight babies don't have any of these obvious problems, and it's not clear whether they, too, have an increased risk for later developmental disabilities.

To learn more about whether these "healthy" babies are at risk, researchers from a variety of federal and state health agencies studied 357 very low birth weight children born in Missouri between December, 1989 and March, 1991, and compared them to children with moderately low birth weight (between 3 pounds 6 ounces and 5 pounds 8 ounces) and children with normal birth weights (above 5 pounds, 8 ounces).

They found that even the very low birth weight infants who were apparently well had higher risks for both moderate and severe measures of delay than either of the two higher weight groups. Depending on the measures, these children were about 1.5 to almost 3 times more at risk than moderately low birth weight infants, and about 2 to 6 times more at risk than normal birth weight infants. The authors conclude that "this study supports developmental follow-up of non-disabled very low birthweight children because of the significantly elevated risk for delay among apparently normal infants." (Schendel DE et al: American Journal of Epidemiology, November 1, 1997, pp. 740- 749)

COMMENT: It is always encouraging to know that a very small baby can survive birth without having obvious disabilities, but this report serves as a useful reminder that we still need to be alert for other delays that may develop in these children-since some problems may only become apparent as the child approaches school age.

CHILD CARE ISSUES

More On Alternative Ways To Manage Head Lice

In the January., 1998, issue of CHILD HEALTH ALERT we reported that some physicians and parents were using petroleum jelly (Vaseline and other brands) to manage cases of head lice that didn't seem to respond to more traditional treatments. A number of readers have contacted us to comment on their experiences with this approach--and none of them was good! While some acknowledged that the treatment might work, they consistently described how messy the petroleum jelly was, how impossibly difficult it was to remove this product from children's hair, and how it should only be considered as a desperate, last-ditch effort.

Some of these same readers suggested other treatments we've heard about, including mayonnaise (not the low-fat kind') and olive oil which. like petroleum jelly, are applied to the hair, then covered with a showercap, left on overnight, and washed out in the morning. These food products are believed to work by smothering the head lice, but we must point out that we're unaware of any scientific studies documenting that these approaches really work. On the other hand, if they're used carefully (and without adding other ingredients!), we're not sure they pose much of a risk. Rather than repeatedly using pediculocides, frustrated parents might want to discuss these alternative approaches with their health care provider.

PRODUCT RECALLS

Recalls: Voyager Car Seat/Strollers...

Cosco Inc., of Columbus, Ind., is recalling about 6,000 Voyager Car Seat/Strollers for in-home repair. The device is an infant car seat that snaps into a frame for use as a stroller. When used as the stroller, the car seat could become dislodged and fall to the ground, potentially injuring the infant. The problem does not affect the product's use as a car seat or carrier. The Voyager models involved in this repair have manufacturing dates from September 8, 1997 through October 27, 1997, and the date is located on the car seat, not on the stroller frame. The car seat comes with a fabric canopy and seat pad; "Cosco" is imprinted on the front of the car seat. It was sold nationwide from September through November 1997, primarily through Wal-Mart, Target, Ames, Service Merchandise, Caldor, and Montgomery Ward retail stores for about $79. Consumers should call Cosco at (800) 221-6736 between 8 AM and 4:30 PM EST Monday through Friday for the repair instructions, or write the company at 2525 State St., Columbus, IN 47201.

... and J. Mason Infant Carriers

MTS Products, Inc. of Santa Clarita, Calif., is recalling over 18,000 J. Mason infant carriers because the handle on the carrier can break, causing the carrier to fall and possibly injure the child. The white plastic infant carrier comes with a fabric seat pad and matching removable sun shade canopy. The fabric comes in the following designs: 1) multicolored fabric (pink, blue, white and green) with a geometric pattern; 2) light blue fabric with white squiggly lines; or 3) light blue fabric with pink and purple patterns. "J. Mason" is imprinted on the handle, which can be used to convert the carrier to a rocking or feeding position. "Made in U.S.A." is imprinted on the bottom of the carrier and there is a red sticker on the bottom of the carrier that reads "Warning Do Not Use As A Car Seat." The product is packaged in a cardboard box with the following UPC codes: 0-26669-08249-2, 0-26669-08252-2, or 0-26669-08253-9.

The carriers were sold nationwide from April, 1996 through August, 1997 for about $20 at Kmart, Rose, and State Enterprises stores. Consumers should call NITS at (800) 242-1922 between 8:30 AM and 5 PM PST Monday through Friday to receive a free replacement infant carrier.

(All reports are from U.S. Consumer Product Safety Commission, Washington, DC)