Child Health ALERT

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

Air Bags, Children, And Automobile Safety

Air bags for both the driver and passenger are being required as standard equipment in cars this year, and will be required in light trucks next year. Although they are designed to add to the protection provided by safety belts in front-impact crashes, there has been growing concern about reports that air bags may them selves cause serious and sometimes fatal injuries to children.

As a result, a number of government health agencies collaborated with the American Academy of Pediatrics and many safety groups to examine the role of passenger air bags in fatal injuries to children under the age of 12.

Of the 32 fatal injuries that occurred over almost 4 years, 21 were among children who were either not restrained or were not restrained correctly. Nine others occurred among children who had been seated in rear-facing child safety seats that had been placed in the front passenger seat. Of particular concern were two reports involving 5 year-olds which suggested that children who are restrained by lap and shoulder belts may also be at risk for severe injury.

An editorial note points out that lap and shoulder belts are essential to protect occupants, and that air bags are designed to act as supplements to these belts. To work effectively, air bags have to deploy very quickly, and they do so at speeds up to 200 mph.

For many reasons related to their size and activity, children are more likely than adults to be in a position where they can be injured by an air bag. For that reason, engineers are designing "smart" air bags that will take into account different ages and sizes of occupants.

Until those become available, all children under age 12 should ride in the back seat if possible and use age-appropriate and size-appropriate restraints, as noted below. Additional information on child-occupant restraints is available from the National Highway Transportation Safety Administration hotline: 1-800 424-9393. (Morbidity & Mortality Weekly Report, December 13, 1996; pp.1073-1076)

Recommendations To Prevent Air Bag-Associated Injuries to Infants and Children:

* Infants under one year of age and weighing under 20 pounds in rear-facing child-safety seats should NEVER ride in the front seat of a vehicle with a passenger-side air bag; they must ride in the back seat facing the rear of the car.

* All children under age 12 should be properly secured in the back seat. For older children who have outgrown child-safety seats and booster seats, shoulder belts never should be placed either behind the back or under the arm.

* All children should be placed in the restraint device that offers the maximum protection for their size and age:

For children up to one year of age and weighing up to 20 pounds, use a rear-facing child safety seat.

For children over one year of age and who weigh about 40 pounds or less or are 40 inches tall or less, use a forward-facing restraint.

For children over 40 pounds or who are more than 40 inches tall, regardless of age, use a booster seat until lap and shoulder belt fits properly.

* If possible, children should not be placed in the front seat. If that is necessary in a vehicle with a passenger air bag, the vehicle seat should be adjusted as far back as possible from the dashboard. The child's restraint harness also should be secure and tight over the child's shoulder.

* Because unrestrained occupants OF ANY AGE can be injured or killed by a deploying air bag, all vehicle passengers should use lap and shoulder belts. For all front seat passengers, the seat should be moved as far back as possible from the steering wheel and dashboard.

[Ed. Note: Readers are given permission and encouraged to photocopy the above article and guidelines.]

PRODUCT SAFETY

Peanut Alert: Pepperidge Farm Seasoned Snack Mix

With increasing concern about serious peanut allergies in children, readers should be aware that Pepperidge Farm, Inc., is recalling limited lots of their Fat Free Pretzel Mix in 9.25 oz boxes and 1.5 oz vending machine packages with a "sell-by" date (located on the top front of the packages) on or before 2/15/97, and Seasoned Snack Mix in 9.25 oz boxes with a "sell-by" date on or before 2/15/97. These packages may contain peanuts not listed on the product label. Only the above items with the specified "sell-by" dates are affected by this recall. Consumers who have purchased these products are encouraged to call Pepperidge Farm at 1-800 892-2724 or return the product to the store where purchased for exchange or refund. (Food Allergy Network, Fairfax, VA; November 22,1996)

Window Cord Safety

Most parents are careful about things in the home that may be hazardous to their children, but one potential danger that is often overlooked is the hazard of dangling cord loops on window blinds, shades, and draperies. All it takes is a few seconds for a curious child to notice and try on a window-cord as a play "necklace", and in a few moments it can become an entangling noose. Tragically, 150 infants and small children have died since 1981 by such accidents, so an effort is now being made by the U.S. Consumer Product Safety Commission and the window covering industry to prevent these accidents in the future.

Their message is simple: People with infants or young children in the home should immediately check and childproof their window coverings. Fortunately, it's relatively easy to "fix" looped pull cords--most blinds and shades can be fixed by cutting the cord loop just above the pull tassel and then placing separate tassels at the ends of the resulting two cords. For window coverings that need a continuous loop, a device that ties it down to the floor or wall is recommended.

To help consumers childproof their window coverings, the Wall Covering Safety Council, an industry-sponsored safety group, offers free cord tassels, tie-down devices, and instructions through its toll-free hotline at 1-800 506-4636.

READER'S MAILBAG

What To Do About The Chicken Pox Vaccine

Q: I am interested in your opinion concerning the chicken pox vaccine. I know the U.S. Centers for Disease Control and the American Academy of Pediatrics endorse its use, yet many pediatricians do not even have the vaccine and the physicians who do tell you the "official view" of the vaccinebut don't push it.

-Anonymous, Worcester, MA

A: First, a few words about the vaccine. Chicken pox vaccine (called Varivax) was licensed in March, 1995. A single injection of the vaccine is recommended for all children between the ages of 12 and 18 months, except for those who have a reliable history of having had chicken pox (they're considered to already be immune). In addition, it's recommended for children who are between 19 months and 12 years of age who haven't yet been vaccinated and haven't had chicken pox.

Why aren't more doctors giving the vaccine? Even though official groups have endorsed use of the chicken pox vaccine, many practitioners have been less than enthusiastic about giving it. This situation comes, at least partly, from the general view that chicken pox is not a serious disease, and that a child who has chicken pox may have longer-lasting immunity than a child who is given the vaccine.

As for the seriousness of chicken pox, general pediatricians are correct that the vast majority of children have an uncomfortable but not very serious illness that typically lasts for less than a week; however, experts who deal with infectious diseases have a different view, since they see the children who have serious complications of chicken pox, such as bacterial infections, pneumonia, dehydration, encephalitis, and hepatitis. Though a general doctor's practice may rarely see these complications, they lead to the hospitalization of thousands of children each year.

Further, a child who doesn't get either chicken pox or the vaccine as a child will be susceptible to getting chicken pox as an adult, and the illness in adults is much more serious and more likely to have complications. Finally, the costs of lost days of school--and lost days of work for parents--that result from chicken pox are substantial, since this illness affects almost 4 million children each year.

The issue of immunity produced by the chicken pox vaccine is somewhat more complicated. Until thousands of children are followed for very long periods of time, it's impossible to know just how long immunity from the vaccine will last. At present, it appears to last at least 6-10 years, and health experts are carefully following the children vaccinated years ago to see if and when their immunity begins to drop. However, if immunity does fall, it isn't expected to pose much of a threat, since a second injection could be added to boost it back up again.

Despite some lack of enthusiasm, pediatricians are slowly beginning to use the chicken pox vaccine; as more children receive it, it's less likely that a child will get chicken pox "the old fashioned way"--by contact with a playmate or classmate. In that situation, it will be more important to make sure all children receive the vaccine so they'll be protected from developing chicken pox as an adult.

RESOURCES

Information On Ear Tubes For Children

Infections of the middle ear (called "otitis media") are a very common problem among children under the age of five, so much so that they are the number one reason that parents take their children to see health care providers.

When children have repeated ear infections, parents begin to wonder whether ear tubes may be the answer; ear tubes, which are placed through the eardrum, help prevent ear infections by providing better drainage of the middle ear cavity. Childhood Ear Tubes, a 25-page booklet, can help parents make an informed decision about whether or not to go ahead with ear tubes for their child. The booklet describes what ear tubes are, how they work, how they're inserted, and their pros and cons; it also includes a list of common questions and their answers.

As part of a series called "RX: Required Reading", Childhood Ear Tubes and its companion booklet, ' Childhood Ear Infections, are particularly helpful because they were written by parents in consultation with medical experts. By providing information that parents would most likely want, Childhood Ear Tubes will increase understanding about this common procedure, and this booklet is a good resource for reference libraries.

This and other booklets in the series, Childhood Ear Infections, Childhood Hernia, and Hospitalization and Anesthesia for Children, are each available for $4.95 plus $1 per booklet for shipping and handling, from the publisher, MedConnection, 18 Wilde Road, Wellesley, MA 02181 (Tel: 617 237-8862; or e-mail rxread@tlac.net). Prices for bulk orders are available on request.

INFECTIONS/ILLNESS

What Happens To Children With Acute Abdominal Pain?

Abdominal pain is a frequent problem in children, and it is a common reason for a child seeing a doctor or even being hospitalized.

However, there is surprisingly little known about how frequently it occurs and what happens to children who are seen for this problem. To learn more, therefore, researchers from Indianapolis, Indiana, studied the records of over 1,100 children who came to an inner-city hospital clinic or emergency department because of abdominal pain that had been present for no more than 3 days.

Overall, children with abdominal pain accounted for about 5% of all the nonscheduled clinic and emergency department visits. The most common problems that accompanied the pain were fever, vomiting, decreased appetite, cough, headache, and sore throat. The most common diagnoses given to these children were infections of the ear, throat, intestinal tract, upper respiratory tract ("colds"), or a nonspecific illness.

In this large group of children, less than 2% were admitted to the hospital because of abdominal pain and about I% required surgery for their problem (the vast majority of these children had acute appendicitis). (Scholer SJ et al: Pediatrics, October, 1996, pp. 680-685)

COMMENT: It's not uncommon for children to have abdominal pain, but this study reveals that such pain very often accompanies mild infections and other conditions that aren't necessarily directly related to the stomach or intestines. Though a child's complaints may focus most on his or her "tummy ache", there's a good chance that the-cause is an infection reflected by a cough, sore throat, or headache.

This study also offers some reassurance to parents who are worried when their child has a tummy ache. After all, even among children who were sick enough to be brought into a clinic or emergency department without an appointment, less than 2% were admitted to the hospital and only about 1% needed surgery, primarily for appendicitis. Though this experience may not apply to other situations and parents should not ignore a child's illness, it is comforting to know that in the vast majority of cases, abdominal pain in children is not likely to signify something serious.

PRODUCT RECALLS

Recalls: Radio Flyer Little Wood Wagon...

Radio Flyer Inc. of Chicago, IL, is recalling 14,000 children's toy Little Wood Wagons because they contain too much lead in the red painted sides, which could cause lead poisoning in young children who might eat or chew on the paint.

The body of the toy (model 6), which comes with a pull handle, measures about 12.5 by 7.5 by 4 inches, and has wheels measuring 3 inches by one inch. The wagons were sold nationwide from June through September, 1996 for $20 to $25 at stores including Mills Fleet Farm, True Value Hardware, and The Right Start Catalog and Stores.

Other wagons sold by Radio Flyer are not involved in this recall. Consumers should look for a decal with the manufacturing date on the bottom of the wagon--if there is one, the wagon isn't involved in this recall, but if there isn't, return the wagon to the store where purchased for an exchange or refund. Consumers may also call Radio Flyer at 1-800 621-7613 (24 hours a day) to receive a free replacement wagon.

... Free Wheel Racer Cars...

Laiko International is recalling over 50,000 Free Wheel Racer toy cars because these plastic toys have small parts which could break off and pose a choking hazard for young children. The cars have orange or pink bodies, black wheels, a silver rear-mounted engine, and a driver's head in the cockpit. Sold through Dollar and discount stores nationwide from November, 1993 through December, 1996 for about $1, the cars came in a clear plastic wrapper with a cardboard header labeled in part "Free Wheel Racer Champion--For Ages 5 & Up--Made in Hong Kong- -Non-Toxic " and had the UPC code number 084036 102204. For more information, call Laiko International at 1-800 735-2456 between 8 AM and 5 PM PST or write them at 16710 Johnson Dr., City of Industry, CA 91745.

... Baby's Play Sets...

The Right Start Inc. is recalling about 8,000 Baby's Play Sets because the blue and white ball attached to the yellow rabbit rattle may separate and cause a choking hazard. The set includes up to 9 red, yellow, and blue plastic toddler toys such as rattles shaped like rabbits, hammers, key rings, horns, and phones. The yellow rabbit rattle is about 5 inches long and shaped like a figure-8; in one loop of the figure 8 is a blue and white ball, printed with two eyes and a smile and containing small balls; this loop has red plastic rabbit ears protruding from it. The toys were packaged in a brown cardboard carton labeled "Item BB1816BU ... Baby's Playset ... Made in China." The Right Start mail order catalog and The Right Start retail stores sold the play sets from September, 1994 through August, 1995 for $14.95. Consumers should return the yellow rabbit rattle or the complete Baby's Play Set to the nearest The Right Start store or call the company at 1-800 710-78 16 for a refund of either $1.50 for each rattle or $14.95 for each complete play set.

(All above are from the Consumer Product Safety Commission, Washington, D.C; telephone (301) 504-0580, ext. 1192)

Correction:

In the December, 1996 issue of CHILD HEALTH ALERT, we described a newsletter called "Healthy Start: Food To Grow On", which promotes children's nutrition; the winter issue is available free from the American Academy of Pediatrics if readers send a self-addressed stamped envelope, but we gave the wrong zip code. The correct address is American Academy of Pediatrics, Department C-HS Winter, P.O. Box 927, Elk Grove Village, IL 60009-0927. We apologize for any confusion we may have caused.

Winter Hint:

When the weather is cold, it's important to keep indoor air from becoming too stuffy. Don't set the thermostat too high--ideally, it should be set between 68º and 72º F.

Also, air out rooms by trying to keep windows open for at least 5 to 10 minutes each day.