Child Health Alert Newsletter

Child Health ALERT

Volume 14 A Survey of Current Developments Affecting Child Health Care July/August 1996

Antibiotics For The Common Cold: How Often Are They Used?...

Colds occur in every climate and in every season, and they are a major cause of lost time from child care, school. and work. It is generally believed that the common cold is caused by viruses. Since antibiotics work against bacteria but not viruses, most health experts recommend against using antibiotics to treat the common cold. To see how often doctors prescribe antibiotics for colds, researchers reviewed Medicaid files from Kentucky. Among patients who had seen their doctor for what appeared to be a cold, 60% filled a prescription for at least one antibiotic, and the large majority were children. The authors point out that "the treatment of respiratory infections with antibiotics may be so ingrained in the belief systems of both American physicians and patients that both expect it." (Mainous AG III et al: Journal of Family Practice, April, 1996; pp. 357-361)

... And Can They Cure Colds?

Though experts argue that antibiotics won't benefit someone with a common cold, a recent study from Switzerland raised questions about whether some colds may indeed be "cured" with antibiotics.

In the study, researchers enrolled over 300 patients who had colds, and they then treated them either with an inactive agent (placebo) or an antibiotic. Five to seven days later, the patients were examined and asked about their symptoms since treatment began.

To see whether there were bacterial causes to these colds, which might then be a reason to use antibiotics, the authors took cultures from the back of the nose. Patients who did not have certain bacteria had no benefit from antibiotic treatment. On the other hand, 20% of the patients did have bacteria that can cause illness, and among this group of patients, 27% were cured by antibiotics. These findings led the authors to believe that bacteria in these patients were the cause of their colds.

Side effects to the antibiotics were quite common, with almost 25% of those treated reporting gastrointestinal disturbances or diarrhea (compared to only 5% who had those problems on placebo). (Kaiser L et al. Lancet, June 1, 1996; pp. 1507-1510)

COMMENT: Ever since antibiotics came onto the scene about 50 years ago, physicians have been prescribing, them to treat colds of various kinds, and the study from Kentucky only confirms what has been known for years. As the first authors point out, a large majority of patients have come to expect that if they have a cold, it should be treated with antibiotics--either to cure the cold or to prevent complications that may follow a cold (such as sinusitis or ear infections).

The second study is far more controversial, because it suggests that in some patients, antibiotics may actually cure or improve symptoms of what seems to be a common cold. Media attention focused on this study may have given the impression that people with colds ought to be treated with antibiotics, but a careful reading of the study does not support that view.

The key point is that there was (and is) no way to tell quickly which patients turned out to have bacteria and which didn't. Taking into account that only 20% of patients had the bacteria and that only about 25% of them were cured it would mean that we would have to treat 100 children with colds to cure 4.

There are a number of other factors to consider. First, there is the cost and inconvenience of taking antibiotics. Second, there is the problem of side effects; in this study they were mild, but they occasionally can be serious. Finally, there is another problem: we have all heard about the growing problem of bacteria that are resistant to the antibiotics we have available at the present time. A major reason for this problem is that antibiotics have been used too freely, so bacteria have had too many opportunities to develop resistance. If we started routinely using antibiotics for adults or children with the common cold, the problem of antibiotic resistance would increase dramatically.

While there are some patients whose colds might suggest the need for antibiotics, the price of using these drugs to treat most colds is simply not worth the small benefits that might result.

PRODUCT SAFETY

Reducing Baseball Injuries...

The U.S. Consumer Product Safety Commission (CPSC) announced results of a one-year study which found that safety equipment for baseball could reduce about one-third of the baseball related injuries to children each year. Directors of a number of baseball organizations endorsed the idea; one pointed out that safety equipment has already reduced injury and insurance rates. The good news is that such equipment is already available on the market. The CPSC recommended the following:

* Softer-than-standard baseballs and softballs, which have a softer, spongier core, can reduce ball impact injuries.

* Face guards that attach to batting helmets and protect the face can reduce injuries to batters.

* Safety bases that release from their anchor can reduce sliding injuries, and those that are based on the child's age, gender and skill level provide the best protection. (Press Release: CPSC, Washington, DC, June 4, 1996)

... And Lead Poisoning Risk From Imported Mini-Blinds

Testing conducted by the CPSC determined that some imported mini-blinds can present a lead-poisoning hazard to young children. They estimated that 25 million non-glossy, vinyl miniblinds have lead added to stabilize the plastic; the blinds are imported from China, Taiwan, Mexico, and Indonesia.

Over time, the plastic deteriorates and forms lead dust on the surface of the blinds; if children wipe the blinds with their bands and put their hands in their mouths, they could consume enough lead to pose a risk.

In homes with children ages 6 and under, the CPSC recommends removing the blinds. New blinds, without lead added, should appear in stores in July, and they will be packaged in cartons iiidicating that they are made without lead. (Press Release: CPSC, Washington, DC, June 25, 1996)

MEDIA ISSUES

Is Melatonin Safe for Children?

Melatonin, a hormone naturally produced by the body, has been the subject of many media reports in the last year or so because melatonin pills are being widely used to treat sleep problems and jet lag. Ina letter-to-the-editor, a pediatrician from New York describes an adolescent patient who, during a routine exam, asked about using melatonin for jet lag. She had already bought a melatonin-containing hormone at a health food store, and she was taking doses nightly as instructed by the salesperson. The doctor reports that a number of patients and parents have asked about this "natural remedy".

He points out that since it is marketed as a dietary supplement and no a drug, melatonin does not require evaluation or approval by the Food and Drug Administration. Manufacturers aren't required to assure that it is pure (or even that a product indeed contains melatonin), and the FDA can't remove a dietary supplement from the market unless it can prove it is dangerous when used according to the package label. He warns about the potential hazards of "natural products" and "dietary supplements", and urges that more research be conducted to assure the safety and effectiveness of melatonin. (Turow V.Pediatrics, March, 1996; p. 439)

COMMENT: This letter offers a timely bit of information and caution We can't remember when a "natural therapy" so rapidly captured the public's fancy, but given how little we know about the product, there is real reason for caution. First, we know very little about the effects--good and bad--of the melatonin that our bodies produce naturally. Studies so far have shown some benefits both for insomnia and jet lag, but they have involved only a few subjects (typically adults) taking known doses of pure melatonin under controlled condition for short periods of time. In contrast, the melatonin products being sold in many stores (not just health food stores) may not state their source or purity, and they are indeed often recommended by untrained salespeople.

Though there is little evidence about the hazards of melatonin, neither is there much evidence for its safety, and we would urge caution in its-use-particularly by growing children--until we know much more about this "natural product."

PARENT/CHILD

Does "Back To Sleep" Affect Head Shape?

In recent years, child health experts have recommended that parents put their newborn children to sleep on their backs, since it has been suggested that sleeping face-down may increase the risk of sudden infant death syndrome (SIDS). As parents have begun to put their children "back to sleep", some doctors have noticed a possible side effect.

Researchers in St. Louis report that over the past few years they have seen many more children with flattening on one side of the back of their heads. The authors are not sure if the change in sleep position has resulted in this problem, but if it has, parents would have to be educated about the need to avoid letting babies sleep on one side only.
(Kane AA et al: Pediatrics, June,1996; pp. 877-885)

In the next month's issue of the same journal, two SIDS experts comment on the possibility that sleep position is causing flattened heads. They point out that the changes seen in St. Louis (and reported by some other experts) have not been seen in other areas of the country, and question whether there is really any cause-and-effect relationship to raise concern. However, until the question is answered, they suggest that parents should alternate positioning the back of the infant's head slightly to the left and slightly to the right.

Though it is recommended that an infant be placed on his or her back when put to sleep, these authors note that there is no increase in risk of SIDS if infants are kept prone (on their stomachs) when they are awake and playing. They encourage parents to place the infant prone during supervised play, since it may be important in the development of motor skills. (Hunt CE & Puczynski MS: Pediattics, July, 1996; pp. 127-129)

POISON SAFETY

A Reminder About Insect Repellents

The very wet winter experienced by so many parts of the country has resulted in unusually large numbers of mosquitoes and other biting insects this summer. This, together with continuing concerns about tick bites and Lyme disease (see CHILD HEALTH ALERT, June, 1994) will prompt parents and child care providers to use various kinds of insect repellents, most of which contain a chemical called "DEET". While there's no question that these products work, there have been concerns in recent years that children could suffer toxic effects from using excessively large amounts, especially if the repellents contain DEET in concentrations higher than 50%.

It's therefore worth repeating some simple advice about using DEET-containing insect repellents:

1) Use as little DEET as possible;

2) Never apply DEET to injured skin;

3) Use the lowest concentration that works; there is some evidence that the effectiveness of DEET doesn't increase at concentrations above 30-35%, so "stronger" products may provide little additional benefit.

4) Only apply DEET to exposed skin or clothing. Applying it to clothing can be 90% effective in preventing tick attachment (though it may damage certain delicate fabrics).

5) Don't apply DEET to children's hands, as they may accidentally get the chemical into their eyes or mouths.

6) Remove DEET with soap and water once it is no ]on-er needed.

With these measures in mind, DEET can be used on children to make their summer more enjoyable. (Dr. Shannon is with tile Divisions of Emergency Medicine and Clinical Pharmacology/Toxicology, Children's Hospital, and Associate Professor of Pediatrics, Harvard Medical School, Boston, MA)

CHILD CARE ISSUES

Corn Starch: A Diaper-Changing Hazard

Many people are now aware that talcum-based baby powders can be inhaled by infants during diaper changing. Small amounts might cause some mild coughing, but if the baby is playing with the container and inhales a large amount, serious lung problems can develop. Some health care providers recommend that no powders be used for routine skin care, and others recommend that corn starch powder be used instead of talcum. Physicians at Schneider Children's Hospital in Long Island, NY, describe a one-month old infant who developed respiratory failure and severe lung problems after inhaling corn starch powder. The child recovered after 5 days of intensive care at the hospital.

The baby's mother reported that she routinely used corn starch powder for her son's skin care during cloth diaper changes, but she wasn't aware of any time when her baby inhaled a large amount of the corn starch. However, corn starch was found in the child's windpipe.

The authors urge that parents be aware of the potential hazard of corn starch use, since like other powders, it can cause serious problems if a baby inhales large amounts. (Silver P et al: Pediatric Emergency Care, April, 1996; pp. 108-110)

READER'S MAILBAG

Are Children's Tattoos Laced With LSD?

Q: I received the following, warning on the internet, and wanted to know if it is legitimate. I'm reluctant to send home information to parents until I'm sure of the details. Please let me know, since I trust your publication:

"Warning to parents: A form of tattoo called 'Blue Star' is being sold to school children. It is a small piece of paper containing a blue star. They are the size of a pencil eraser, and each star is soaked with LSD. The drug is absorbed through the skin simply by handling the paper. There are also brightly colored paper tattoos resembling postage stamps that have the picture of the following:
Superman, Mickey Mouse Clowns, Disney Characters Bart Simpson Butterflies. This is a new way of selling acid by appealing to young children. These are laced with drugs. If your child gets any of the above, do not handle them. These are known to react quickly and some are laced with Strychnine. Please feel free to reproduce this article and distribute it within your community and workplace. Get the word out about this danger to our children."

V. Mistry, R.N.
School Nurse
Special Children's Center
Ithaca, NY

A: As more and more child care professionals begin to use the internet as a source of health care information, there is an increasing problem of sorting out whether the information is true or not. We asked Dr. Michael Shannon to comment on the warning Ms. Mistry found on the internet:

DR. MICHAEL SHANNON COMMENTS: This message is a hoax, and the most amazing thing about it is how long it's been around. For the last 10 years this identical warning has been sent throughout the New England area, terrorizing parents, nurses, teachers, and physicians. This is an absolute fraud, and it is filled with wrong information. For example. LSD is not absorbed through the skin. and neither is strychnine. Someone sadistic has obviously taken great pleasure in perpetuating this myth. (Dr. Shannon is a member of the Divisions of Emergency and Clinical Pharmacology/Toxicology, Children's Hospital, and Associate Professor of Pediatrics, Harvard Medical School, Boston, MA)

PRODUCT RECALLS

Infant Girls' Rompers...

The Kmart Corporation, of Troy, Ml, is recalling 23,000 rompers for infant girls because the paint on the buttons contains excessive amounts of lead. The short-sleeve, crew-neck rompers come in white with pink flowers or white with blue flowers, and were available in three sizes: 121, IS, and 24 months. Three shiny plastic buttons on the front of the garments are about 1/2 inch in diameter. The sewn-in tags in the neck read "Young Classics (TM) 60 % Cotton 40 % Polyester RN # 42000 Bangladesh"; the style number 1832 appears on the rompers' hang tags. They were sold in Kmart Stores for $6.99 from January through April, 1996 under the Young Classics label in the Kidsworld department. Consumers should return them to any Kmart store for a full refund; for more information, call 1800 63KMART.

... And Chair Recliners

Golden Chair of Houlka, MS, and Allen Mfg., of Benton, TN, are recalling about 142,000 recliner chairs because small children can get trapped or strangle in them. If the space between the chair's seat and footrest is more than 5 inches wide, a child's head can get caught, and the space in the recalled recliners was up to 6 inches wide. Those involved are Golden Chair recliners, covered in beige, blue, brown, or mauve fabric; the label, stapled underneath the footrest, reads Furniture Manufacturing Co"; "Lic. No. NY 58770" may also appear on the label. Allen Manufacturing recliners are covered in fabric and vinyl in various colors, and can be identified by a label, "#VA-9300-Tn" attached to the bottom of the footrest. Consumers who have these chairs should measure the space between the seat and footrest; if the opening is more than 5 inches, consumers should stop using the chair immediately and call the manufacturers-Golden Chair at 800 965-1277 or Allen Manufacturing at 888 338-0550 (888 is also a toll-free number).

"Healthy Handwashing" Poster Available

One of the most frequent concerns of our readers, and a topic we have discussed many times, is the importance of handwashing. In an effort to encourage better handwashing practices, we have developed an attractive and colorful "Healthy Handwashing" poster that uses lively animal figures to illustrate key points. This 18 x 22 inch poster is printed on heavy paper, and would be a useful addition to homes, child-care centers, and health care offices. The cost (including postage and handling) is $7 for one and $5 for each additional poster (bulk order information is available on request). A poster is sent free with each new subscription or two year renewal. For further information and an order form, send a business-size stamped, self-addressed envelope to "Healthy Handwashing", Child Health Alert, P.O. Box 610228, Newton Highlands, MA 02461.