Child Health ALERT

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

Tylenol Maker To Warn Parents About Overdose Risks

The manufacturers of Tylenol (acetaminophen) will soon inform parents, through labels and advertising. that too much of the drug, can harm their children. This action was prompted by claims that unintentional overdoses of acetaminophen have caused liver damage and even deaths in children. New labeling for infant Tylenol should be on store shelves in a few weeks, and it will say that the contents are concentrated acetaminophen and that taking more than the recommended dose could cause serious health risks. McNeil Consume Products, the manufacturer of Tylenol will take out magazine ads beginning next month to inform parents of correct dosages. and a television campaign is also in the works.

In a related development, an advisory committee to the U.S. Food and Drug Administration last month recommended additional changes in the label, so that information is provided on correct dosages for children under 2 years of age. (Associated PresslNew York Times, October 19, 1997)

COMMENT: Many parents have been confused by news reports about this development, thinking that these reports raised concerns about the basic safety of Tylenol and other brands of acetaminophen. In fact, it has been known for many years that acetaminophen when taken in correct doses is remarkably safe for children and adults. It has also been known for many years that significant overdoses of this drug could cause liver damage and even death. What's new are the concerns about how often children might receive unintentional overdoses of acetaminophen, which could cause them harm.

How might overdoses occur? Tylenol and other brands come in different formulations for children of different ages. When it comes to liquid products, there are two designed for children-for infants, a concentrated form is given with a dropper, and for young children, a less concentrated form is given by teaspoon. Unfortunately, parents who don't read the product label, or who have misplaced the dropper, or recall a doctor or nurse saying to "give Johnny a teaspoon of Tylenol" might give a teaspoon dose of the concentrated infant Tylenol instead of the children's Tylenol. The problem is that a teaspoon of the infant drops contains a much larger dose than a teaspoon of the children's liquid! Though unintentional overdoses are fortunately very rare, the possibility of a problem does exist.

By warning parents about the possibility of confusing one Tylenol dosage strength for another, the new labeling should improve a potentially confusing situation. However, it's not clear to us that other manufacturers of acetaminophen, including store brands, will have similar warnings, so the problem may not be solved. Furthermore, we think it's important not to assume that all responsibilities lie with the manufacturers dosage information has always been on the product labels, and no matter what other warnings might be added, they will do little good if adults who give the medications to children don't read those labels. Just because a children's medication is available without prescription doesn't mean that it should be used casually, and we can't overstate the importance of reading the label every time a medication is given.

The second part of the news report suggests that the FDA is likely to have the product label provide dosage information for children under 2 years of age. In the past, this information was left out, and parents were instructed to consult their physician about doses for young children. Because of concerns that parents would give the medication to children under 2 without consulting their doctor first, a committee advising the FDA felt it would be better to provide the dosage information than leave parents guessing about how much to give.

RESOURCE

Are Relaxation Tapes Helpful For Young Children?

Parents and children live in a busy world. Jobs, car-pools, child-care, sports, and other activities can create a lot of stress for parents as well as children, Some years ago, medical researchers showed that stress and other emotions were connected to peoples' physical health-something called the "mind-body connection". It came as no surprise, then, that research also showed that relieving stress could improve physical health. Over the years, various approaches have been developed to teach adults how to know when stress is present and how to relieve it.

In more recent years, the focus has begun to shift to include children, since their feelings and thoughts, like those of adults, can affect their health, either positively or negatively. For this reason, many experts think it is useful to approach issues of stress awareness and management in children who are just beginning to learn health habits.

One delightful way to introduce children to this important topic is an audiotape called "Wanka, The Caring Elephant". This tape was developed and narrated by Roxanne Daleo, Ph.D, a child therapist and health educator specializing in stress management and relaxation techniques. Each side of the tape is 17 minutes long. Side one is an enchanting tale for children of all ages that teaches sharing and cooperation. Side two is a guided relaxation journey where Wanka invites children to use their imaginations to create a beautiful resting place of their own. The journey is filled with joyful music and soothing sounds of singing birds. The images created by the rhythm and rhymes in the story are designed to help children settle down for a rest.

Dr. Daleo created this tape in an effort to encourage children three years and older to develop healthy habits related to their mind-body interaction. The tape was a response to educators and parents who were seeking effective tools to assist children in a variety of important areas, such as coping with anger, hyperactivity, and overbooked schedules. The most effective way to use this tape, she notes, is to play it in a special quiet space where children can return over and over again. Children should sit or lie comfortably, maybe taking their shoes off, and just listen to the tape. Using it regularly. ideally as part of a routine (such as before bed or nap time) offers the greatest benefits, which include improvements in self-esteem, concentration, and self control. Once the tape is over, its beneficial effects can be reinforced by the children doing some related creative activities-an interpretive dance or other art project, for example.

Another way to help children recognize the mind-body connection doesn't require an audiotape. According to Dr. Daleo, children can be encouraged to tell a story about their day, and adults can ask them questions about what they saw, heard, touched or smelled-even if the images they describe aren't always soothing ones, the very act of going over the events, of the, day can be healing. When parents are involved, this approach has the added benefit of being a good way for them to connect with their children.

We think this tape is a wonderful resource for young families, child care centers, and schools, and it also would make a great holiday gift. Readers wishing to order "Wanka, The Caring Elephant" (at $12.95 plus $1 S&H) or the tape along with a cozy pillow (at $22.95 plus $3.00 S&H) should write Mindworks for Children, P.O. Box 2493, Cambridge, MA 022382493 or call (781) 876-5585.

CHILD SAFETY

Follow-Up On Hazards Of Baby Walkers

Last month, we reminded readers that baby walkers presented serious health risks to infants because of the frequency with which these youngsters fall down stairs or reach for things they shouldn't (CHILD HEALTH ALERT, October, 1997). Though parents and others who care for children might think that walkers help children learn to walk, we pointed out that there was some evidence that the reverse may actually be the case, and now another study suggests that walkers might indeed slow infants' development.

In this study, researchers from Buffalo and Cleveland compared babies who used walkers an average of two and a half hours a day with those who didn't use walkers. The babies, ranging from 6 to 12 months of age, were evaluated at the start of the study and again three months later. On average, babies who did not use walkers sat at 5 months, crawled at 8 months, and began to walk in their 10th month; by contrast, these milestones were delayed by one or two months among those babies who used walkers. Mental skills also appeared to be lower in those who used walkers.

The authors are careful to point out that all the milestones of these children, whether they used walkers or not, were within normal ranges. However, one of the authors explains the differences they found in the following way: "Infants learn by exploring objects in their environment. They drop things, then go after them by reaching, rolling on the floor or crawling. But while a baby in a walker could motor over to things, she can't get to the things she wants to obtain. If she drops something, she can't pick it up. And if babies use a walker after they start to crawl, it deprives them of their ability to freely explore their environment, and this can adversely affect cognitive development." (Brody JE: New York Times, October 14, 1997)

COMMENT: This study was given considerable publicity, but readers may not be aware that though its findings were published in the New York Times, they haven't been published yet in a medical journal. As a result, there's no way to know how the study was designed and whether it's conclusions are justified. Whether or not the study results are correct, however, we think that the author's explanation for how walkers may slow development makes sense, and adds one more argument against the use of baby walkers.

Safety Hint:

Carbon monoxide is an odorless, colorless gas-and one that is very toxic. It's produced when fossil fuels (oil, gas, coal, kerosene) are burned inefficiently. Each fall and winter we hear reports of adults and children who are overcome or even killed because of carbon monoxide that came from a poorly operating furnace or other heating device. While carbon monoxide detectors may help wam about the presence of the gas, the best prevention is to make sure that carbon monoxide isn't being produced in the first place. Before the heating season comes in full force, this is a good time to have a professional inspect all furnaces, oil burners, and other devices that bum fuel indoors to be sure they are functioning properly.

INFECTIONS/ILLNESS

New Concerns About Bacterial Contamination Of Poultry

Very recently, news reports given wide national attention alerted the public to the fact that 70% to 90% of chickens might be contaminated by bacteria that could cause potentially serious cases of illness. The bacteria called Campylobacter, are estimated to cause 2 to 8 million cases of human disease each year, many of which can require hospitalization and some of which can occasionally result in death. Typically, symptoms include cramps, abdominal pain, bloody diarrhea, and fever, usually lasting about a week. Campylobacteriosis, as the illness is called, occurs when people eat infected chicken that is undercooked or eat other food that has come into contact with raw chicken.

There is particular concern about this disease because Campylobacter are becoming resistant to certain antibiotics. It is common for poultry producers to treat chickens with antibiotics to prevent infections and encourage the birds to grow, but overuse of these drugs has resulted in bacteria becoming resistant to them-in fact, studies in Minnesota found antibiotic-resistant Campylobacter in 20% of infected chickens and 84% of infected turkeys. Since these same antibiotic-resistant bacteria cause human disease, there is worry that people with campylobacteriosis may not respond to certain antibiotic treatments.

There's no easy lab test to identify these bacteria, so it may be difficult to diagnose the illness. Preventing poultry from infection in the first place is also difficult, because techniques used by poultry producers to eliminate other bacteria (such as Salmonella) don't seem to work against this Campylobacter. While poultry may be the main source of these bacteria, they can also come from unpasteurized milk, untreated water, and in perhaps 5 to 10% of cases, from contact with feces of pets carrying the bacteria. (New York Times and various national news broadcasts, October 20, 1997)

COMMENT: A great deal of attention is now being focused on the safety of the foods we eat, and readers might wonder why this is happening now. Some illnesses have probably been around for years, but only recently have health experts been able to identify them or track down their sources. An example of this might be infection with E. coli 0157:H7, found in undercooked hamburger and unpasteurized apple cider or juice. Other illnesses are probably fairly new to the United States, and seem to come from contamination of products imported from developing countries. An example of this problem is Cyclospora contamination of raspberries imported from Central America.

Campylobacter infection of poultry may have been this common for many years, but health authorities are getting better at detecting it. However long it's been around, this report is troubling. Nonetheless, it should be kept in perspective. Though we can't rely on the food processing system to protect us and our children from campylobacteriosis, the consumer can provide very effective protection by following some very simple guidelines.

Like so many other food-borne diseases, human infection by Campylobacter can easily be prevented by the following three steps:

1) Thoroughly cook all poultry (170ºF in the breast, 185ºF in the thigh);

2) Thoroughly wash plates and cooking utensils (such as cutting boards, serving dishes, forks, basters) that come in contact with raw poultry or its juices;

3) Thoroughly wash, cook, or throw out all foods that come in contact with raw poultry or its juices.

PRODUCT RECALLS

Recalls: Francisca Baby Cribs...

J.C. Penny Company has begun a recall of about 6,000 Francisca baby cribs because they have short side rail spindles that can loosen and separate, posing a serious safety risk The affected models are 343-3935 and 343-4065. Consumers should return the cribs to their nearest J.C. Penney store for a refund or replacement. For further information, call (800) 709-5777.

... First Alert Child Safety Gates...

Also being recalled are about 18,000 First Alert True Fit child safety gates. Plastic parts on the gates can break off, creating a potential choking hazard for young children. The recalled gates are models CSSGI, manufactured from October, 1996 through May, 1997. They were sold throughout the U.S. To get a free replacement, consumers should call BRK Brands, Inc at (888) 777-5599.

... Dex Wipe Warmers...

Halcyon WaterSpring, Inc., of Ontario, Canada, is recalling over 500,000 Dex Wipe Warmers, an electric heating pad that warms baby wipes, since the products could overheat and melt. The Wipe Warmer, distributed by Dex Products, Inc., of Benicia, California, is about 27 inches long and 3 1/2 inches wide, and wraps around disposable plastic containers to warm the baby wipes inside. The cloth cover is white and is covered with pink, blue, yellow, and green handprints. It has Velcro fasteners and the tan or off-white plastic warmer inside the cloth cover has a white sticker that lists the model number, WW-01. (Products sold after December, 1996 are not involved in this recall-they have a red bar across the top of the white label on the warmer unit.) The Wipe Warmer was sold in various retail stores nationwide for about $10 to $15 from January, 1994 through December, 1996.

Consumers should call Halcyon WaterSpring at (888) 735-5585 between 9 AM and 5 PM EDT Monday through Friday for information on how to receive a full refund or replacement. Consumers can also write to Halcyon WaterSpring, Inc., 355 Champagne Drive, Downsview, Ontario, Canada M3J266.

... Chinese Jump Rope...

Klutz Inc., of Palo Alto, California, is recalling 66,000 jump ropes included with the children's activity book, "Chinese Jump Rope:' The elasticized ropes are joined together by metal crimps that might fail during use, resulting in injury. The book with two ropes sold for $10.95 beginning in March through the Klutz catalog, major retailers, and independent book, toy, and gift stores. For a free replacement, write Klutz Inc. at 2121 Staunton Ct., Palo Alto, CA 94306 or call collect (417) 65 7-0888.

... Evenflo Play Yards...

Evenflo Company, Inc., of Piqua, Ohio, is offering free hinge cover kits for 1.2 million portable play yards because if the hinges are not rotated properly, the play yard could collapse and trap a child or allow the child to wander away. Also, if someone sits or leans on the play yard, the plastic hinges could crack or break, presenting sharp edges that could cause injuries. The play yards sold nationwide at department, discount, and juvenile products stores for $60 to $130, beginning in January, 1990. Models involved are Happy Camper, Happy Cabana, and Kiddie Camper.

The free hinge covers fit only when the hinges are rotated into the right place, assuring that the play yard is set up properly. They also provide additional reinforcement to the sides of the play yard. To receive free hinge covers or a new play yard, call (800) 447-9178 or write Evenflo Company Inc., 1801 Commerce Drive, Piqua, OH 45356.

... And Repair Kits for Graco Stationary Entertainers

Graco Children's Products Inc., of Elverson, Pennsylvania, is providing a free replacement seat ring for about 63,000 Graco stationary entertainers made before March, 1996. The white plastic seat rings on these devices have sharp edges that can cut or scratch a child's legs, usually when the child is being lifted out of the seat. The entertainer has a plastic tray, supported by three adjustable legs; the chair is in the center of the unit and swivels so the child can play with the toys attached to the tray. The model affected has a white plastic seat ring located under the padded seat cover (those with yellow plastic seat rings are not involved in this recall).

The Graco stationary entertainer was sold nationwide for about $59 to $69 in juvenile products and discount stores beginning in November, 1995. Consumers should call Graco at (800) 423-9078 for a free replacement seat ring and installation instructions or write to Consumer Affairs, Graco Children's Products, Inc., P.O. Box 100, Elverson, PA 19520.

(All reports from the U.S. Consumer Product Safety Commission, Washington, D.C., and the American Academy Of Pediatrics, Evanston, IL)