Child Health ALERT

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

Handwashing-With Or Without Soap To Prevent The Spread Of Viruses

It has been shown over and over again that handwashing is an effective way to prevent the spread of infections, particularly in settings-such as child care-where children are in close contact. Medical experts recommend using soap, and marketing experts push antibacterial soaps. However, a specialist in pediatric infectious disease recently brought some fresh thinking to this important subject.

Dr. J. Owen Hendley, from the University of Virginia, points out that both bacteria and viruses are common causes of respiratory and intestinal infections in children, but antibacterial soaps are designed to kill bacteria. not viruses. So how can the spread of viruses be reduced? Dr. Hendley notes that the most common viruses that cause respiratory illness in children are only spread through close contact, such as someone sneezing or coughing into another person's face, or when a child infects himself by touching secretions that contain the viruses. Fortunately, these viruses can be washed from the hands very easily with nothing more complicated than running water. "The main thing is the rinsing for the removal of virus from the hands, not what you put on them. It's physical removal of the virus." Simple rinsing will also remove many bacteria that don't belong on the skin. (Richards CA: Infectious Diseases in Children, September, 1997)

COMMENT: Dr. Hendley points out that bacteria-killing soaps aren't usually applied in a way that allows them to work most effectively, since they're typically not left on the skin long enough before being rinsed down the drain. Soap is a useful aid to removing bacteria and even viruses that might not easily be rinsed off. However, if parents and others who care for children have to choose, it's better to encourage children to wash their hands frequently, even if they don't use soap correctly. Frequent handwashing remains the best and simplest defense against the spread of both bacterial and viral infections.

New Approaches Offer Hope In Treating Bacterial Infections

Over the years, certain strains of Staphylococcal bacteria ('*Staph*') have become resistant to various antibiotics except one (called vancomycin). A strain of Staph that was also resistant to vancomycin was discovered in Japan in 1996, and now a similar strain has also been discovered in the U.S. Fortunately, this strain could be controlled by other antibiotics, but the U.S. Centers for Disease Control and Prevention worry that it may be an early warning of increasing problems with bacteria that are resistant to various antibiotics. (Morbidity & Mortality Weekly Report, August 22, 1997, pp. 775- 777)

The traditional solution to this problem is to develop new antibiotics, a process that takes years of time and considerable resources. As an alternate approach, a team from Yale University has used genetic engineering to take bacteria that are resistant to a certain antibiotic and make them sensitive to it, a change that allows the antibiotic to kill the bacteria. Though they're optimistic, the researchers point out that so far they've only tried it in laboratory experiments, and they caution that it will be several years before it could be available for actual use. (Citation in the British Medical Journal, August 16, 1997, p.387)

COMMENT: These techniques might, after years of experimentation, prove to be effective new ways to prevent and treat a host of infectious diseases, but for now we must rely on the techniques available to us. As we noted above, a major way to prevent the spread of infections is frequent handwashing. As we've noted previously, a major way to keep antibiotics effective is to make sure we don't overuse them; that means that physicians shouldn't prescribe them and parents shouldn't request them where they're not needed, such as treating the common cold.

PRODUCT SAFETY

Despite Warnings And Education, Babywalker Injuries Continue

Babywalkers have been used for decades, but over recent years it became clear that they were associated with high rates of injury, many of which were serious or even fatal. The number of injuries blamed on babywalkers is greater than those associated with other baby products, including strollers, carriages, high chairs, playpens, and cribs. Studies have shown that between 12 and 40% of infants who use babywalkers are injured while using them; most of these involve falls down a flight of stairs, which often result in head injuries. Other injuries include finger entrapment, tip-overs, and bums or poisonings resulting from the infant's ability to reach previously unreachable areas.

Concern over the frequency and seriousness of injuries led to widespread public education, and warning labels were included with these devices. However, researchers from Children's Hospital in Columbus, Ohio, reviewed their emergency room experience between 1993 and 1996, and found over 250 children who had been treated for injuries related to their babywalkers. The vast majority had fallen down steps, and 10% of the children seen in the E.R. had to be admitted to the hospital because of skull fractures.

Interviews of the parents indicated that in more than 3/4 of the accidents, the child had been under supervision, and 59% were aware of the potential dangers of babywalkers before the accident. After the accident, one-third of the parents used the babywalker again.

The authors conclude that "despite the currently used prevention strategies, including adult supervision, warning labels, care giver education programs, and stairway gates, serious injuries associated with babywalkers continue to occur to young children." They call for mandatory design changes in these devices, and banning of those babywalkers that don't meet these tougher standards. (Smith GA et al: Pediatrics, electronic edition, August, 1997, p. e1)

COMMENT: This report describes a large number of children who were injured during the years when various efforts were being directed at preventing these injuries by reducing the sale and use of babywalkers. Though some parents believe that these devices help children learn to walk, that is not the case, and there are some studies that suggest the opposite might be true.

Though a number of child health advocates have called for a ban on babywalkers, this has not happened. The authors point to Canada's approach, which requires that babywalkers be wider than a standard doorway, so the risk of falls down stairs is reduced. While government officials debate about what to do, parents and others who care for children should recognize that babywalkers are dangerous, and that serious accidents can occur quickly, even while a child is under adult supervision. The best approach is to avoid using them.

ASTHMA/ALLERGY

Allergy Alert: Peanuts In Quaker Rice Cakes...

Peanut allergy is on the increase, and a number of children have such serious reactions to peanuts that they have to carefully avoid all products that might contain even trace amounts. The Quaker Oats Company is therefore informing peanut allergic people that some flavors of Quaker Rice Cakes will be manufactured on equipment that also is used to make peanut-containing rice cakes. The affected flavors are: Chocolate, Apple Cinnamon, Buttered Popped Corn, Cinnamon Crunch, Blueberry, and Strawberry. Only the large versions of these cakes will be affected. Products manufactured under these conditions will include the statement "May contain traces of peanuts" beneath the current ingredient listing, and should be on store shelves by mid-September. Certain flavors are not being processed on shared equipment (Caramel, Plain Salted, Plain Unsalted, White Cheddar, and Monterey Jack), but consumers are urged to read the ingredient labels in case products change in the future. (Food and Allergy Network, Fairfax, VA, September 9, 1997)

... And Recall Of EpiEZPen Injector

People who are highly allergic to such things as peanuts or bee stings often carry with them a special device that allows them to quickly inject themselves with epinephrine ("adrenalin"), a drug that can be life-saving in a serious allergic reaction. One particular lot of such a device, called EpiEZPen, is being recalled because a small number of the automatic injectors may activate prematurely. This product, from Meridian Medical Technologies, was distributed under the name Survival Technology Inc., and Center Laboratories. The lot involved is 6SA145.

It is important to note that this recall does not affect the EpiEZPen, Jr.. which is often prescribed for use in children. Consumers who have a product with this lot number should return it to the place of purchase for a free replacement. For further information, call 1-800 527-4278, extension 13. (Food and Allergy Network, Fairfax, VA, September 23, 1997)

RESOURCE

Vaccine Hotline

Parents often have questions about all the vaccines that children are supposed to receive, the schedule they're supposed to follow, and the safety of the various oral and injected vaccines; this is particularly true when new vaccines are added to the list. Fortunately, there is a resource that can help answer many of these questions. The vaccine hotline, set up by the U.S. Centers for Disease Control and Prevention, has both English and Spanish information specialists, is toll-free, and can be called from 8 AM to I I PM Eastern time Monday through Friday. The number to call is 1-800 232-2522 (English) or 1-800 232-0233 (Spanish).

CHILDCARE ISSUES ]

Mary Ucci:

Some Thoughts About Halloween...

Halloween can be an exciting and pleasurable time for children and their families. Like other holidays, Halloween provides a good opportunity for families to get together, to play together, and to build lasting memories. At the same time, Halloween can be over stimulating and tiring, and with its masks and costumes, it can also be a frightening time for many children between the ages of two and six years. These fears arise because most young children can't really distinguish between fantasy and reality. For that reason, it's important to give children time to talk about their fears of Halloween, the scary masks, and the life-like costumes. At our center, we encourage teachers to reassure children with messages such as "Susie, even when you're wearing your turtle costume, I know that you're still Susie." Parents and other adults might also want to remind older children that, while they are not afraid of masks and costumes, many preschool children genuinely are. Being mindful of the young child's perspective will help assure that Halloween is an enjoyable and non-threatening holiday.

(Mary Ucci is a member of the CHILD HEALTH ALERT Editorial Advisory Board, an advocate for developmental approaches to preschool teaching, and a specialist in establishing developmentally appropriate environments for young children.)

Apple Cider Caution

Though publicity about infections from certain E. coli bacteria has diminished, it is still important to be aware that raw apple cider can be contaminated with these organisms (the same ones that are found in undercooked hamburger). The bacteria come from cow feces, and they can contaminate apples that have fallen on the ground near cow pastures. At a minimum, apples used for apple cider should be thoroughly washed and brushed, but the best way to be safe is to make sure that the apple cider that you serve to everyone has been pasteurized.

Making Halloween Fun, But Keeping It Safe

Halloween can be a time of great fun for children, but it is also a time when adults who care for children have special concerns about safety. The following tips from the Massachusetts Poison Control System should help insure that Halloween is safe without interfering with children's enjoyment.

Treats:
- Encourage children to have fun collecting treats, but tell them to wait until they return home before eating any.
Inspect all-treats and-throw out any-with - torn or unsealed wrappers.
- Homemade treats should be discarded.
- Bringing candy or other treats to be x- rayed is not completely reliable, since many objects cannot be detected this way.
- Report any suspicious treats to your local police.
- If your child has allergies, check the ingredient list carefully.

Trick or Treating:
- Set curfews for your children.
- Children should understand that they can trick or treat only at homes of neighbors they know.
- Check your walkways and lawns for obstacles, and leave your outside lights on.
- Keep pets indoors or confined to an area where they will not interfere with children.
- Younger children should always be accompanied by an adult.
- Consider sharing and planning neighborhood parties as an alternative to trick or treating.

Costumes.
- Check masks to be sure children can see and breathe easily.

- Make sure costumes are flame-resistant and roomy enough to allow the child to dress warmly underneath.

- Purchase face paints, glues, and -litters made of nontoxic materials. Be aware that some children can have allergic reactions to these products.

- Neon glowsticks and neckbands contain a chemical that is irritating to skin and could be harmful to eyes. Children should not

bang, crush, or throw glowsticks or neckbands, and they should avoid doing anything that might release the chemicals.

Jack O'Lanterns:
- Let your child have fun drawing a face on the pumpkin and scraping out the contents, but an adult should do the carving.

- Jack O'Lantems with candles should be watched carefully and placed where they can't start a fire.

PRODUCT RECALLS

Recalls: Lil'Napper Infant Swings...

Century Products Co., of Macedonia, Ohio, is providing a free repair kit for about 125,000 of its Lill Napper infant swings. These swings have shoulder harness straps that are placed over each shoulder and buckled between the child's legs. If the straps loosen or are unbuckled. a child can become tanoled in the straps and strangle. In fact, three deaths and one near strangulation have occurred when children from 6 to 9 months old became entangled with the harness around their necks. The free repair kit consists of a new seat pad with a restraint system that has waist and crotch straps, along with installation instructions (no tools are required).

Affected models are 12-344, 12345, 12-347, 12-475, and 12-476; the number is located on a small white sticker on the bottom of the swing seat under the foot area. The Lil' Napper swing has a plastic, two-position seat with a removable plastic tray. The seats are covered with either a vinyl or fabric seat pad. There are four white tubular metal legs supporting the swing, and the Century brand name and swing controls are on the motor assembly at the top of the swing.

Other Century swing models have different restraint systems and are not being, recalled. The Lil'Napper was sold at juvenile product, department, and discount stores nationwide, beginning in 1991, for about $90. Consumers should call Century at 1-800 231-1448 for a free repair kit or write to Century Products Company, 9600 Valley View Road, Macedonia, OH 44056.

... And Coaster Baby Cribs

Coaster Company of America, Inc., of Santa Fe Springs, CA, is recalling almost 1,900 full-size metal baby cribs because they pose entrapment or choking hazards to babies that could lead to serious injury or death. Two models are involved in the recall. One is a full-size white metal crib (item no. 2364), some of which have too much space between the slats and all of which have scrolls along the crib top. Plastic -old end caps cover the ends of each scroll. There are two or three stickers on the end of the mattress support-the orange sticker is labeled, in part, "Warning: Failure to follow these warnings and the assembly instructions could result in injury or death and the yellow sticker is labeled, in part, "Warning: Any mattress used in this crib must be at least 17 1/4 inches ... by 51 /8 inches ... with a thickness not exceeding 6 inches..." Some cribs also have a white sticker that is labeled, in part, "Coaster Co. of America ... Los Angeles, CA ... Item No. 2364 ... Made in Mexico..."

The company is also recalling another full-size white metal crib (item no. 2368). These have slats that are too widely spaced and a side rail latching device that could be accidentally activated by a baby. There is a small silver sticker on the end rail that is labeled, in part, "Coaster Co. of America ... Santa Fe Springs, CA... Made in Taiwan..." The crib may not have a model number on it or other labeling information.

Both models were sold by small independent retail stores nationwide, including furniture, mattress, baby, gift, and appliance stores, for about $169 to $199. The crib with scrolls (item no. 2364) was sold from June, 1996, through April, 1997, and the crib without scrolls (item no. 2368) was sold from January, 1995, through December, 1996. Consumers should return the crib to the store where purchased for a full refund or replacement. For more information, call Coaster Company of America, Inc., at 1-800 221-9699, ext 157, between 8 AM and 5 PM PST Monday through Friday.

(All notices were provided by the U.S. Consumer Product Safety Commission, Washington, D.C.)