Pills and Detergents and Outlets..Oh My!

This week’s guest columnist is Dr. Claire Ronkartz, a Family Practice resident at the University Hospital and Clinics here in Lafayette.

It’s a classic medical board question: “A two-year old visiting her grandparents’ is found with some blood pressure pills.  What is the best first step managing this patient?” Though I’ve answered this questions many times on tests, I was still at a loss when it really happened!  My two year-old had discovered some luggage with unsecured medication inside, and was mouthing one when we came upon her. So I called Poison Control (stop reading now and write down this number: 1-800-222-1222). They advised a trip to the Emergency Department, where our girl drank an activated charcoal mix, was watched for some hours, and we went home.

Although we thought we had meticulously placed all medications out of reach, in locked containers, accidents still happen.  So when your child begins crawling (or even after!), it’s a good time to think about child-proofing.  From button batteries to cosmetics and talcum powder, a young adult’s first “grown-up” house, when they have kids, can be a house-of-horrors for youngsters.  The newest hazard is laundry-detergent pods. Designed for ease of use by adults, these tasty-looking, colorful gems can burn mouths and throats and eyes, causing vomiting and breathing difficulty. Do they have to make them look so good to eat?

The best way to toddler-proof your house is to be a toddler.  Get down on your hands and knees and crawl through every square-inch of your house.  Open every cabinet and drawer you can reach, and put every single thing you find in your mouth.  If you don’t dare eat what you grab, it needs to be somewhere safer.  Then from your hands and knees, look up.

What’s above you that looks attractive, or even just mildly fun to play with? Find something to climb on- a kitchen step-stool, chair, or ottoman.  Can you push it over and crawl up within reach of what you see?  Grab the boiling pot.  Eat the medication sitting on the counter.  Absurd as this sounds, if it can be done, a toddler has already done so in the past, and will in the future.  Make sure it’s not your’s.

Now that you’ve done a decent job of making home safe for your little one, you may feel adventurous and head out for vacation, or maybe just Wal-Mart.  One such trip to the store nearly ended in tragedy for me.  My child launched herself out of the shopping cart in the one second it took to reach for some salad dressing.  Luckily my husband was right there and grabbed her as she tumbled out head-first!  From then on she was seated and belted in the cart. While that’s not as fun as shopping cart surfing, it may save a trip to the the ER.

Going out with toddlers poses a new set of risks than your home.  Perhaps most important when you are out is safety around cars, moving or parked. Every week in the U.S., at least 50 children are backed over in driveways and parking lots. LIttle ones who dart outside to say goodbye often go unseen by a driver when the vehicle is set in motion. Many times the driver is a parent, relative, or neighbor.  

Following a few simple tips can protect your family from this tragedy.  Teach children that parked cars may move at any time.  Let them know that even if they see the vehicle, the driver may not see them.  Always hold a child’s hand in the parking lot. Teach them never to play in, around, or especially behind any vehicle.  Be especially vigilant when someone else is leaving the house and driving away.  Outside house doors should be toddler-proofed.

The world of baby safety can be overwhelming.  And now manufacturers prey on your fears, offering lots of products- toilet bowl locks, outlet plugs, stove knob covers, baby gates, etc.  While some of these items may be helpful, doing the simple things we’ve discussed above goes a long way.  The last thing to do is be prepared for an emergency: post or put in your phone the Poison Control number (again, 1-800-222-1222).  Take a CPR/Heimlich class.  Read the books.  Know the location of your nearest child-capable ER.  And for goodness sake don’t buy those stupid detergent pods.

Is Anything Really Toddler-proof?

This week’s guest columnist is Dr. Asma Khan, a Family Practice resident at the University Hospital and Clinics here in Lafayette.

9 pm: a frantic call from my sister. She was in the kitchen warming a bottle for her infant, went back into the kids’ room, and found her 2 year-old daughter with her purse. Diet pills were scattered about and a half chewed one in the girl’s mouth.  Though the daughter wasn’t showing any signs of distress, my sister sure was!  She wailed through the phone, “What do I do?”

This is a classic accidental ingestion, and a serious concern for parents.  In the 1970′s, the Consumer Product Safety Commission mandated that medicines be sold in child-resistant packaging. This requirement has saved countless lives.  Also in the past 50 years the advent of Poison Control Centers has reduced deaths among children who get into medicines.

Fast forward to now, we still see children in the Emergency Department with ingestions. In 2014, the 55 U.S. Poison Control Centers provided telephone guidance for nearly 2.2 million people, mostly for children under age six.  Many more come to the ER. This begs the question: why, with “child-proof” containers, are kids still getting into these things?

One big reason is the proliferation of medicines in households.  Many adults are on 2 or more prescription medications, and most also have over-the-counter medicines like Tylenol and cold relievers.  Parents try to store them in high cabinets, but they sometimes miss pills in purses or left on counter tops.  Adults who are sick or have sick children may keep medicine close at hand to be convenient for the next dose.  Abundant medicine within reach becomes a field day for curious toddlers.

How can parents prevent children from ingesting these things?  First, pick a safe storage spot that kids can’t see or reach.  Know that any medicine or vitamin can cause harm, even those without a prescription.  Put medicines away after every use- never leave them on a kitchen counter or child’s bedside table- children sometimes try to help parents by taking the medicine themselves.

Putting medicines in high cabinets is often not enough.  I know one ex-toddler named Brian who would go exploring in the middle of the night.  Once at 2 am his mom heard noises from the kitchen and found him standing on the counter (having pushed the stool over as a ladder), and was getting a hammer out of the cabinet above the refrigerator.

Knowing Brian’s abilities, his father installed hook-and-eye latches on the house doors so he couldn’t get out.  Some nights later the parents heard more noises and found him wandering outside anyway.  He had used a broom handle to push the latch up, and out he went!  Soon all the cabinets in the house had locks, and the door latches had spring-loaded catches that couldn’t be jimmied from below.

Like we discussed above, toddlers sometimes get into medicines and accidentally poison themselves, despite having those medicines in high cabinets.  Many children have super-toddler abilities like Brian. Fortunately, most medicines have safety caps that click to tell you they’re closed safely.  Some are so toddler-resistant that adults have a hard time getting them open- this is good!  But sometimes adults have so many pills, and have such a hard time with child-proof caps, that they put their medicines in a weekly pill organizer. These are NOT toddler-proof, and should be treated with EXTREME CAUTION with kids around.

Never tell kids that medicine is candy to get them to take it. Instead, explain that taking medicine is for feeling better. If kids are told it’s candy, and then they see grandma taking “candy” from her pill organizer, where to you think they’ll go next?

Sometimes we have guests in our homes, especially during holidays. There’s hustle and bustle, and lots of curious, exploring kids.  Discuss medication safety with your guests. Help them keep purses, bags, and coats with medications out of reach.

Finally, before you find yourself in a toddler-ingestion situation, be prepared with Poison Control’s phone number handy.  It’s 1-800-222-1222.  Put that in your house and cell phone.  Before you run to the ED, they can advise about whether you need to go in, call 911, or not worry.

Take care with household medicines and kids.  Because nothing is really toddler-proof. 

He Ate What???

One of my most dramatic cases recently started like this:  The police were called to the home for a domestic dispute between drunken parents.  When they arrived, they found a home littered with liquor bottles, trash, and pills.  They also found a three year-old girl unconscious and unresponsive on the floor.   Paramedics were called.

When the child came in the ED, she was breathing and her vital signs were stable, but she would not wake up.  We drew blood samples, put in a catheter for a urine sample, pinched her and called out her name, and not a peep.  Everyone assumed she drank from one of the liquor bottles or took a narcotic pill from the floor, but all those tests came back negative.  The police rounded up and brought in all the prescription drugs in the house- eight total- from the parents and grandparents.  I called poison control and they ran all those drugs in their database.  Four of the family’s meds could account for the girl’s stupor.  She was admitted to the Pediatric Intensive Care Unit for observation.  We all wondered when and if she would wake up.

If you are a parent or grandparent of a toddler or soon-to-be-toddler, now is the time to poison-proof your house.  Get down on your hands and knees and crawl around at the toddler’s level.  Open all the drawers and cabinets to see what poisons they can get to.  Pull on all furniture to see what TVs or lamps will tumble on your (and their!) head.  Then clear all the dangers: put locks on cabinets or put all poisons out of reach, secure all falling hazards.

All of that, however, will only get you so far to keeping your toddler safe.  As all parents know, toddlers can be fast, stealthy, and wily.  How many times have I heard a parent sob: “I only turned my back for a second, and he was so fast!”  To stay ahead of a toddler, you must think like a toddler.  When your little one watches you cook and grab ingredients from the high cabinets, they learn that is where the food is.  So they will pull the kitchen stool over, climb up, and try what is up there. 

When you tell them their medicine is candy, and then they see grannie take her pill, they want grannie’s candy too.  In to the weekly pill holders they’ll go.  At parties, you drink out of a red plastic cup.  Then later, when you drain your lawn mower’s gasoline into a red plastic cup and set that down within reach, it must be something worth drinking, right?

Therefore, to beat your toddler, you must go the extra step- poisons and pills hidden and out of reach of even footstools they can use.  Toddler-proof workshops and car ports too.  Don’t tell them medicine is candy to get them to take it.  You can’t watch them every second of every day, so give yourself the biggest margin-for-error, the biggest lead time on them you can. 

Finally, if they do get into something they shouldn’t, call Poison Control first: 1-800 222-1222.  Get Poison Control stickers and put them on all phones; put the number in the contacts in your cell.  The Poison Control Tech can tell you what to do and where to go.  They will tell you NOT to give your child something to drink, NOT to make them vomit.  They will tell you if you need to flush eyes and skin with running water. 

Sometimes they will tell you to stay home, like when you call because your child drank shampoo.  They will tell you if you need to see a doctor, but can come calmly.  They will tell you if you need to call 911, and then they will talk to the paramedics and the recieving Emergency Department about what to expect. 

So get to work on that child-proofing right now!  That goes for you too, Grandma and Granddad!