MARK B. LEVIN, M.D.
JOHN M. COTTON, M.D.
TIMOTHY J. PATRICK-MILLER, M.D.
LOUIS J. TESORO, M.D.
HELEN M. ROSE, M.D.
THE PEDIATRIC GROUP, P.A.
66 Mt. Lucas Road, Princeton, N.J. 08540-2733
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New Approach to Initial Treatment of Poisonongs in Children
For decades, the American Academy of Pediatrics (AAP) has recommended that parents have Ipecac syrup in their home to administer to children in the event of certain types of accidental poisonings. New data has prompted the AAP to a recommend that ipecac be abandoned. Studies have shown that ipecac may result in unanticipated suboptimal gastric emptying, persistent gastric irritability, frequent incidence of diarrhea and lethargy. If the ingestion does NOT involve a medication, the AAP recommends 100-200 ml (3 1/2 - 6 1/2 ounces) of fluid intake and a call to the poison center. In the instance of medication ingestion, a call to the poison center would be the first gesture.
Emergency medical treatment centers may opt to use activated charcoal, which is nothing more than powdered charcoal, for a patient who arrives there having ingested a toxin. Activated charcoal binds poisons in the stomach making them less available for absorption. Its effectiveness (i.e., "activation") relates to being powdered, which allows for more particles of smaller size having more total surface area to bind poisons. The downside of activated charcoal is that it really is charcoal -- black and thick when made into a slurry by adding water to the powder. It has little or no taste, but its esthetic appearance often inhibits children from taking it. For older children and adults, it is available in tablet form which should be chewed.
Of course, the most important intervention any parent can make regarding poisonings is to child-proof the environment to be sure a child does not have access to toxic substances. In the instance of an older child or an adolescent, this includes making sure that glues, petroleum distillates (gasoline, etc.), aerosol cans and medications are inaccessible, too. Be sure to always re-cap medication bottles in their child-proof containers. Avoid describing medicines to toddlers and young children as "candy".
The final preparatory steps for every parent are to always have the national poison center telephone number handy (1-800-222-1222) and to have taken a recent course in Cardio-Pulmonary Resuscitation (CPR) with emphasis on how to handle children.
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