Poison Prevention: Children Act Fast ... So Do Poisons with Paige Cucchi, MSPH and Robert Geller, MD

WebMD Live Events Transcript

National Poison Prevention Week: Children act fast ... so do poisons! Talk with the experts from the Georgia Poison Center.

The opinions expressed herein are the guests' alone and have not been reviewed by a WebMD physician. If you have questions about your health, you should consult your personal physician. This event is meant for informational purposes only.

Moderator: Our guests today are Dr. Robert Geller, Medical Director, and Paige Cucchi, Public Education Coordinator, of Georgia Poison Center. We are discussing poison prevention as part of National Poison Prevention Week. To ask a question please type /ask followed by your question. For example: /ask What is the topic?

Robert J. Geller, MD, is the medical director of the Georgia Poison Center. Dr. Geller is board certified in medical toxicology and pediatrics. He is also an associate professor of pediatrics at Emory University and a staff member at Grady Memorial Hospital and Egleston Children's Hospital.

Paige S. Cucchi, MSPH, is the public education coordinator for the Georgia Poison Center. Cucchi is the co-author of a school-based poison prevention curriculum for kindergarten through third grade, which has been used in over 500 elementary schools throughout Georgia. She also coordinated the development of a community-based train-the-trainer program for health care and education professionals. Cucchi is the immediate past co-chair of the national public education committee of the American Association of Poison Control Centers. She is also the co-chair for the national poison prevention campaign committee, responsible for the planning of a national campaign to promote poison center and poison prevention awareness.

Welcome, Dr. Geller and Miss Cucchi. What is a poison?

Dr. Geller: Any substance in excess can become poisonous. By poisonous, I mean that it harms any living being, that it prevents us to do the things that we normally would do. Substances that we normally consider very good for people, when taken in excess amounts, can be poisonousto that same person. The famous Greek physician, Paracelsus,  was quoted, I think around the time of Jesus, "The dose makes the poison." We still believe that today.

Moderator: Are unintentional poisonings really a problem?

Atlanta_Speaker Yes, unfortunately, there are millions and millions, literally, of childrenadults, and pets who are unintentionally poisoned every year in the United States. One of the goals of National Poison Prevention Week is to make people aware of this problem and alert them to steps they may be able to take to reduce the chances of such a poisoning happening to them or their loved ones.

Moderator: Who is at greatest risk of poisoning?

Cucchi: Children are at greatest risk. More than 50% of the reported poisonings involves children 6 and younger. but few people realize that adults have poisoning, too, and in fact, 30% of the calls received by the Georgia Poison Center involves adults. And finally we have to remember that pets, too, can be poisoned. And like children, dogs and cats are curious, and they can be poisoned by the same substances that people are poisoned by.

Moderator: How are adults poisoned?

Dr. Geller: There are a number of methods by which adults can be poisoned. Adults can be poisoned by failing to read the label on a product and by not following the directions for use on the product. Also, some adults can be poisoned on the jobsite or at home doing various tasks at which products leak out of a container. And thirdly, unfortunately, some adults are intentionally trying to harm themselves and take medicines in doses in excess of those intended to be used safely. And of course, I didn't mention in that list, but we need to consider also the fact that some adults or even children may use drugs for the purpose of drug abuse.

Moderator: Dr. Geller, what is the first thing you should do when you suspect poisoning?

Dr. Geller: I think the first thing you should do is try to assess the status of the victim briefly. Obviously, if the victim isn't breathing or doesn't have a heart rate, you need to start CPR (cardiopulmonary recussitation).  The next thing, if it's safe to do so, the next thing to do is to prevent further exposure of the victim. And the circumstance I'm thinking of, let's say the victim is lying in a pool of chemical. We want to move them out of the chemical, but only if it's safe for you, the rescurer, to do so. Then, after we've done those two things, it's helpful, if there are bottle or labels or pills lying around, pick them up and call the poison center for help in deciding what to do next.

Moderator: Dr. Geller, if I find my child playing with a bottle of medicine or some household product, how can I tell if he/she has swallowed some and what should I do?

Dr. Geller: Actually, that's a more difficult question that it sounds. The intuitive answer is to assume that if the bottle is still closed, the child didn't get any but there are times, when that is not true. And a child who is able to open a bottle, may be able to close it as well. So I think that in addition to looking at whether the bottle seems to be about as full as it was when you last saw it, we'd like to see if there's any evidence of the substance in the child's mouth, on the child, or around the child's mouth. We could add that we want to use all of our senses determining if there is anything on or about the child.

Cucchi: I think a key point is that it's better to be safe than sorry, and make that call to a poison control center, if you suspect a poisoning has occurred, for further advice even if symptoms are not showing.

Moderator:H ow effective is child-resistant packaging? Is it necessary to use child-resistant packaging if no children live in my home?

Cucchi: Child resistant packaging is an effective method to reduce the number of self-induced poisonings. It's important to note that child safety packaging or child resistant caps are not childproof and they are used often as a delay mechanism to keep the child out of the product, but they must be used properly, and properly meaning the cap needs to be secured on the bottle at all times. So to be effective, keeping the caps on all the time, but also keeping the product, whether it be a medicine or a cleaning product,  storing these products in locked cabinets as well provides an additional barrier to keep the child out. So even if you don't have children who live in your home, it's a good idea to use child resistant packaging if you have visitors who have children who come and visit your home. The national theme for poison prevention week is, "Children act fast" which mean children can get into poisonous products if they are not stored properly. So lock them up in child resistant packaging, then lock them up in a locked cabinet

Moderator: Is there evidence that deaths from child poisonings have decreased since child-resistant packaging began to be used?

Dr. Geller: When the poison prevention packaging act of 1974 was first enacted, there was a phase-in period that allowed manufacturers to put child safety closures on their products over a period of time, and different products were phased in in sequence One of the first products to be required to be sold in child safety closures was aspirin. What we have seen with aspirin and with every other class of products that required the use of child safety closures was approximately a two-thirds reduction in the death rate from poisoning. for that product class. That number is very interesting when taken in light of a study that shows that only about two-thirds of child safety closures are actually in use at any time.

tenuli_WebMD: What are the most common poisons children get into?

Cucchi: The most common substances reported in poisonings reported to the Georgia Center include medication and vitamins. About 50% of the poisonings that we receive involve medicines. Common medicines would include things like painkillers, cough and cold medicines, anti-depressants, and vitamins. Household products such as cleaning, home maintenance, laundry, automobile, and gardening products. As well as cosmetics, personal hygiene, and art and hobby supplies are also common poisoning. And the third common call we receive is in regard to indoor/outdoor plants, berries and mushrooms. Many people also don't recognize that bites from insects, snakes, spiders, and even animal bites are common calls that the Georgia Poison Center receives as well.

Moderator: Paige, are there some good housekeeping rules to follow to poison-proof my house?

Cucchi: the first thing is to store your poisons properly, which includes keeping them in locked cabinets out of the reach and sight of your children and pets. Keep poisons stored in the bottles that they came in and make sure that the bottles are clearly labeled. Use child resistant packaging as much as you can, and make sure the caps are on tight at all times. And never store poisons in drink or food bottles. Second main point would be to use your poisons safely, which means reading the label on the bottle before using a poison, whether it be a medicine or a household cleaning product. While using a poison, never leave it out where a child may find it, and make sure you return the poison to a locked cabinet after you are done using it. When giving medication, never turn it into a game or call medicine candy. Avoid taking medicine in front of your child, or give medicine to another child while they're watching. Children are natural mimics, and tend to try to take medications when you're not looking. And the last thing to remember is to supervise your child. Studies suggest that poisonings occur when you are busy and routines are disrupted.

Moderator: Dr. Geller, can you please discuss the role of vitamins, particularly iron tablets, in child poisonings?

Dr. Geller: Yes. Iron is a commonly used substance, both for people who need iron supplementations to maintain their blood counts and pregnant women. For approximately the last ten years, leading cause of death in children under six from overdose on prescription drugs is iron prescribed for the pregnant mother Unfortunately, that product sometimes used to be dispensed in containers that were not child safe. Fortunately, new rules adopted by the US Consumer Products Safety Commission in recent years now require the use of child resistant packaging for iron tablets. And we hope to see decline in the occurrence of injury or death from iron in young children. 

Moderator: What happens when a child gets an overdose of iron?

Dr. Geller: A little bit of iron is good for your body. A lot of iron overwhelms the ability of the body to handle it properly and when that happens, the iron that can't be handled properly interferes with the proper function of cells throughout the body. Ultimately, if this is very severe, the patient can go into shock, just as if they had lost a lot of blood from a wound and the failure to maintain blood pressure can be fatal. Also, various organs within the body may be poisoned, so that even if the patient maintains their blood pressure, serious injury may still occur.

Moderator: Dr. Geller, what kind of first aid can I give when I suspect poisoning?

Dr. Geller: The first thing that I would recommend would be to assess the status of the patient. As in other medical emergencies, what we teach is first check your ABCs, and those stand for A for airway, B for breathing, and C for circulation. If any of those three is seriously abnormal, then we need to call 911 and initiate CPR. If those are normal, the next step we would recommend would be calling the poison center. We do not generally recommend initiating any efforts at emptying the stomach without specific advice to do so from the poison center or a physician.

Moderator: What is syrup of ipecac and why should it be kept on hand?

Dr. Geller: Syrup of ipecac is a product which can be bought without prescription, and which is effective in people in causing vomiting within 20 to 30 minutes after it is taken. Having it on hand in the household permits it to be used if a physician or poison center recommends doing so. However, there are many situations in which emptying the stomach might make things worse instead of better. And so we don't recommend doing that without specific advice.

Moderator: Dr. Geller, I also heard that activated charcoal can be used for first aid in case of poisoning. Can you please comment?

Dr. Geller: Activated charcoal intended for medicinal use is very effective when used in the appropriate circumstance in binding up some poisons. However, it has the texture of sand and the taste of sand, and most efforts at getting young children to take it are met with failure unless you have experience in getting such things down kids. Therefore, we are not strong advocates here in Georgia of having activated charcoal in the home. Some of our colleagues in other institutions, disagree with us on this issue, however. And I respect their ability to get people to get this stuff into young kids.  But we have not had great success in this area.

Moderator: Paige, what kind of activities is the Georgia Poison Center involved with for National Poison Prevention Week?

Cucchi: Well, actually, we hosted the first annual statewide poison prevention week poster contest for residents of Georgia, and we worked with Wal-Mart pharmacy and Atlanta Parent Magazine to sponsor this poster contest for children ages 4 to 12. And we selected first, second and third place prize winners for three age groups and awarded those prizes at a Poison Prevention Week kickoff luncheon, held on Monday at Fernbank Natural History Museum. In addition, we honored our volunteers and members of our speakers bureau at this luncheon, as well. We also distribute statewide Poison Prevention Week planning kits which provide information and materials to help communities plan and organize activities to promote poison prevention and Poison Prevention Week. And then we coordinate programs for children and adults throughout the state by utilizing volunteers of our poison prevention instructors speakers bureau to go out on our behalf to teach poison safety programs. And finally, we conducted a media campaign, distributing TV and radio public service announcements throughout the state

Moderator: Paige, what do we need to teach our children about poisons to help them be safe?

Cucchi:Our basic safety message for childrenis very simple and straightforwqard. Because poisons come in many shapes, sizes and colors and because poisons can be tricky, and what I mean is poisons can be look-alikes, where they can look like products that are good to eat and drink, for example, medicine can look like candy, therefore, we teach children that they should not touch or taste anything unless they ask a grown up first. So our first basic safety rule is, don't touch, don't taste, ask first. We want children to realize that there is such a variety of products out there, that they can turn to an adult for help in determining what to take.

Cucchi: We do have a poison prevention curriculum for grades kindergarten through third that was developed in conjunction with Georgia State University, College of Education and that program is available to elementary schools throughout Georgia.  The program is designed to teach children to identify common poisons to know what to do when they see a poison and to know what to do if they've been poisoned, or someone they know has been poisoned.

Moderator: Who answers the emergency telephone lines at the Poison Center?

Dr. Geller: When a caller calls about a poisoning emergency to our emergency number, the call is answered by one of our poison information specialists. These are people with pharmacy, nursing, or poison center backgrounds.  We do not use secretaries or answering services to answer emergency calls. The emergency number throughout Georgia is 800-282-5846 In metro Atlanta, they can also reach us at 404-616-9000.

Moderator: Paige, please explain the training program for volunteers that you helped to develop for the Georgia Poison Center.

Cucchi: It's basically a program designed to train poison safety advocates, including pharmacists, nurses, EMTs, paramedics, and educators, to conduct poison prevention programs for children and adults. These participants of the program attend a four-hour training to learn about poisoning and are provided with the resources they need to conduct the program. They in turn go out into their own communities using messages, materials, and other resources developed by the Georgia Poison Center to promote poison prevention.

Moderator: We are almost out of time. Dr. Geller, do you have any final thoughts you'd like to share with us?

Dr. Geller: If anyone in our audience has further questions, they can reach us or our colleagues either at the poison center's website for non-emergency questions. In an emergency, our staff are always available at the emergency number we just gave, 24 hours a day, seven days a week, to help the people of Georgia. 

Moderator: Miss Cucchi, do you have anything else you would like to add?

Cucchi:For educational information for residents of Georgia, they can call directly the education department at 404-616-9235.

Moderator: We are out of time. I would like to thank our guests, Dr. Robert Geller and Paige Cucchi of the Georgia Poison Center. Please be sure to visit the Georgia Poison Center website at www.georgiapoisoncenter.org  for more information. If you are out of the area and want to find your local poison center, please visit the American Association of Poison Control Centers' website at www.aapcc.org. Remember, find your poison center number now and keep it near your phone. In an emergency, call your local poison center!

Please join us again next Thursday at 8:00 pm Eastern for "Medicating Our Children: The Use of Drugs in Behavior Disorder Treatment". Our guests will be pediatrician Leslie Rubin, MD, and psychologist Wayne Fisher, PhD, of the Marcus Institute in Atlanta. We will be discussing the issues surrounding the treatment of children with behavior disorders. Thanks again for joining us. Good night.

Please visit the WebMD message board, "Healthy Parenting: Caring for Your Toddler with Stuart Janousky, MD" for more information.

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