By: Dr. Raphael Strauss and Dr. Robyn Kreiner (Strauss Allergy & Asthma, Commack & Woodbury, NY)
WARNING REGARDING EPIPEN DEVICE MALFUNCTION
The FDA is alerting patients, caregivers, and health care professionals that EpiPen 0.3 mg and EpiPen Jr 0.15 mg auto-injectors, and the authorized generic versions, may potentially have delayed injection or be prevented from properly injecting due to:
1. Device failure from spontaneous activation caused by using sideways force to remove the blue safety release.
2. Device failure from inadvertent or spontaneous activation due to a raised blue safety release.
3. Difficulty removing the device from the carrier tube.
4. User errors.
Check to see if your device slides easily out of the container and the blue cap is firmly in place and not raised. Please check the link for further information:
Proper use: When using your auto-injector: REMEMBER “BLUE SKY ORANGE THIGH”
1. Hold it in your fist with the ORANGE END POINTING DOWN.
2. Pull the BLUE CAP straight up to remove the top and do not force it sideways. Verify the injectors slide easily out of the storage case and verify the BLUE safety release is not raised.
3. During the pandemic, we recommend FOR SYMPTOMS OF ANAPHYLAXIS: GIVE EPI, OBSERVE IN PLACE, MONITOR IF STABLE AND IMPROVING; DO NOT CALL 911 immediately.
If there is a problem with your EpiPen or generic equivalent auto-injector please contact your doctor as alternatives are available. It is vital to have your lifesaving product work as designed in an emergency situation. Please take a minute to make sure your injector does not have this malfunction If you are unsure how to use your emergency medication or have other concerns, this a great time to schedule a telehealth visit to review your allergies and emergency action plan!
Please visit our website www.straussallergyasthma.com and follow us on Facebook for further information.
Button Battery Injuries in Children: A Growing Risk
More than 3,000 button batteries are ingested each year in the United States. It may be as frequent as every three hours that there is a child in the ER somewhere in this country for a battery-related emergency issue.
Small, shiny and appealing to children, button batteries can result in a major injury and even death if ingested.
What Are Button Batteries?
Button batteries are the small round batteries found in small electronics, such as:
- Remote controls
- Games and toys
- Hearing aids
- Bathroom scales
- Key fobs
- Electronic jewelry
- Holiday ornaments
As more homes use these small electronics, the risk of these batteries getting into the hands of curious and crawling infants and young children increases.
What Should Parents Do?
Parents and caregivers should not assume that every battery-powered product that enters their home is safe for use by children. In many products, for example, the battery is easily accessible or can fall out when the product is dropped. Make sure that the battery compartments of all electronic items are taped shut and loose batteries are always stored out of children’s reach.
A button battery stops powering a device way before it runs out of a charge. So, what we think of as a “dead” battery still has the charge to harm a child should it get caught in their ear, nose, and throat or swallowing passage. The higher the voltage of the battery (3V vs. 1.5V), the faster the injury.
When a child ingests a button battery, their symptoms could be virtually absent or similar to those of a common infection. This makes it challenging for health care professionals who are evaluating the child.
- When a button battery is placed in the nasal cavity or the ear canal, drainage or pain may be noted, which is not unique to button batteries. Non-specific symptoms combined with an unwitnessed placement can lead to a delay in diagnosis and even greater injury. Batteries that are lodged in the nasal cavity can cause nasal mucosal injury, periorbital cellulitis, scar tissue formation and nasal septal perforation. Injuries in the ear canal include hearing loss, tympanic membrane perforation, and facial nerve paralysis.
- When lodged in the body, the electric current in a button battery rapidly increases the pH of the tissue adjacent to the battery, causing significant tissue injury even within two hours. Esophageal button battery injuries can include esophageal perforation, mediastinitis, vocal cord paralysis, tracheoesophageal fistula, esophageal stricture, or death caused by a significant hemorrhage of an aortoesophageal fistula.
Figure 1 (left): Endoscopic view of button battery injury to nasal septum in right nasal cavity of a child.
Figure 2 (right): Rigid esophagoscopy showing button battery injury extending into the muscular layer of esophagus in a child.
If You Suspect Your Child Has Ingested a Button Battery
If a parent or caregiver is suspects their child ingested a button battery, the child needs to be taken immediately to an emergency room.
Healthcare professionals in the primary care, urgent care, and emergency room setting need to consider that any metallic foreign body in the nose, ear canal, or esophagus is a button battery until proven otherwise.
The diagnosis can be confirmed on a two view x-ray, which from a distance can sometimes be mistaken for the more commonly ingested foreign body, a coin. See Figures 3 and 4 below. Note: The button battery has the double ring, or halo sign, as opposed to a single ring of the coin.
Figure 3 (left): Double ring, or halo sign, of a button battery in the esophagus of a child.
Figure 4 (right): Homogenous appearance of a coin in the esophagus of a child.
The treatment for a button battery stuck within the body is urgent removal in order minimize local tissue damage. Both immediate assessment of the area of battery contact and follow-up surveillance for long-term, delayed complications should be performed to identify acute or delayed injuries.
Awareness is Key to Prevention
Parents and caregivers need to be aware of the risk posed by button batteries in their home. Keep loose and spare batteries locked away and store any product that uses button batteries out of reach. A child’s curiosity can be dangerous. Take the necessary precautions to prevent these situations and be sure you are prepared.
Lead Exposure: Steps to Protect Your Family
The most important step parents, doctors, and others can take is to prevent lead exposure before it occurs.
- Test your home for lead. If your home was built before 1978, talk with your local health department about getting your home tested for lead. If you don’t know how old your home is, assume there is lead. In the United States, lead is in paint in 87% of homes built before 1940, 69% of homes built from 1940–1959, and 24% of homes built from 1960–1977. Homes in the Northeast and Midwest are most likely to have lead in paint. Ask the landlord about lead before you sign a lease. Before you buy a home, have it inspected for lead.
- Before any work is done on your home, learn about safe ways to make repairs. When repairs are being done, seal off the area until the job is done and keep your child away until everything is cleaned up. Be sure to use a certified contractor. Removing lead paint on your own can often make the condition worse. If work is not done the safe way, you and your child can be harmed by increased exposure to lead in dust. See the EPA’s Renovation, Repair, and Painting rule Web page for more information.
- Keep your children away from old windows, old porches, and areas with chipping or peeling paint. If it is in your home, cover it with duct tape or contact paper until it can be completely removed. If you rent your home, let your landlord know about any peeling or chipping paint. Landlords are legally required to repair lead problems found on their property.
- Do not allow your child to play in the dirt next to your old home. Plant grass over bare soil or use mulch or wood chips.
- Clean your home regularly. Wipe down floors and other level surfaces with a damp mop or sponge. Taking shoes off at the door can help reduce tracking in dirt.
- Teach your children to wash their hands, especially before eating. Wash pacifiers and toys regularly.
- Keep clean. If your work or hobbies involve lead, change your clothes and shoes and shower when finished. Keep your clothes at work or wash your work clothes as soon as possible.
- Use cold flushed tap water for mixing formula, drinking, or cooking. If you are in an older home, run the water for several minutes before using it in the morning and start with cold water for drinking or cooking.
- Eat healthy. Give your child a well-balanced diet that includes breakfast and food high incalcium and iron. A good diet can help your child absorb less lead.
By: Dr. Eric Levene, Chester Pediatrics (White Plains, New York)
The Tide Pod Challenge has become a viral social media sensation. Teenagers are eating these laundry pods and posting videos of themselves on social media. They are then daring one another to follow suit. There have been many discussions on how this trend developed, but the Tide pod meme has caught on.
In the first half of January 2018, there have been 39 reposts of intentional Tide Pod ingestions, which is an increase from 52 for all of 2017.
So, what happens when a teen eats a Tide Pod? The pods contain ethanol, polymers and hydrogen peroxide. First, there is a bitter taste and you may become nauseated. The pod’s coating dissolves in the mouth releasing the cleaning agents, causing a burning sensation. A chemical burn could occur in your mouth, lips, tongue and checks. In many cases the symptoms will dissipate in a few hours but you could end up hospitalized or worse. The burn could cause difficulty breathing and esophageal burns. These burns could require months of hospitalization and multiple surgical procedures. In the most severe cases patients may have had seizures and may require ICU care. As per Dr Michael Lynch a the Pittsburgh poison Center, the more you swallow the greater your risk.
In response, both YouTube and Facebook are trying to remove these posts from their sites. P&G, the makers of Tide, have taken to Twitter with a video of Super Bowl bound, New England Patriot, Rob Gronkowski to warn teens against this problem.
We recommend that you talk with your Tweens and Teens about this latest “Craze”. Review with them the possible injuries that can occur with eating laundry detergent. Discuss how to say “NO” to the challenge.
Please remember these laundry pods are attractive to younger children who think they are candy and they should be kept high or locked away or both.
If you may have consumed any toxic substance, call the Nation Poison Hotline 1-800-222-1222.
By: Megan Hays, MSN, CPNP. Peconic Pediatrics (Riverhead & Southold, NY)
December, January and February are the most common three months of the year for home fires. With this in mind, we have created a quick quiz to test your knowledge of important fire safety topics. See below for answers and helpful resources to further deepen your fire-safety knowledge – and have a safe and happy 2018!
1) What is the leading cause of all winter home fires?
- Child’s play
- Christmas trees
2) Children starting fires is almost always due to worrisome mental illness.
3) What is the most common time of day for winter home fires?
- 12 a.m. to 5 a.m.
- 9 a.m. to 3 p.m.
- 5 p.m. to 8 p.m.
4) Practicing fire escape plans and testing smoke and carbon dioxide detectors should be done at least annually.
- The leading cause of all winter home fires is D) Cooking – specifically having a heat source too close to combustibles.
As for Christmas tree fires – while they are rare, they are more likely to occur in January when the tree is dry. They are also more likely to be serious than other fires. The National Fire Protection Association (NFPA) reminds us to never store an old Christmas tree in the garage or near the house, and recommends disposing of trees by utilizing a local tree recycling program if one is available. The NFPA also has some helpful tips on how to put those holiday electrical decorations away safely:
- Use the gripping area on the plug when unplugging electrical decorations. Never pull the cord to unplug any device from an electrical outlet, as this can harm the wire and insulation of the cord, increasing the risk for shock or electrical fire.
- As you pack up light strings, inspect each line for damage, throwing out any sets that have loose connections, broken sockets or cracked or bare wires.
- Wrap each set of lights and put them in individual plastic bags, or wrap them around a piece of cardboard.
- Store electrical decorations in a dry place away from children and pets where they will not be damaged by water or dampness.
Candles play a part in about 3% of home fires and 3% of home fire deaths. Having kids in the home can make candle safety both more difficult and more important, so consider using electronic flame-free candles in the home during your child’s early years. If you do choose to use live-flame candles, never leave a child alone in a room with a burning candle, and be sure to keep all matches and lighters out of reach and locked away from curious kiddos. Also keep in mind that more than half of candle home fires can be attributed to combustible items being too close to the flame, so it is important to keep candles at least one foot (12 inches) away from anything that can burn. Additionally, one-third of candle fires occur in the bedroom, and are especially dangerous if the person attending the candle falls asleep. Be sure to blow out all candles if you are sleepy, or before leaving the room.
2. Children starting fires is almost always due to worrisome mental illness – this statement is For most kids, playing with fire is an exercise in curiosity, but that does not make this behavior safe or okay. If you are concerned that your child is exhibiting fire-setting behavior, reach out to your local fire department or pediatrician for resources and support. Mental health services can be helpful for children who seem to be especially focused on fire starting or who are demonstrating thrill-seeking or attention-seeking behaviors. For all children, it is important for adults to set a good example for fire safety in the home. Never play with fire in front of your children, and keep any matches, lighters or combustible material out of the child’s reach and locked. Kids under 6 are most likely to start fires in the home than other age groups. The NFPA provides a great 1-page PDF for preventing play-induced fires here (nfpa.org/education).
3. The most common time for winter home fires is from C) 5 p.m. to 8 p.m., although the most common time for fires started by child’s play is between 2 p.m. and 8 p.m. This is a busy time of day with kids home from school and dinner cooking, so be extra mindful of fire safety during these hours.
4. Practicing fire escape plans and testing smoke and carbon dioxide detectors should be done at least annually – this statement is The United States Fire Administration (USFA) recommends practicing fire escape plans and testing smoke and carbon dioxide detectors monthly. Children should be involved in these activities, specifically in creating and practicing escape plans. Have a designated meeting spot, such as the porch of a trusted neighbor, in case evacuation is needed. Make sure that kids and all family members also practice closing doors behind them during these drills — closing doors limits the speed in which fire can spread. Below are the USFA’s tips on fire escape planning:
- Make and practice a fire escape plan.
- Plan two ways to escape from each room.
- Pick a place to meet after you escape to check that everyone got out.
- Practice your escape plan every month.
- Plan for everyone in your home – including babies and others who need help to escape.
- Involve children in making and practicing your escape plan.
- Teach children to never hide during a fire – they must get out and stay out.
Have a safe and warm winter!
- The United States Fire Association website:
- The National Fire Protection Association website:
- Your local fire department: Reach out to your local department or check out their website/Facebook page for tips and upcoming fire safety events to educate yourself and engage your children.
- The NYC Fire zone (kids’ education center):
- The New York Times 12/30/17 article regarding fire safety in response to the recent tragic Bronx fire:
By: Megan Hays, NP (Peconic Pediatrics, Riverhead & Southold, New York)
Tis’ the season … to make a pediatric health safety checklist – and check it twice!
The holiday season provides families with the perfect opportunity to visit or host friends and family, to provide children with new toys, and to feast and celebrate together.
The American Academy of Pediatrics and Poison Control both remind us, however, that these festive opportunities also merit extra attention to safety when kids and babies are underfoot! To keep you safe AND sane, we here at Allied have compiled some holiday-specific safety reminders to keep you and yours safe while celebrating this holiday season.
New toy checklist
The holidays are a season of giving! While we are thankful to receive gifts from family and friends, be sure to also ask yourself the following questions:
- Is it safe?
- Say “no” to baby walkers! These cute toys help babies get around – and that’s not always a good thing. They are associated with higher instances of falling, drowning, or reaching unsafe items.
- Secure all batteries! Batteries and magnets are a very dangerous choking hazard. Make sure children are not able to access batteries in toys.
- Snip that pull string! Toys with a pull string greater than 12” are more likely to pose a strangulation hazard
- Watch for detachable (or breakable) parts! Double check toys to ensure any removable parts that could cause a choking hazard have been removed and put away.
- Is it age-appropriate?
- Beware of choking hazards, particularly for children who are under 3 or developmentally delayed.
- Toys that plug into an outlet are not appropriate for children under 10; battery-powered toys are better (and remember to secure those batteries!).
- Are there other children in the house that could choke on the toy or its pieces?
- Does the toy fit through a cardboard toilet paper tube? If so, it can be a choking hazard for children under 3. Recruit big kids to check their toys and keep them cleaned up or away from your little one, or create a special area for these toys that the baby can’t access.
Holiday décor safety checklist
- Mistletoe berries and holly berries both contain chemicals that can cause nausea, vomiting, diarrhea and abdominal pain. (Holly berries pose additional health threats to dogs.)
- Poinsettias: While the flowers are harmless, the sap can cause irritation to the skin, eyes, or stomach lining. The sap can also cause a cross-reactive allergic reaction in 40% of patients with latex allergy. The most common reaction is a skin irritation, so rinsing the skin often prevents further problems.
- Antique bubble lights: Beyond the risk of broken glass, bubble lights contain a fluid (usually methylene chloride) that is dangerous when touched, eaten, or inhaled. Such contact can cause nausea, vomiting, headache, drowsiness, coma, seizures, heart attack, or, unfortunately, death. The amount of methylene chloride in a single bulb is unlikely to cause symptoms, but it is still best to keep these nostalgic lights out of the home if possible, or at least keep kids away from the lights.
- Balloons pose an extra choke hazard for children under 8, and ribbons longer than 12” pose a strangulation risk. Do not leave young children unattended with these festive items.
Household toxin checklist
When traveling to another person’s home or having guests in yours, the child may be more likely to have access to dangerous toxins. Here are some specific items to be mindful of, along with a reminder of how to contact poison control.
- Medication and Vitamins: Studies show that most grandparents identify outlets as the #1 kids safety risk around the holidays, but medication ingestion is 36x more likely to send a kid to the ER. Furthermore, studies show that older adults are more likely to have unsecured medicines in their home. Ask your hosts and houseguests to keep medicines and vitamins out of reach and in child-proof containers.
- Cleaning supplies: Double check that they are kept out-of-reach or in a locked cabinet.
- Alcohol: Ensure that there is a designated “child watcher” during parties to make sure no curious kids or toddlers have an opportunity to consume partygoers’ drinks. According to Poison Control, alcohol can cause a child’s blood sugar to drop, leading to seizures, coma and even death. During and after the party, be sure to provide elevated locations for guests to keep their drinks, and to clean up drinks right away. While we’re at it – don’t forget to appoint a designated driver!
- Tobacco: Smoke and things that smell like smoke can put a child at risk for ear and lung infections. Cigarette butts provide additional concern as a curious child may eat them. Ask guests to refrain from smoking in the house – provide a place to smoke outside and a flameproof receptacle so they aren’t tempted to drop them in the yard where your children play.
- Poison control: If you think a child may have swallowed something that will hurt him or her, call the poison control hotline at (800)222-1222. Save it in your phone to make sure it is always at hand. The poison control website also has an online tool for further guidance.
Being mindful of these hazards will help to ensure a safer and happier holiday for everyone. Certainly, an ounce of prevention is certainly worth a pound of cure. May you and yours have a safe and happy holiday season!
(Megan Hays’ pretzel cabin gingerbread house)
No one knows your child like you, and no one can take care of him or her medically like your pediatrician. An Allied doctor is on-call at all times and we want to hear from you. Learn why to call us first and how we can help you.
By: Dr. Eric Levene, Chester Pediatrics (White Plains, NY)
Halloween is almost here. We are spending time decorating our homes, schools, and offices. We are planning parties for our kids as well as for parents. We are putting the finishing touches on our homes and costumes for both adults and kids.
It’s time then to remind everyone of a few safety tips so we can all enjoy the day. It is important whether we are with our kids trick or treating or biting our nails while they are out on their own, that we keep the following in mind.
You are decorating your home, and pumpkin carving is a fun family activity. Give your child markers to draw on their pumpkin, let the adults do the carving. Consider an electric light instead of candle to light the jack-o-lantern. Check your steps for anything a child could trip on when coming to your door. Replace any burned-out bulbs, and sweep away any wet leaves.
Some costumes take planning and time, and some children may throw it together that morning. Decorate the costumes and bags with reflective material. Instead of a mask, us face paint or make up. Do a test patch before Halloween to make sure your child does not have a reaction to it. Make sure your child can see in their costume and they are not tripping over excess material. Sneakers that fit well will avoid many issues. If you are buying the costume, make sure it is flame resistant. Use glow sticks or electric lights in clear treat bags to allow your child to be seen better at night.
While trick or treating put the electronic devices away and look ahead. Always walk on sidewalks or paths. If there are no sidewalks always walk facing traffic. While crossing the street, remember the left right left rule when crossing. Teach the kids to make eye contact with the drivers before crossing. Remind the younger kids no racing out into the street. Remind your older kids to stay in groups, only go to homes with lights on and never enter anyone’s home. They should have a cellphone for emergencies.
Please remind your kids not to eat any candy they have collected until an adult has had a chance to look at it.
If you are driving on Halloween night, SLOW DOWN. Kids don’t always remember the rules. Take an extra look at intersections and driveways. Remind your teen drivers to put their phones down.
Have a safe and fun Halloween!
By: Dr. Eric Levene, Chester Pediatrics (Whiteplains, NY)
The Solar eclipse, August 21, is a rare occurrence in the continental United States. Use this opportunity to stimulate your child’s interest in science while creating a bonding experience you will talk about for years. Just make sure to take the proper safety precautions (described below) to protect your eyesight.
During a solar eclipse, the moon appears to completely cover the sun producing a shadow that falls on the earth. At this time, the sun’s outer atmosphere, the corona, becomes visible. Do not look at the partially eclipsed sun through an unfiltered camera, binoculars, or telescopes. NEVER look at the eclipse with your naked eyes. Any glimpse of the suns brightness is not only uncomfortable, but it is dangerous. Your eyes could be severely damaged and might blind you. For more information use this link https://www.preventblindness.org/solar-eclipse-and-your-eyes
If you plan to watch the eclipse you should get a pair of solar viewing glasses. Sunglasses cannot be used in place of these special glasses. If you are using solar viewing glasses always inspect them for scratches and damages. If they are damaged, do not use them. Recently it was reported that many supposed solar eclipse glasses are not really approved for eclipse viewing. Use this link to check your brand. https://eclipse2017.nasa.gov/safety
Keep an eye on your children. Make sure they keep their glasses on if you have them. Have them look at the shadows of a leafy tree. They will see lots of little crescent suns on the ground. Another way to view the eclipse with your children is through pinhole projection. This a safe and inexpensive way to view the eclipse and have fun with your kids. The project includes using cardboard and paper. The associated link is a video to help making this project. https://eclipse2017.nasa.gov/how-make-pinhole-projector-view-solar-eclipse.
During this eclipse the shadowed sun will sweep a 70 mile wide path across the United States from Oregon to South Carolina in 94 minutes with a total solar eclipse. All other areas will have a partial eclipse. In the New York metropolitan area the eclipse will begin at 1:23 pm with the maximum partial eclipse at 2:44pm and ending at 4:00pm.
Summer is here and it’s time to go swimming. Recently there have been multiple news reports of children dying days to weeks after swimming with seemingly no symptoms and their death is attributed to “dry drowning”. Unfortunately, most of these reports contain significant amounts of misinformation and have caused unnecessary concern and confusion. In order to clear the confusion, we must start with some definitions.
The medical definition of drowning is “the process of experiencing respiratory impairment from submersion/immersion in liquid.” (Definition of Drowning: A Progress Report. Bierens J, Drowning 2e. Berline: Springer, 2014.) Drowning does not imply death or impairment. Drowning has only three outcomes: fatal drowning, nonfatal drowning with injury or illness, or nonfatal drowning without injury or illness. The use of other terms such as near-drowning, dry drowning, wet drowning, or secondary drowning are not medically accepted conditions and create confusion. The World Health Organization, the American Red Cross, and the CDC all discourage the use of these terms.
So what are we as parents to do this summer to keep our children safe? Prevention is key. Drowning is a leading cause of preventable pediatric death. Always closely supervise your child in and near water. Children should always be within arm’s reach when they are in or near water. At a party always have a designated adult who is supervising swimmers. Never assume that if multiple adults are around someone will see your child. Unfortunately, many drownings occur when multiple adults are present and all assume someone else is watching them.
Remember drowning is defined as having respiratory impairment after submersion or immersion in water. A child who swallows some water and coughs but symptoms resolve completely in a few minutes does not need to be evaluated. If symptoms are similar to a drink going down the wrong pipe children can be safely monitored at home. Any child who has worse than expected or persistent symptoms including coughing, wheezing, gagging, chest or abdominal pain, or seems abnormally tired should be evaluated by a medical professional. A child whose symptoms completely resolve after a few minutes will not suddenly develop new symptoms days to weeks later.
We wish you and your family a safe and happy summer!
For additional information
Dr. Visentin works at Allied Physicians Group – Peconic Pediatrics