Dr.Silva: Tots,Tweens & Teens™

Lead Poisoning

A 9 month old infant girl from Connecticut was found to have lead poisoning.  Doctors discovered that the young infant had a high lead level during her routine physical exam.

CDC Report

According to a report (http://bit.ly/2wBf8LJ) by the Centers for Disease Control & Prevention (CDC) on August 31, 2017, her blood lead level of 41 micrograms per deciliter of lead was much higher than  acceptable.  According to CDC, an acceptable blood level is up to 5 micrograms per deciliter.

Home Investigation

Investigators reviewed the home in detail.  Although there was lead paint on two of the windows in the home, the infant girl was not able to reach those windows, so she couldn't have contracted lead poisoning from them.  In addition, the her 3-year-old and 5-year-old siblings didn't have lead poisoning, so the windows were not the source of the lead.  

Teething Bracelet

The baby girl's parents bought her a homeopathic magnetic bracelet to help with teething pain.  She had used the bracelet for teething relief, chewing on it, causing her to ingest the lead.  The homeopathic community believes magnets help with healing.  Tests on the beads of the bracelet revealed that it contained 17,000 parts per million (ppm). According to the U.S. Consumer Product Safety Commission (CPSC), for the most part, products containing 90 to 100 ppm are considered safe.

Chewing & Lead Poisoning

Please be careful with items that your child may chew on.  Sadly, each year, there are recalls on children's jewelry due to high levels of lead and cadmium poisoning (https://drsilvatotstweensandteens.com/2010/02/cadmium-jewelry-poisoning.html).  Infants and toddlers place objects in their mouths as part of their development and natural curiosity.  They learn about their world orally, in this fashion.  Depending upon the lead level in a child's body, lead poisoning has long-term consequences including, but not limited to lower IQ, speech delay, behavior problems, seizures, and death.  Treatment does not necessarily reverse the negative effects of lead on the brain and body.

Routine Physical Exam & Lead Testing

Please remember to follow-up with your pediatrician for your child's physical exam, as so much is done at these visits, including lead level testing, if recommended.  Consider buying a lead surface test kit for your children's toys or objects they may place in their mouths, as lead poisoning is a nightmare for any family to handle whether from teething bracelet or toys.

What is Ebola? 

Ebola is a virus that was first discovered in 1976 near the Ebola River in Africa. Sporadic outbreaks have occurred in Africa since then. There are five (5) strains of Ebola that infect animals in Africa. Four of the strains infect humans.

What are the Signs & Symptoms of Ebola?

Symptoms include fever, headache, muscle aches, vomiting, diarrhea, abdominal pain, unexplained bleeding or bruising.  Ebola can only be spread when symptoms begin. Symptoms typically occur between 8 to 10 days after infection.  However, symptoms may occur as late as 21 days after exposure to Ebola. 

How is Ebola Spread?

If a person is ill with Ebola virus, they can spread it by blood, body fluids (urine, saliva, sweat, feces, vomit, breast milk, and semen).  It can also be transmitted via objects contaminated with the virus (like needles and syringes). Lastly, it can spread via infected bats, apes, gorillas, and monkeys. (https://www.cdc.gov/vhf/ebola/about.html)

Where is the Ebola Outbreak? Where Has Ebola Spread?

This year is the largest Ebola outbreak in history.  It has taken place largely in West Africa.  Currently, areas designated by the U.S. Centers for Disease Control and Prevention (CDC) as having widespread transmission of Ebola are in West Africa, specifically Guinea, Liberia, and Sierra Leone.  Countries that have had travel associated transmission and local transmission are (Port Harcourt and Lagos) Nigeria, (Madrid) Spain, and (Dallas and New York City), New York.  Countries that have had travel associated transmission are (Kayes) Mali and (Dakar) Senegal.

Are there are recent updates in Florida?

As of October 26, 2014, Florida Governor Scott issued an order mandating the Department of Health to have a 21 day monitoring of anyone who has returned from areas where individuals have been infected by Ebola virus, as designated by the CDC. (http://bit.ly/1wH4o6M) New York, New Jersey, Illinois and now Florida have instituted a 21 day health evaluation plan. Twice daily monitoring is to include measuring temperature twice daily.  Gov. Scott also stated that if individuals monitored are assessed to be high-risk, then a mandatory quarantine will be required.

Are There U.S. Guidelines for Healthcare Workers Caring for Patients with Ebola?

The CDC has issued guidelines for healthcare workers and healthcare settings for those caring for patients infected with, suspected to be infected with, or having died of Ebola. (https://www.cdc.gov/niosh/topics/ebola/healthcare.html#us) There are also CDC Ebola waste management guidelines. On October 14, 2014, the CDC admitted that they were unprepared for Ebola in the U.S. (http://bit.ly/1E4V6F4)  Since then, the CDC has formed the previously mentioned guidelines.  

Are there flight Restrictions from Africa?

As of October 21, 2014, the U.S. Homeland security Department announced that travelers from Guinea, Liberia, and Sierra Leone have limited airport entry into the U.S.  They are limited to five (5)  international airports in New York, New Jersey, Atlanta, Chicago, and Washington, DC.  These airports will have extra screening of passengers for possible Ebola exposure, which include taking temperatures and other assessments as well.  All U.S. airports are screen for possible Ebola exposure. (http://www.cdc.gov/vhf/ebola/pdf/ebola-algorithm.pdf)  Currently, there is no travel ban from or to Guinea, Liberia, and Sierra Leone to U.S. due to Ebola.

It is highly unlikely that Ebola will spread in the U.S. as it has in endemic West Africa. However, we must keep a vigilant eye on developments, travel screenings are necessary, and healthcare workers must follow CDC guidelines to prevent spread of this disease.

Starting this summer, Tylenol will now have standardized dosing for their Infants' & Children's products. In 2009, the FDA made several safety recommendations, including changing the concentration of Tylenol so that it is unform regardless of the age of the child. That's precisely what they've done. As a result, the measuring devices will also change. The current concentrated Infant's Tylenol will cease to be manufactured.

The idea behind this standard concentration is to decrease the risk of overdosing a child. In this case, safety and standardization go hand in hand. An overdose of Tylenol can result in liver damage and/or death. This change is particularly helpful if you have children of various ages in your home. When exhausted in the care of your sick child, you will no longer risk choosing the wrong bottle (i.e. the wrong concentration) in the store or at home. Hence, your child is less likely to be overdosed or even underdosed.

This will have an impact if/when you choose to give your child Tylenol. It also will have an impact when you ask your child's Pediatrician for dosing questions. Why? Because both past & new formulations will be available in the market at the same time. So, your child's doctor will need to know the concentration of the specific bottle you have at home in order to tell you what dosage of Tylenol is appropriate for your child. In reality it won't be a big deal. But it is best to be prepared, as there is likely to be some confusion until all of the old formulations are truly a thing of the past.

On May 4, 2011, The Consumer Healthcare Produscts Association announced that other manufacturers of Acetaminophen (generic Tylenol) will also change their formulations so that their concentrations will also standardized to 160 mg/5 ml.

For more information regarding the change in Tylenol concentration and measurement, please go to http://www.chpa-info.org/