Allergies, injuries and poisoning symptoms in children indoors and outdoors. Jaiva Larsen, MD

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1 Allergies, injuries and poisoning symptoms in children indoors and outdoors Jaiva Larsen, MD

2 Staying out of the Emergency Room

3 Allergies

4 Allergies Eczema Hives Allergic rhinosinusitis/conjunctivitis Asthma Anaphylaxis

5 Major Allergens in Children Indoor Dust mites Pets/animal allergens Mold Cockroach Tobacco smoke Solvents/chemical irritants Products of combustion Outdoor Pollens Molds Bites/stings

6 Diagnosis & Treatment Diagnosis Pediatrician Allergy specialist Blood testing Skin testing Treatment Comprehensive Action Plan Environmental Control

withstand washing Vacuum HEPA filter or double layered microfilter bag Dust with damp cloth

7 Environmental Control Dust Mites Allergen impermeable casing for pillows and mattresses Wash pillows/mats etc weekly Wash in hot water (130 F) to kill mites Choose synthetic materials that withstand washing Vacuum HEPA filter or double layered microfilter bag Dust with damp cloth Consider stuffed animals, upholstery, drapes, carpet AC filters NO ozone generators generate harmful ozone

8 Environmental Control Warm blooded Animals Reduce child s exposure to pets if allergic New home Keep pets outdoors Reduce allergens Bathing animal 2x/weekly HEPA filter Rodent Pests Use least toxic extermination method e.g. traps Rodenticides are most toxic pesticides

9 Environmental Control - Cockroach Allergens Deprive roaches of food/water Clean up all food items/ crumbs/ spills as soon as possible Store food and trash in closed containers Limit spread of food around house, especially bedrooms Fix water leaks under sinks Mop kitchen floor at least once a week Clean counter tops daily Use least toxic methods first

10 Environmental Control - Mold Control Sources of moisture Check faucets, pipes, ductwork, roof for leaks and repair as soon as possible Clear ductwork annually American Society of Heating, Refrigerating and Air Conditioning Engineers (ASHRE) standards Clean small areas with chlorine bleach 1:10 solution Toxic Mold/ black mold Stachybotrys chartarum Clinical effects same as other common molds Allergenic in sensitive individuals

11 Environmental control Outdoor Allergies Stay indoors Air conditioned environment Especially during the afternoon Check pollen count forecast

12 How to use an Inhaler Remove Cap Shake inhaler Breathe out. Place inhaler in mouth Press down on the inhaler Breathe in slowly (3-5 seconds) Hold breath (10 seconds) Consider a spacer

How to use an Epinephrine Autoinjector Remove the safety release mechanism Firmly push the auto-injector against the middle of the outer thigh until you hear a clicking sound.

13 How to use an Epinephrine Autoinjector Remove the safety release mechanism Firmly push the auto-injector against the middle of the outer thigh until you hear a clicking sound. This can be done through clothing, if needed. Hold firmly against the thigh for 5-10 seconds (depending on the manufacturer) to deliver the medication. Remove the device from the thigh and discard it.

14 Bites and Stings Allergic reactions Bees Kissing bugs Venom Effects Bee swarms Bark scorpion Black widow Arizona brown recluse Rattlesnake

15 Injuries

16 Injuries An estimated 9.2 million children annually had an initial emergency department visit for an unintentional injury Injuries are the leading cause of death in children ages 19 and younger

18 Drowning Prevention Learn life saving skills Swimming CPR Fence it off Life jackets Supervise kids around water Even the bathtub Basin/bucket

19 Playground Safety Check that playgrounds have soft material under Use playground equipment that is right for the child s age. Make sure there are guardrails in good condition Look out for things in the play area that can trip a child Supervision

20 Sports Safety Gear up Helmets, wrist guards, knee or elbow pads Good equipment Action plan for injuries Consider heat injury Model safety focused behavior

21 Head injury worries Loss of consciousness Not acting normally Change in skull shape Bruising on side or back of head Vomiting Severe headache Severe mechanism e.g. fall more than 3 feet,

22 Poisonings

23 Pediatric Poisoning in AZ 48% of poison exposures in AZ are children under 6 years old

24 Why are children vulnerable to poisoning? Exploring the environment Crawling, licking hands Eat & drink more per pound Breath more per pound Greater skin surface area Still developing

25 Pediatric Environmental Toxins Pesticides Heavy Metals Lead, arsenic, mercury Endocrine disruptors Indoor Air Quality Mold SVOC/VOC Particulates Outdoor Quality Particulates/diesel Sun Exposure Second hand smoke

pesticides are potentially harmful Mechanism of action

26 Pesticides A pesticide is a substance, natural or synthetic designed to kill, control or repel living things All pesticides are potentially harmful Mechanism of action Potency Dose Length of exposure Route Ingestion Inhalation Skin contact

hospitalized 4 children die Yasmeen Balderas, age 17

27 Case Report January 2017 Amarillo, Texas Aluminum phosphide applied under mobile home Washed with water 5 hospitalized 4 children die Yasmeen Balderas, age 17 Josue Balderas, age 11 Johnnie Balderas, age 9 Felipe Balderas, age 7

TOXICITY CATEGORY (Signal Word) 2 IPM Pesticide Use High toxicity DANGER Category I Moderate Toxicity WARNING Category II Low Toxicity CAUTION Category III Very Low Toxicity CAUTION (optional)

28 TOXICITY CATEGORY (Signal Word) 2 IPM Pesticide Use High toxicity DANGER Category I Moderate Toxicity WARNING Category II Low Toxicity CAUTION Category III Very Low Toxicity CAUTION (optional) Category IV Nonchemical Least toxic chemical Least mobilized Out of reach Acute Oral LD mg/kg mg/k Inhalation LC 50 Dermal LD 50 Primary Eye Irritation 0.05 mg/l 200 mg/kg Cornea opacity not reversible within 21 days > mg/l mg/kg Corneal involvement or other eye irritation clearing in 8-21 days > mg/kg > mg/l > mg/kg Corneal involvement or other eye irritation clearing in 7 days or less >5000 mg/kg >2.0 mg/l >5000 mg/kg Minimal effects clearing in less than 24 hours Primary Skin Irritation Corrosive Severe irritation at 72 hours Moderate irritation at 72 hours Mild or slight irritation at 72 hours

29 Cleaning agents Detergents Caustics Hydrocarbons

30 Carbon Monoxide

31 buprofen Medications/herbs/supplements > 60,000 children seen in ED each year because they got into medications One pill can kill Opioids Sulfonylureas Clonidine Wintergreen oil Over the counter safe Acetaminophen most common cause of liver failure in USA

32 Recreational Drugs Nicotine Alcohol Caffeine Marijuana

33 Poisonous Plants

34 First aid for pediatric poisoning Call 911 for Emergency Unconscious Not breathing Throat/lip swelling Seizure Bleeding Questions? Possible poisoning Call Arizona Poison and Drug Information Center Do not induce vomiting Irrigate for eye or skin contact For gases, get into fresh air

Preventative measures for injuries Safe handling of

35 Conclusions Consider simple low costs interventions to keep kids safe Environmental control for allergies Preventative measures for injuries Safe handling of dangerous chemicals Call the poison center anytime 1(800)

36 Thank You

Welcome. We can control some of the things that cause problems in our homes.

Welcome. We can control some of the things that cause problems in our homes. Welcome Lots of our children have asthma lots of us do, too. Luckily, we ve learned a great deal about how to avoid the things that trigger asthma attacks. We can control some of the things that cause