Science Friday
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It’s not poinsettias: A medical toxicologist discusses the most common household risks to kids during the holiday season.
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It's the holiday time of year, and maybe you'll be having kid visitors. How much do you need to worry about kid-proofing your place?
Toddlers are super fast and can get into things, and so it's very easy for things to happen.
It's Tuesday, December 10, and you're listening to Science Friday.
I'm Sci-Fri producer Charles Burquist. Today, we take a trip to the Poison Control Center. Their number, of course, is 1-800-222-1222. But what happens when you call them? What should you do if a kid has swallowed something they shouldn't? And what household risks should you really be worried about around the holidays? Here's Ira Flatow.
Joining me now to talk about some of the toxin and poison threats around your home this time of the year is Dr. Xingy Fang, professor of medicine at UT Southwestern Medical Center, specializing in pediatric emergency medicine. And she's also a medical toxicologist with the North Texas Poison Center that's in Parkland, Texas, near Dallas. Welcome to Science Friday.
Thank you for welcoming me.
Let's get right into this. So many good things to talk about. Of course, there's this conventional wisdom that holidays are busier than normal in the emergency room due to kids doing unexpected things. Is that truly the case?
It is truly the case. Kids in general always are getting into things, but I think over into holidays, we are always worried about potential things that they can get into. Certainly, a lot of family gatherings, I think going to grandma and grandpas. Oftentimes grandma and grandpa don't remember that toddlers are super fast and can get into things. And so it's very easy for things to happen during the course of, you know, an evening or even a week if they're spending time with the grandparents.
Okay, let's get into some of those things they can get into. And one of the things you hear to be careful about is the holiday greenery.
Yes.
I mean, the poinsettias and the holly, is that correct? Because we've heard about that for decades.
Yeah, and I remember as a kid, we were, there's a little bit of an urban myth that you shouldn't be touching the poinsettias because they are, they're toxic. And I'm happy to report that is a bit of an urban myth. It's not to say that it's completely benign, but it certainly isn't going to kill you. So poinsettias are in the euphorbia species. They produce this very milky sap that has a lot of four- ball esters in them, which are very irritating. And so oftentimes you'll get a contact dermatitis. So either redness to the skin, you can get blistering and also the skin peeling as well. But I think the urban myth came about as early as over 100 years ago
because there was a case of a two-year-old in Hawaii that was reported to have died. But it wasn't a super well documented case. And I think from there, the urban myth has just kind of blossomed.
How about the holly? Is that a threat?
Holly, also, the illic species, there are tons of different subspecies of them. And they have these beautiful red berries that are really appealing to kids and that beautiful green foliage. The green foliage isn't quite as tasty, but I think sometimes the kids will reach for the red berries. And I'm happy to report, at least the red berries in themselves have extremely low levels of toxins. And so there's a very low rate of inadvertent toxicity for holly ingestions.
Right. What about mistletoe?
Mistletoe is oftentimes in people's homes, but also is more of an irritant rather than a true life-threatening poison.
Well, that's good to hear. All right, let's go on to other things. So much for the greenery. What should people, what should people be looking at to kid-proof their homes around the holidays? Give me your top list.
So I think my top list, number one, I think grandparents should put away their medications. You know, certainly, we all know that childproof caps are not necessarily childproof, but more senior-proof.
That's for sure.
Kids have this unwieldy ability to open these childproof caps. So putting away medications to areas that they can't reach. Because, you know, a lot of grandparents and parents are on medications that are commonly prescribed, which include calcium channel blockers and beta blockers for hypertension. Kids can get into real trouble with ingesting those. They can really depress the heart rate significantly. Diabetic medications is something to think about. So glypiside, olfanoeduria. So these are medications that are prescribed for type 2 diabetes.
And so what it does is it increases the production of insulin from the pancreas. And it does that to anybody that takes it. And so it certainly can get kids into trouble and drop their blood sugars.
What about sleeping pills that are out there? Is that, you know, a real hazard to kids walking around the house?
So certainly, most sleeping pills these days are relatively safe. So they're mostly benzodiazepines such as Valium, Ativan, Xanax. And the oral form of these benzodiazepines are actually relatively safe. So, you know, back in the 50s and 60s, we were all familiar with substances such as Milltown, which were mostly barbiturates, such as phenobarbital. And so those were a lot more dangerous. They would cause respiratory depression to the point where patients would stop breathing. But luckily, with the oral form of these benzodiazepines in terms of overdoses in kids, they actually do quite well. So they do fall asleep. It
can be very concerning, but we usually will monitor them in the emergency department until they wake up.
Well, we could go through a whole list of these.
Yeah, for sure.
But what about the other things like gummies? People have these gummies, marijuana stuff lying around. That must be really like a magnet.
It really is a magnet. And unfortunately, many of these THC products are really marketed almost towards children. So you'll see them look at gummy bears that contain THC or other types of candies that contain THC as well as chocolates. And they can look really innocuous. And so it's very easy for a child to get. In fact, pretty much all of the kids that we see that are toddler age that come in with altered mental status for unknown reasons, not related to head injury, not related to trauma, not related to witnessed ingestion oftentimes end up being secondary to THC ingestion.
What about kids getting into the spiked eggnog?
Yeah, that's a great, and not just eggnog in itself, right? So any type of ethanol related drink. So kids are actually at a higher risk for developing hypoglycemia, low blood sugars, because they don't have as good glycogen stores in their liver than you and I do. And so ethanol basically ends up removing the substrate for gluconeogenesis. And it makes it harder for The child who doesn't have as much glycogen stores to begin with to convert of you know, acids into sugar or glucose, which is then taken up by the brain. And so these kids end up being at a higher risk for developing seizures if they ingest ethanol.
So it's not just, it's not just eggnog, but any kind of drink and any mixed drink or something that looks fruity, right?
Yeah, and it's really hard to tell if that drink has alcohol in it. So I can see a small child going, mm, this tastes really good and drinking the whole thing. I don't think necessarily they would want to drink, you know, a straight up whiskey or bourbon. But certainly with the mixed drinks and cocktails, the taste of the ethanol can be really hidden. And so it's really easy for them to not find those.
And what you're saying is they're not just getting drunk, but they're getting poisoned.
Yes, and remember, kids are a lot smaller. Um, so in terms of the milligram per kilo amount that a child ingests, it's going to be proportionally much higher than if you and I drank the same amount.
One thing that people kid proofing a house tend to think about is the cleaning supplies, right? Under the sink, we have your bleaches and stuff like that. How much of a threat is that?
So fortunately, most of those are going to uh cause mostly GI irritation. Um, so you're not going to really get significant poisonings from household concentrations of bleach. I think that's one that people really worry about.
Yeah.
However, it's really important and sometimes we have families that work in the cleaning industry. And so they may bring back industrial strength compounds. So industrial strength bleach or industrial strength solvents like ammonia. Those are when people really get into trouble. Um, so luckily for kids who take a couple of sips of household bleach, they may get a little bit of mucosal irritation, but in general, it's not as toxic as thought. Um, but it's always good to put those things away because it's our so fast.
Yes, and you hear stories about batteries, kids swallowing batteries. Is that something we should be concerned about? I mean, apart from just choking on the battery.
Yes. The one thing that you do need to remember with batteries are going to be the button batteries. Um, so the small kind of coin sized batteries, they're really easy to swallow because they're small in size. And they actually have been associated with pretty significant electrical burns to the esophageal mucosa. Um, so actually there's a website that you can get into for button battery ingestions. And they do have some recommendations of what you can do at home prior to coming to the emergency department. And one of this is you're trying to prevent the anode of that button battery from making contact with the esophageal mucosa. So, um, the recommendation is actually to have the kid to take a couple tablespoons of honey.
And then going into the emergency department, because then what that does is create an actual physical barrier.
Right.
Between the actual button to the mucosa.
Let me ask you about what happens if you suspect that a kid has taken something wrong, kid acting weird. Where should your thoughts first go to to think about what to do next?
So I think number one is if your child is not acting quite right and you don't have a good reason for why that child is acting that way. So you didn't witness an ingestion, you did not witness a significant head injury. You should come to the emergency department. So we need to figure out why it is that the child isn't acting appropriately. In that case, you know, we may need to do things in the emergency department, including doing a CT scan at the head. Make sure there's no skull fracture or internal bleeding. We'll run some tests. Uh, we need to make sure that the kid didn't get into anything that could be potentially life threatening.
However, if you see that a kid actually ingested something, then certainly you can call the poison center. So it is a national number. It's one eight hundred two two two one two two two. If you're calling from your cell phone, remember that it's going to get the local poison centered according to the area code on your phone. So luckily here in Texas, we have five different poison centers. Here in Texas. So if you have a Texas number, you'll get one of our Texas-based poison centers. Each state has different situations regarding your poison center. So with you guys in New York, the New York Poison Center is the granddaddy of them all. So extremely well-known, really famous toxicologists are from there,
and they've been doing great work for decades.
Wow. So what kinds of information when you call are they going to want from you?
So they're going to want things like, number one, how old the child is. Number two, you know, about the approximate weight of the kiddo. What exactly happened? So as far as you know, what was the time of the ingestion? What was the situation around the ingestion? And what type of symptoms the child is currently exhibiting? And the poison centers are stacked with people who are called certified specialists in poison information, or C-spies for short. And oftentimes, they'll be able to give you some really good advice as to what to do. And oftentimes, they'll say, you know, I think this kid should be evaluated in the emergency department, and they'll oftentimes call the hospital to let them know that this kid is coming. But if it's something that could be watched at home,
they will also give you advice on exactly what to do.
Coming up, why the view of some old-school standbys, like syrup of ipecac, has changed over the years.
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You know, years ago, everybody had a bottle of syrup of Ipecac.
In the medicine cabinet to induce vomiting. Is that still a thing?
No, it isn't.
No.
Yeah, so I remember having a bottle of that as a kid. I think my mother was always worried I was going to get into things. But actually, the American Academy of Pediatrics and the American College of Medical Toxicologists no longer recommend having syrup of Ipecac at home. And the reason is, is that there's different substances that you actually don't want to vomit up. So hydrocarbons such as tiki oreo, gasoline, kerosene, things that potentially you can even have around the house. You do not want to induce vomiting because the danger is actually from the aspiration into the lungs rather than just the ingestion.
So it's a bigger danger to get it in your lungs than to get it in your stomach?
Correct.
Will they ever pump your stomach?
So that used to be a rite of passage for every emergency medicine intern.
Is that right?
To do it. However, I would say in the last 20 years, the pendulum has actually swung the other way. So we really don't pump the stomach anymore. Number one, it has to be a really large bore tube. And the tube itself at the very end has small perforations or fenestrations in there. And they can only really suck up pill fragments. So really unable to aspirate large pills. You have to have a really cooperative patient who's willing to swallow this very large bore hose into their stomach and basically get two liters of fluid pushed in and out of it. So you can imagine if somebody did ingest something and they meant to ingest it,
they're hardly going to be really cooperative with it. However, there are a few caveats. If it's an ingestion that is potentially life threatening, you have protected their airway either by intubating them or they agree to do it, then potentially you could do it. But it is no longer a regularly performed procedure anymore.
What other threats do you see around the holidays?
I think the other things you need to think about are, you know, things like Ornaments, so a lot of these ornaments are glass and if they break, you want to make sure kids don't injure themselves on that. I think weather-related incidents, certainly with areas that have a lot of snowfall and people can certainly slip and fall, so you have to worry about trauma. Anytime there's ethanol involved, both for, especially for older adults and who are ingesting alcohol, you do need to worry about trauma. So are they falling? Are they driving? So those are always things to think about during the holidays.
And of course, we're eating a lot of food and there's always the timeless food poisoning problem, right?
Yes, the food poisoning, so I think is something that you do need to worry about during this time of year as well. So making sure that you are cooking your meats to an appropriate temperature, depending on what it is. I think making sure that things are properly stored. So if your whole family suddenly gets sick, then there's a good chance in that secondary to food poisoning.
And of course, it's always been known that this is a hard time emotionally for a lot of people.
Yeah, so you know, Christmas time, holidays, it's probably the busiest time for us at the Poison Center. We get a lot more calls regarding overdoses. I think it's important to reach out to your loved ones to make sure that they're doing okay. Making sure that people are getting the help that they need during this time of year, that they get the emotional support that they need. I think we have to remember, you know, although, you know, vast majority of us, it's a joyful time of year, we get to spend it with the ones we love, but there are still people out there that need help. And if you have know anybody who you've been worried about, please reach out to them. Certainly, we see a lot more suicidal ideations during this time of year.
Well, thank you for all that very helpful information and we wish you a happy holiday.
Thank you, Ira. It was a pleasure.
Dr. Singy Feng, Professor of Medicine at UT Southwestern Medical Center, specializing in pediatric emergency medicine and a medical toxicologist with the North Texas Poison Center in Parkland, Texas.
That's it for today. Tomorrow, Ira talks with author Davis Sobel about Marie Curie and some of the women who passed through her lab over the course of her research career. Lots of folks helped make the show happen, including Dee Peterschmidt. Sandy Roberts. Beth Ramey. John Dancoski. And many more. I'm Sci-Fry producer Charles Burquist. Thanks for listening. We'll see you soon.
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