Tag Archives: Recommendation

From the Desk of Doc Smo – Getting the Dose Right!

In the era of computerized medical records, robotic surgery where surgeons don’t touch their patients, ICD-9 databases gathering statistics on millions of people in real time, I guess it is time to give up some of the “old ways” such as measuring medicine with a teaspoon. How twentieth century can you get? Teaspoons can be quite variable in volume. Johnny and Janie’s dose of medicine shouldn’t depend on your silverware pattern, should it? This is one of the conclusions of a task force called PROTECT (Prevention of Overdose and Treatment Errors in Children Task Force). They are strongly recommending that all pediatricians, pharmaceutical companies, and parents begin immediately prescribing and delivering liquid medications in metric volumes only! Teaspoons and tablespoons are out and milliliters are in. Furthermore, they recommend that we deliver medicines with a metric syringe rather than the less accurate measuring cups that come with so many medications used by children.

 

I know that we cling to the familiar; such behavior is human nature and gives our world more predictability. But when the health and safety of our children are at stake, it is time to change. As the task force points out, unintentional medication errors are a big problem in a society of 350 million people. Check out the statistics that they have gathered:

 

• Over 70,000 emergency department (ED) visits result from unintentional medication overdoses among children under the age of 18;
• One out of every 180 two-year-olds is treated in an ED for an unintentional medication overdose;
• Over 80% of ED visits among children under the age of 12 are due to unsupervised children taking medications on their own, and 10% of ED visits in this age group are due to medication errors;
• Over-the-counter medications are involved in approximately one-third of ED visits among children under the age of 12 [1].

Source cited below

 

Pharmacists got past their archaic system of measuring in drams, minims, and grains, so parents and doctors should be able to go metric in the 21st century. Put away those teaspoons and get out a good metric syringe to measure your child’s medicine. As we are learning, even medicines that are readily available like acetaminophen and ibuprofen may not be so benign, especially for children and especially at the wrong dose.

 

Check out other task force recommendations at the link that I have provided from the CDC.

 

www.cdc.gov/MedicationSafety/protect/protect_Initiative.html

Safe Sleep Environment for Infants 2011 (Pedcast)

This podcast is part of the Essential Series for parents with newborns and infants.  Knowing the dos and don’ts when it comes to safe sleep environment for infants is something that parents must master.   Sleep associated deaths may, to a large degree, may be preventable.  Listen to what experts feel is the safest environment for babies to sleep.

Transcript:

Intro:
-Welcome
-I created this podast in order to bring parents useful information they can use to help their children from the crib to the country club, from the bassinette to the board room.
-This episode is part of my essential knowledge edition of DocSmo
-Today we are going to talk about the new recommendations, appropriate for most babies, from the Academy of Pediatrics regarding Safe Sleep Practices for infants.
-A task force, working for the AAP, consisting of academic pediatricians. Reviewing available data and making recommendations based on available evidence and some opinion, albeit informed opinion.
-So get ready and sharpen up your pencils if you are a new parents bringing a newborn home from the hospital. I have some detailed recommendations for you hot off the AAP press. Important since deaths during sleep are the most common cause of death in infants during the first year of life!!! Pay close attention and learn what the experts at the AAP think constitutes the safest sleep environment for infants.
-Let me remind my listeners that, I am not your child’s doctor and for specific advice regarding your child, consult the wonderful person you call your child’s doctor.

First some definitions so we are all on the same page;

Our discussion today revolves around deaths that occur in infants during sleep time in the first year of life after they have transitioned from the birth process. These fall into a few categories;
-APNEA is the medical term for lack of breathing that is centrally mediated, that is, your brain forgetting to breath…common in premature infants before they have mature centers in their brain’s to control breathing, especially during sleep. Remember, no need for breathing in the womb so many immature premies just forget to breath…especially if they are asleep.
-SIDS Sudden infant Death Syndrome- Any sleep associated infant death that cannot be explained after a thorough medical investigation that includes an autopsy, toxin screens, metabolic tests…no trauma, no sickness, no suffocation etc. Presumably, the terminal event in a SIDS death is an apneic spell.

-SUID Sudden Unexpected Infant Death- Any sleep associated sudden death of an infant whether explained or unexplained which includes SIDS deaths as well as suffocation, asphyxia, entrapment, infection, ingestions, metabolic diseases, cardiac deaths, and trauma whether accidental or non accidental.

-New distinctions about sleep related deaths depend not only on traditional medical information like autopsy and lab tests but also on scene investigation. In recent years, a new tool that can explain many of these sleep associated deaths.

The goal of the new emphasis on safe sleep environments is to eliminate all sleep associated deaths in infants, whether they be SIDS type or SUID type. Here is the consensus of the AAP experts of the do’s and don’ts when it comes to a safe place for your infant to when they are unattended–Hot off the press.

Do’s
-Except in rare cases, Back to sleep for EVERY sleep in the first year. Not side, not elevated, not in or on a device such as a wedge.
– Your babies “sleep surface” should be firm and conform to Consumer Product Safety standards for ALL sleeping, day and night.
-Your babies mattress should have no gaps around the edges (suffocation risk) and should only be covered by a fitted sheet…no loose bedding, no toys, no bumpers
-Dress your baby in light, comfortable clothing such as a one-piece sleeper in a room that is between 68-72 with no more than one layer more than that which would make an adult comfortable. No clothing that can get near the babies face.
-Breastfeed your infant
-Consider using a pacifier after breastfeeding is established.
-Put your infant’s crib or sleep surface in the room with the parents for the first 4-6 months?
-Its OK to put your baby down on their tummies for supervised Tummy Time everyday as soon as you get home to prevent flat spot on head however, this time must be supervised and follow the same rules I just outlined except the child is on their tummy rather than back.

Don’ts of sleep;
-NEVER Use pillows, soft bedding, sheep skins, quilts, pajamas with hoods, or blankets that can get near a babies face. If a blanket absolutely has to be used, tuck it firmly under the mattress so it cannot get loose.
-Crib should be free of loose toys or mobiles that can be reached. And nothing should be tied to the baby like jewelry or pacifier tether.
-No co sleeping. Feeding at night…must go back into crib. Infants should not sleep with siblings, parents, strangers, or anyone.
-Do not rely on monitors… cardio respiratory or any other type.
– Do not use a crib that has any broken or mended parts
-NEVER let a baby sleep on an adult who is drowsy or asleep
-NEVER let a infant sleep in a device that covers their face.
– Do not leave your baby to sleep in a car seat or carrier
– NEVER smoke before or after your baby is born
-Never use drugs or alcohol while caring for your baby

Easier said than done. I recently got a note from a Mom with a now 3 month old late preterm infant and you could hear the angst in her note. Let me read a portion of it for you. ” …it can be very frustrating as a parent (trying to preserve one’s own sanity) when doctors make these rulings that are not so easy to execute in the trenches!- Like –Never doze with your baby!! No toys in the bed!! Car seat MUST face back (This mom is particularly distressed when I’m alone with a young baby in the car!) Or—Sleeping in unapproved device may result in DEATH! Never leave baby unattended!!(How do I go to the bathroom, she asks??) She goes onto to say, It’s enough to make anyone lose their marbles. I know doctors just want the best for us, but take pity on us poor sleep deprived parents!”
– Here is hoping that you don’t lose your marbles. We need all the healthy, energetic healthy parents we can get to raise this next generation.

– If you want to read the full Academy of Pediatrics recommendations about safe sleeping environments, check out the references in the Smo Notes.
-Thanks for joining us today.
-Take the plunge and subscribe for your free pediatric education by getting the RSS feed from DocSmo.com or signing up on iTunes, Facebook or twitter.
-Remember this is a blog so your comments are welcome and may possibly be posted for others to ponder and comment on.
-This is your podcast host, Dr Paul Smolen, broadcasting from studio 1E in Charlotte, NC… hoping it is not a great leap for you to provide a safe place for your infant to sleep!

-Until next time

Smo Notes:

1.  Charlotte Observer- safeSleepPoster.pdf (application/pdf Object)-http://www.charlotteobserver.com/images/graphics/post/safeSleepPoster.pdf

2.  http://pediatrics.aappublications.org/content/early/2011/10/12/peds.2011-2284.full.pdf+html

3. http://aappolicy.aappublications.org/cgi/content/full/pediatrics;116/5/1245#SEC15

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