Arsenic in a Child's World

Ann Pike-Paris, MS, RN


Pediatr Nurs. 2004;30(3) 

In This Article

Case Study

Tim P., a 10-year-old boy, presented at a local emergency room one Sunday with a chief complaint of bloody diarrhea. His mother stated that he had been having multiple episodes of diarrhea, but the bleeding was new. Tim was referred to a gastroenterologist at a large urban hospital, who performed a colonoscopy and diagnosed Chron's disease or colitis. Prednisone 40 mg/day was prescribed with decreasing doses over several weeks. Due to depression and weight gain, Tim was placed on sufasalyzene; however, he was allergic to sulfa and it was discontinued. The diarrhea continued along with the additional symptoms of nausea, raspy voice, headaches, abdominal pain, tingling of the feet and hands, lethargy, and eczema. Mrs. P. related that Tim disliked the sensation of clothing as "it bothered his skin."

Mrs. P. stated that she had a full-term pregnancy with no complications. Tim's birth weight was 8 lb. 15 oz. After breastfeeding was discontinued at 3 months, Tim developed severe eczema and was treated with cortisone topically. Until the bouts of diarrhea, he seemed a healthy, active child, although his mother always felt that he had a very deep voice for his age.

Seeing no improvement over a course of months, Mrs. P. sought other opinions. Over a 2-year period, a naturopath saw the child. A dietary change of no dairy products, wheat, salt, or sugar was ordered. This had little or no impact on the diarrhea. A second homeopathic physician tried 30 remedies resulting in short remissions, but the diarrhea continued. Concurrently, Mrs. P., concerned that Tim was eating too little, began to supplement his diet with extra vitamins and dietary supplements. She reported asking all of the health care professionals caring for her son if he should be tested for heavy metals to rule out any possible exposures. Until spring of 2002, this was not done.

Tim lives with his parents, who are married and have resided in the same house for over 20 years. He has a 14-year-old sister living at home as well; all family members are reportedly in good health. Mrs. P. describes her son as sensitive and popular with peers. Tim was always very active, participating in multiple sports, and has had a good academic history. Recently he had to give up sports due to excessive lethargy; however, he has been able to maintain many friendships. He also began to miss school 1-2 times per week and would often leave early due to excessive fatigue.

The home is 30 years of age and is not known to be near any environmental hazard sites or to have been treated with pesticides. There are two large pressure treated wood decks, which were built over 13 years ago. The child reportedly spent 5-6 months a year playing on and under these structures and in the dirt below, as well as eating on them. He played frequently on the large play structure at the local elementary school, also built of pressure treated wood. Neither parent engages in a potentially hazardous occupation. The family drinks town-supplied water. The town is coastal and a seasonal resort.


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