Pediatric Research 2014: The Year's Most Interesting Studies

Alan Greene, MD; Laurie Scudder, DNP, PNP


September 08, 2014

In This Article

Managing Risk

Medscape: Use of electronic cigarettes -- e-cigs -- among preteens and teens doubled, from 3.3% to 6.8%, from 2011 to 2013.[14] And in an equally worrying trend, the number of nicotine exposures reported to poison control centers resulting from ingestions by little kids of these often flavored and sweet-smelling products tripled from last year to this year.[15] It sounds like these products have to be added to the daunting list of issues discussed during well-child visits. What are the succinct messages you suggest sharing with families?

Dr. Greene: Clinicians need to be aware that e-cig use -- or "vaping" as many kids and adults call it -- is skyrocketing. The number of calls to poison control centers is actually increasing even faster than that. In 2010, there was an average of about 1 call per month; as of February 2014, that number was up to 215 calls per month. More than one half of the calls to poison control centers involve kids 5 years old and younger.

It is worth noting that hookah use is also going up dramatically in kids. One in 5 boys or 1 in 6 girls report using a hookah by the time they are seniors in high school.[16] Hookahs may have a lot more smoke and nicotine inhalation associated with them.

So here are my succinct messages. One is that I have changed what I say to parents about poison control centers. I used to give people refrigerator magnets or stickers with the poison control hotline number. I now tell patients and families how important this service is and, while they are in the office, suggest they put that number (1-800-222-1222) as a contact in their cell phone and in their kid's cell phone at a teen visit. Most people aren't looking at their refrigerator when they have this issue -- but most people do have a phone that has a contact book.

Two, when asking about tobacco use (which many pediatricians do), ask specifically about hookah and e-cigs, because a lot of folks think they are so much safer that they won't mention them. So ask about them specifically. Try to find out what they think about the safety of other methods of tobacco use. These are not strategies that are going to add significantly to the time required for a well-child exam, which is an important thing.

Medscape: Earlier this year, the US Food and Drug Administration (FDA) issued an important warning related to the safety of acetaminophen. The FDA recommended that healthcare professionals discontinue prescribing and dispensing prescription combination drug products that contain more than 325 mg of acetaminophen per tablet, capsule, or other dosing form.[17] Although many children are not ingesting products with these larger doses of acetaminophen, the FDA noted that acetaminophen overdoses were often the result of patients inadvertently taking more than one acetaminophen-containing product. This does have implications for pediatrics. What are you telling your families about safe use of these products?

Dr. Greene: I want to see a culture shift in our approach to acetaminophen. Acetaminophen is a useful and effective medicine, but somehow it got this halo of safety. If you ask most people what they think is the safest medicine, the response you'll hear most often is a brand of acetaminophen. "I don't take any medicines while I'm pregnant except, of course, acetaminophen, because it is so safe."

Consumers don't recognize that acetaminophen is far and away the leading cause of acute liver failure in the United States. It's the second leading cause of liver transplantation. It's a drug with real consequences and needs to be respected. If we can just change the mindset on the part of the public from thinking this is a universally safe drug to a recognition that this is a strong medicine with good uses that need to be considered before using it, I think we will have accomplished a lot.

And as pediatric folks know better than anyone, tied to that is a similar need to change the mindset about fever. Many people think of fever as something that needs to be treated, but as we well know, fever is an important part of our immune response to either a vaccine or an infection and contributes to a more effective immune response. The newly emphasized concerns about acetaminophen give new impetus to the need for these discussions.


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