Child Health Threat - We Have To Act NOW!

Last year, many children’s cough and cold medications were taken off the market because in the 37 years that they have been used (and what I estimate to be billions of doses worldwide), there were “54 reports of deaths in children associated with decongestant medicines made with pseudoephedrine, phenylephrine or ephedrine” and “69 reports of deaths associated with antihistamine medicines containing diphenhydramine, brompheniramine or chlorpheniramine.” Note that the reports didn’t say that the deaths were caused by the medications - only associated with the medications. I explain the difference in my discussion of the FDA ALERT on children’s cough and cold medications here. If you don’t want to be caught up in the media hype about “associations” with disease, I recommend that you read the post.

In addition to those deaths, children’s cold and cough medications were deemed of little benefit and it is estimated that their use caused more than 7000 visits to the emergency department per year. See also this article in the journal Pediatrics.

Once these studies were made public, pediatricians took to the street with torches and pitchforks. The pediatricians lobbied the government. A special panel was convened (headed by a geriatrician - really!) and the panel determined that cold medications were no longer safe for children. Then the FDA got involved, chastising any parents that would dare give their children such medications because “potentially life-threatening side effects can occur.” As a result, many manufacturers took children’s cold medications off the market.

[Golf clap]
Congratulations. Public fear works well in accomplishing one’s goals.

I just read a WebMD article stating that 1.3 million babies each year sustain injuries that are sufficient to send them to the emergency department. That’s almost 200 times as many ED visits as from the evil cold medications.

The most dangerous things for infants include beds, car seats, walkers, strollers, and stairs.

Here’s my problem: even though these injuries collectively injure and kill several orders of magnitude more children than the dreaded Triaminic and Robitussin, the pediatricians remain silent. No pitchforks. No special committee headed up by some dermatologist. No Congressional mandate.

I have to admit, the American Academy of Pediatrics does have a comprehensive guide to car seats and it also has a policy statement recommending a ban on the manufacture and sale of mobile infant walkers.

But there’s no AAP demand to ban strollers that injured almost 65,000 kids in 4 years, though. No recommendation that kids sleep on mattresses on the floor so they don’t fall out of bed. No demand to Congress that kids be raised in only single level houses to avoid stair injuries.

Then, after my recent discussion of antibiotic overuse, I looked through the policies containing the word “antibiotics” on the AAP web site. There was a 2001 policy recommending antibiotic use in sinusitis. That hasn’t been updated even though there is evidence that antibiotics are useless for sinusitis in adults. There was a 2004 policy recommending a watch and wait approach in selected kids with otitis media. There was also a 2006 recommendation to use antibiotics in bronchiolitis only when “specific indications of the coexistence of a bacterial infection exist.” The recommendation doesn’t say what those indications are, though, so it’s open season for antibiotics in kids with bronchiolitis and … a fever … or ear pain … or yellow sputum … or yellow boogers.

I also did a web search and found reference to a 1997 CDC/AAP guideline for judicious use of antibiotics, but I wasn’t able to find anything online.

That’s it.

According to this article, there are 25 million inappropriate prescriptions for antibiotics given each year, at a cost of $726 million.

If your kid has a cough, a runny nose, a sore throat, or a fever, the AAP has no policy about how antibiotics are generally inappropriate in those circumstances. Welcome to the new age of MRSA, kiddies.

In 2005, the death rate attributed to MRSA alone was 18,650 and the number of life threatening MRSA infections was about 94,000. That’s more deaths than due to AIDS. And we aren’t talking about “associated with,” we’re talking about “caused by” here.

MRSA is just the tip of the morbidity and mortality iceberg for the billion plus of doses of inappropriately prescribed antibiotics. IN TWO DAYS MRSA caused more deaths than children’s cough medications were “associated with” in 37 years. I can’t even begin to guess how many ED visits occur each year due to antibiotic misues (for things like vomiting, diarrhea, and drug rashes).

Now antibiotics for virus infections are just as effective as cold medications for stuffy noses, but I’ll be darned if I didn’t see at least a few kids every shift during the winter that were in the ED because their cough or runny nose wasn’t getting better on the magic little pink liquid their doctor prescribed.

So, all you pediatricians, where are your pitchforks, now?