Talking Poison to Preschoolers

Today wraps up National Poison Prevention Week, but educating families about poison prevention is a passion that I can and will sport all year round. I love surprising parents and kids about how much some medicines look like candy, how some cleaners look like drinks, and how children can access child-proof items.

Yesterday, I went into my daughter's preschool class of four and five year-olds. I didn't go all out with my props this time, but I did find things around the house to show and tell. These included a bottle of green multi-purpose cleaner, a bottle of water (which I tore off the label and asked if they would still accept my bottle to drink), gummy vitamins, real gummy bears, my daughter's purple fluoride tablets, toothpaste, my orange nasal inhaler, freeze pops with electrolytes and some without, a bar of soap, spray on sunscreen, and a tub of red finger paint. I thought I would only take 10 minutes, but I ended up with a 20-minute presentation. The children were able to tell me what a poison is ("something that makes you sick or die"). I was glad one of them brought up death because I wasn't sure if they were ready for that term. My daughter is familiar with it because we have had quite a few recent deaths in the family, but she has asked us to define the term.

I also made a STOP sign with "Stop! Ask First" and wrote out the Poison Control Center's phone number on a large piece of construction paper. Every time I showed them something that they weren't quick to comment about, I waved the stop sign. The three main points I had wanted to get across to them were: 1) stop and ask a trusted adult first, 2) medicine is not candy, and 3) call 1-800-222-1222 for poison emergencies (yes, someone is available to take calls 24/7). I also emphasized that poisons aren't just harmful when swallowed, but also when touched, smelled, and brought to the eyes. The final activity was teaching them the phone number. Yes! The teachers have taught them how to read numbers (although there are lots of 2's). I always get a kick out of hearing them recite the phone number with me! I'm glad I was able to show the teachers something new: freeze pops with electrolytes. They were still talking about it as we were leaving the school.

Take home packets included an activity book about Lenny Lendahand, brochures about plants being poisonous, general information about the Poison Control Center, a checklist of what to do in case of an accidental poisoning (no more syrup of ipecac, mind you, for ingestions), a game that I created about medicine vs. candy, and telephone stickers with the 1-800 number. These were all free from the CT Poison Control Center. I'm sure you'd be able to get them from your local chapter. Find yours here and make a difference in your child's classroom next time. You don't have to be a health care professional to talk about poisons to children of any age at home or at their schools. Just spread the word that they can be prevented and the phone number.

Here are some links to give you ideas:

Poison Prevention Preschool Lessons

Poison Education Resources

Poison Prevention from the University of Buffalo

Poison Prevention.org

Why is my pharmacist asking so many questions?

I remember not too long ago, a friend of mine was complaining that the pharmacist asked her too many questions when she was getting her prescription filled. "What were you asked?" I wondered aloud. It turns out she was prompted to provide information about her weight, whether she was pregnant or breastfeeding, what other medications had she taken in the past, and what other medications is she on now. I explained to her that these questions are meant to help complete her profile so that the pharmacist can identify potential drug therapy problems with her medications before any adverse effects occur. She accepted that and later felt appreciation rather than the initial resentment.

In Connecticut, "a pharmacist shall make a reasonable effort to obtain, record, and maintain...:

(1) name, address, telephone number, date of birth or age, and gender;

(2) individual history where significant, including disease states, known allergies, and drug reactions;

(3) a comprehensive list of drugs and relevant devices dispensed by the pharmacy within the last 180 days; and

(4) the pharmacist's comments relevant to the individual's drug therapy."

This information will be helpful to the pharmacist when a patient presents a new prescription to identify any potential problems with the overall drug therapy. Basically, the pharmacist is looking for any:

• duplication of therapy (e.g. is the patient taking multiple medicines that work the same way or multiple products that contain the same active ingredient?);
• contraindication between the medicine and a disease (e.g. does the patient have a condition that precludes him/her from taking the medicine?);
• drug interactions (e.g. will this medicine increase or decrease the effects of the other medicines the patient is currently taking or vice verse?);
• issues with the dose and length of therapy prescribed (e.g. if the patient stated that he has kidney problems, is the dose going to be too high? or does the patient need to be on 3 weeks of high-dose steroids by mouth for an acute asthma attack? or if the patient is pregnant, she should not be taking certain medicines for blood pressure or cholesterol control);
• interaction of a medicine and allergy (e.g. if the patient stated that she is allergic to soy, she should not be given Atrovent as an inhaler); and
• clinical abuse or misuse and any other significant clinical issues relating to the appropriate use of drugs (e.g. is the patient really still in pain 4 weeks after a root canal treatment?). One's weight can be used to determine the appropriateness of the dose.

It is our duty as pharmacists to ask these questions. Unfortunately, as a patient, I've only been asked about my allergies and nothing else when I have had my prescriptions filled. In fact, I had to ask about the effect of the medications on the breastfeeding baby. I also wish I was asked my children's weight when I present their prescriptions. Well, it's not relevant when it is for a topical cream, but it could be for an oral antibiotic. It really doesn't matter what state you live in, because all pharmacists have been well-trained in all aspects of medications and common disease states. So, if you're visiting a pharmacy for the first time, and your child has a chronic illness or is currently on multiple medicines from a different pharmacy, ask if there is any other information the pharmacist might need for your child's profile. To make it easier, fill out a medication list (The Pediatric Pharmacy Advocacy Group has a sample you can download) and have a copy available for the pharmacist to review. It could save you some hassle later on.

Get ready for flu season 2009-2010

This week, the CDC released a new guidance to help minimize the spread of any flu virus in child care and early childhood programs during the 2009 and 2010 season. This toolkit contains resources for providers and parents, including action steps for parents to protect your child from the flu, action steps for parents of children at higher risk for flu complications; action steps for parents if children are sick, or if the child care/early childhood programs are closed, and must stay home; and action steps for providers regarding daily health checks for children, staff recommendations, and decision-making about closures. These can be found at the CDC website.

General tips from the CDC to protect you and your child include:

1. Get you and your child vaccinated for seasonal flu AND H1N1 flu (when available); caregivers for children under 6 months should consider vaccination
2. Stay home if you or your child is sick for at least 24 hours until after a fever breaks (temperature is < 100 degrees Fahrenheit or < 37.8 degrees Celsius) or there are no more feeling of chills, feeling warm, flushed appearance, or sweating
3. Practice good hand hygiene with proper handwashing using soap and water or an alcohol-based hand sanitizer
4. Cover the mouth and nose with a tissue when sneezing or cough/sneeze into elbow or shoulder, not hands
5. If someone at home is sick with the flu, children in the household should stay home for at least 5 days from the time the first person got sick
6. Keep your child home for at least 7 days if your child is sick, even if they are ready to run and play before that. If your child is still sick after 7 days, keep him/her home until 24 hours after the symptoms have completely gone away.
7. Seek urgent medical attention if one or more of the following signs are noticed:

fast breathing, trouble breathing, shortness of breath, or stopping breathing;

bluish, purplish, or gray skin color especially around the lips and the inside of the mouth, or around the nails;

not drinking enough fluids, refusing to drink;

not urinating, decreased number of wet diapers, or no tears when crying;

severe or persistent vomiting;

not waking up or not interacting (e.g., unusually quiet and inactive, no interest in playing, no interest in favorite toy);

being so irritable that the child does not want to be held, or cannot be consoled;

pain or pressure in the chest or stomach;

sudden dizziness;

confusion; and

flu-like symptoms improve but then return with fever and worse cough.