Halloween should be a fun time for kids. Help keep everyone safe by following a few simple tips.
Halloween is a favorite holiday for many kids – they get to dress as their favorite characters and get treats! But it’s also a time that kids are at increased risk. Consider a few safety tips to help keep it safe for all of our kids.
Food allergies and other health conditions
First and foremost, many kids have medical reasons to not eat many of the treats they get on Halloween.
Keep these kids in mind and have non-food items to give out. Check out my post on Teal Pumpkins to learn more.
Before the big day
Clear your sidewalk of any potential hazards for trick-or-treaters, such as low hanging tree branches, toys, electrical cords, and other obstructions.
Get flashlights, pumpkin lights, or glow sticks for your Jack O Lanterns.
Let kids participate in pumpkin decorating according to their abilities.
Toddlers can paint pumpkins. Get creative with rhinestones and glitter.
Kids can help remove the seeds after an adult removes the top – though many don’t like the texture of the goo!
Let school aged kids help design the Jack O Lantern. An adult should do the carving until kids are mature enough to handle a knife safely. Kids can:
Trace a template or their own drawing onto the pumpkin.
Use cookie cutters to press into the pumpkin as a template to cut.
Try tools designed to punch out pumpkin pieces to create a fun Jack O Lantern – just search online for “Pumpkin Punch Decorating Kit” and look for kid-safe tools.
For more pumpkin decorating safety tips, see Safewise.
At least one member of each trick-or-treating group should have a cell phone.
Feed kids before going out. This will help keep them from snacking on their treats before you have a chance to check them.
Adults should closely supervise young children.
Don’t force children to trick or treat if they’re not comfortable with it. This does not toughen them up. They can still participate by helping to decorate or by handing out treats.
Talk to older kids about safety as they earn the responsibility to go out with friends.
They should know the boundaries in which they can roam.
Be clear on when they should check in and when to be home.
Do not go to homes without a porch light or otherwise decorated to show they are participating.
It should be understood that they should never enter a home without your knowledge.
Only accept hand made treats from people you know.
Kids should always stick with their group and not fall behind or run ahead of the group.
Respect property and people. Be mindful of younger trick-or-treaters and stay out of their way. Don’t try to frighten them and let them go first. Say “thank you” and be polite. Trick or treating does not give permission to trick others. They should respect peers who might be afraid of a haunted house or other things on Halloween and not pressure them to do things they don’t want to do. No one should make fun of anyone for being scared.
If you’re driving, be very attentive to parked cars and other objects that could limit your view of kids about to go into the street.
Keep your own pets safely away from the crowds and watch your kids around unfamiliar animals.
Add reflective tape to costumes to help visibility in the dark.
Masks can hinder the ability to see well – use makeup instead. Test a small patch of skin in advance to be sure your child’s skin isn’t sensitive to it.
Kids can carry a lighted trick-or-treat bucket, wand, or other accessory or wear a glow stick bracelet or necklace.
Avoid costumes that are too long and increase the risk of tripping.
Weather is unpredictable. Make sure you can add layers if it’s cold or remove layers if it’s warm.
If kids are going to be walking for trick-or-treating, be sure their feet will be comfortable and their shoes safe. Plastic costume heels are not safe for our little princesses!
If a sword, magic wand, or other accessory is part of the costume, make sure it’s not sharp or too long for them to safely carry. Talk to kids about how to safely carry it so they don’t accidentally hit other people. Leave it at home if you think they would tire of carrying it or if it could be mistaken for a real threat.
Do not use contact lenses unless they’re prescribed by an eye specialist.
Bike safety starts before you even get on the bicycle.
Summer’s in full swing. I love to see neighborhood kids out playing. We don’t see that enough these days. I want kids to have fun outdoors for fresh air and exercise. Bike safety should be taught early on and encouraged every time people young and old are on bikes.
Twice already this summer kids have told me about friends who had ugly accidents due to wearing flip flops or sandals on a bike. My patients hear the message to cover their heads with a helmet and feet with proper shoes before bikes and scooters. These kids listened but not their friends.
My favorite bike safety tips are in this easy to read and share infographic.
Lawn mowers send many kids and adults to the ER every year. Learn to use them safely with the tips below.
As the winter months (finally) end and the weather warms up, we need to get our lawns in order again. I haven’t written about lawn mower safety in a long time, but as I drive around my neighborhood I’m reminded just how many people don’t realize the dangers.
We need to respect lawn mowers and use them safely.
In 2016, more than 86,000 adults and 4,500 children in the U.S. were treated in emergency departments for injuries related to lawn mowers according to the U.S. Consumer Product Safety Commission. Riding mowers lead to the most injuries, but even walk behind mowers are dangerous.
People can suffer minor and serious cuts, burns, broken bones, eye injuries, loss of limbs, and death. A lawn mower can eject a rock, piece of metal, or wood up to 100 miles per hour, leading to injuries of people in the yard but not near the mower.
Only use a mower that has protection over hot and sharp parts. Never remove these protective coverings.
Teach kids to never touch a lawn mower. Many are burned by touching a hot mower, even when it is off.
Add fuel only to mowers when they are cool and off.
Never operate a mower when under the influence of alcohol or drugs that impair your level of alertness.
Never leave a running mower unattended. Turn it off before walking away.
Wear protective gloves, goggles, sturdy shoes, and long pants when you use lawn mowers. Never mow barefoot or in sandals.
No one under 16 years should ride on or operate a riding mower.
Riding mowers should have the reverse switch behind the driver, forcing the driver to look behind when placing the machine in reverse.
Push mowers should be used only by people over 12 years of age.
Push mowers should have a control that stops forward motion when the handle is released.
If children must be in the yard during mowing, they should remain at least 20 feet away at all times. Ideally children should not be allowed in the yard when the grass is being cut due to the possibility of flying debris.
Remove stones, toys, and debris from the lawn before mowing to prevent injuries from flying objects.
Mow across slopes with a push mower to avoid pulling the mower over your feet if you happen to slip.
Mow up and down slopes with a riding mower to prevent the mower from tipping over.
Do not cut wet grass.
Use hearing protection. Do not listen to music through your ear buds. The high volume required during mowing is harmful to your hearing.
Do not talk on your phone when mowing. It is a distraction that can lead to accidents.
It’s not just Momo… Even if she started as a hoax, we DO need to protect our kids online.
The news is full of stories about Momo and other scary things our kids are exposed to online. Many stories say this is a hoax. YouTube has said this would be against their rules. It doesn’t really matter if this started as a hoax or if it’s against the rules. The fact is that our kids are exposed to things online.
Our kids do see inappropriate things
I recently saw a preschool aged child for a well visit. During the visit it came up that the child had been exposed to Momo online. When the mother learned that the child saw scary Momo videos, she came up with a great plan. They took images of Momo and transformed her into funny faces, much like what I did for the image above.
I think this mother’s idea is great. She took a character that was scary to her child and made it funny. She used the opportunity to talk to her child. It became a great teaching moment.
Our kids can never “un-see” what they’ve seen, but we can help them to not view it as so scary. If you are unable to do this alone, talk to your pediatrician or a therapist.
When things happen we need to find ways to help our kids process them. If your child’s mood or behavior suddenly changes, it is quite possible that they have experienced a traumatic event of some sort. If they won’t talk to you, seek professional help.
What can we do to prevent online exposures?
We can’t stop all exposures, but we can do many things to help protect our kids. This includes monitoring software, anti-virus software, and teaching our kids how to behave responsibly and safely.
Our kids will be online, whether it’s at home or at school or at a friend’s house. They are growing up with the world at their fingertips through the internet, so we must teach them to use it wisely.
Like in other benefits and responsibilities of growing up, our kids should have fewer limits and less monitoring as they show maturity. We cannot expect them to be responsible online at 18 years of age if they never practice with supervision along the way.
Give your kids age-appropriate allowances for games, videos, and other online experiences. I love to use Common Sense Media to learn about movies, games, and other media.
Set up parental controls.
Research parental control software. It’s easy to search “parental control apps” or “parental control software reviews” to find the pros and cons to various brands.
Choosing the best for your family is not easy, but read several reviews to find what is best for your family’s needs.
Adult supervision and guidance
If our kids are playing outside, they will have close supervision when they’re young, less as they get older.
Online use should be no different.
Your 3-4 year old should not go to the park alone and they shouldn’t go online alone. If they are online, project the screen to the television so you can watch along or sit with them and play along with them. They should not be online when you are busy doing something else. It is not a safe babysitter.
As kids get older and can understand how to navigate the internet more safely, they can have less and less direct supervision. This does not mean they can have a free for all. Parents can still help them choose age-appropriate sites and have software to keep blocked sites from being accessible.
You can’t just avoid online use
Several parents over the years have tried to end the conversation when I bring up social media safety by saying, “we don’t allow any of that.”
It is not sufficient to simply not allow any social media. Our kids and teens will come across it, whether it’s their own account or a friends.
What things did you do as a teen that your parent didn’t know about? It’s even easier for kids to hide social media accounts than it is for them to do many of the things we used to do as kids.
As kids grow
Talk to older kids and teens about why pornography sites are harmful.
Have discussions about oversharing. Predators look for ways to identify where kids hang out. Kids shouldn’t give a team name or mention that their soccer game is tomorrow morning at 9. That innocent information can help a predator find them. Even photos with identifying information, like a school shirt or team jersey, can be risky if shared publicly.
Kids sometimes get tricked into sharing photos that are inappropriate. This includes pornographic images as well as snapshots identifying where to find them.
Talk about their digital footprint. Schools and employers will look at your child’s online history. It needs to be positive and what they post today will be there forever.
Teach kids basic right and wrong
We cannot protect our kids from everything, but we can teach them to be good decision makers.
Use real life examples and daily experiences to help your kids learn to make safe choices. Let them accept more responsibility and make more choices as they get older. Allow them to make the wrong choice sometimes. They’ll learn from these little mistakes much more than they would if you refuse to let them do that little mistake. This helps to prepare them to make the right choice with the riskier options as they grow.
For example, if your middle school child wants to stay up late to watch a movie but you know he has an early soccer game, discuss the situation with him. Let him make up his own mind in the end – without being judgmental. If he struggles getting out of bed and disappoints his teammates because he’s too tired, is that really the worst thing in the world? I bet the next week he won’t beg to stay up late so much. Just don’t play the “I told you so” game or give attitude about it. That will make him mad at you.
Let kids learn from their own mistakes without discussion or lecture. Kids learn from things like this if we let them. Trust me, there are lots of opportunities for them to learn to make safe, responsible choices as they grow.
In the end, if our kids want to find an inappropriate site or do something they’re not supposed to do, they will. If they use good judgement and make safe choices in other aspects of life, they are more likely to do so online too.
It’s not just Momo… Even if she started as a hoax, we DO need to talk to our kids about risks online.
Follow your kids on their social sites. Talk about what sites they can and cannot use, but remember that it is easy for them to set up hidden accounts. That’s why it’s so important to talk to your kids and let them make their own choices as they grow. If you don’t allow options and never let them fail, they will not learn. The more you restrict them, the more they’ll hide from you.
Sometimes vaccines are given too soon to count toward the required vaccine schedule. This can easily happen if there are changes to the standard vaccine schedule for any reason, but what does that mean for the child? Are they in danger? Do they need extra shots? Is that even safe???
Early vaccines don’t count.
Don’t try to sneak in early before a recommended age.
It’s not appropriate in most cases to give vaccines at shorter intervals or before the recommended age.
The 12-15 month vaccines are occasionally given before the 1st birthday, which does not count in every state. State laws can dictate a grace period in which vaccines can be given earlier than the standard schedule, but not all do.
This is an issue with some children moving from a more lenient state to one with a lesser (or no) grace period.
In some states they can get their MMR a couple days before their first birthday.
Does this protect them against measles, mumps, and rubella?
~ Probably. (Nothing’s 100%.)
Does every school count it?
~No. If they move to a state that doesn’t, they need to repeat it.
International travel changes things.
It is recommended for international travelers over 6 months to get an MMR early due to worldwide measles outbreaks.
This dose does not count toward the 2 doses typically given after the 1st birthday because younger children do not make immunity as reliably, but is felt to potentially benefit those at higher risk due to travel.
If the MMR vaccine is given when they are already protected, the vaccine doesn’t work.
We don’t know if a 6-12 month old is safe or not, so when the risks increase, as with international travel, it is recommended to give a shot to help if needed.
But that shot might not work, so it should be repeated after the 1st birthday.
Minimal intervals are important.
Most vaccines are given as a series, and each vaccine within a series needs to be separated by a minimal interval.
Before vaccine logic was built into our electronic health record, it could be difficult to know which vaccines were recommended if people got off the standard schedule.
Not all EHRs have smart vaccine logic, so if you’re off schedule, be sure to discuss intervals before giving vaccines.
The hepatitis vaccines are more commonly given off an appropriate schedule than other vaccines. I’ll touch on each of them and why they’re problematic.
Hepatitis A vaccine interval problems.
My office routinely gives the first Hepatitis A vaccine at 12 months and the second at 18 months. The CDC schedule states:
Hepatitis A (HepA) vaccine. (minimum age: 12 months)
2 doses, separated by 6–18 months, between the 1st and 2nd birthdays. (A series begun before the 2nd birthday should be completed even if the child turns 2 before the 2nd dose is given.)
Despite warning parents to schedule the 18 month visit 6 months or more from the 1 year visit, sometimes they don’t have the correct spacing. This generally happens when they do the 1 year visit several weeks after the birthday but then try to “get back on track” and do the 18 month exam on time.
The good news is our smart EHR tracks minimal intervals and doesn’t suggest the vaccine if it’s too early.
I typically wait until the 24 month visit to do the 2nd Hepatitis A vaccine if it is too early at the 18 month visit, but I ask the family to come in just before the 2nd birthday. This allows the child gets the vaccine before 24 months of age and fit the main recommendation of getting both doses between the 1st and 2nd birthdays.
Sidenote about HEDIS
A delay to wait until the 2 year well visit follows the CDC recommendation to have the doses separated by 6-12 months.
If a child gets the Hepatitis A vaccine after the 2nd birthday, the physician loses quality points.
These points help rank physicians for insurance company purposes.
As long as it doesn’t happen often, it’s not an issue.
But if schedules are off too often, a physician’s contracts with insurance companies could be at risk because they are seen as not high quality, regardless of why the vaccine is given after the 2nd birthday.
If you want to keep your favorite physician and use your insurance, please help them meet the standards of care for all metrics. This includes coming in for annual well visits and having regular follow up for chronic issues. It also means taking the recommended medications, such as preventative medicines for asthma and doing certain labs, such as lipid panels, or screenings, such as depression screenings.
Don’t confuse the HEDIS measures and insurance contracts with this Big Pharma farce. First off, we pay pharmaceutical companies to buy their vaccines. They don’t pay us. Sometimes they buy a lunch for our staff so they can have our attention when they talk about their products, but there is no big money to be made from vaccine companies.
Insurance companies pay us for the vaccine and the costs associated with giving vaccines. These costs are not only for syringes and band aides. We must carry insurance for the vaccine inventory. There must be a dedicated refrigerator and freezer to safely store vaccines. We should use a refrigerator alarm system to alert us if the temperature is too warm or too cold. We pay staff to keep logs about refrigerator temperatures and inventory. All of these costs add up.
Trust me, no one gets rich off of vaccines.
Some insurance companies offer bonuses if we meet HEDIS measures, but more often I think they just pay less if we don’t meet measures.
Why do they pay more if we give vaccines?
Because the insurance company comes out ahead if we vaccinate. Vaccine preventable diseases cost them much more than vaccines. They want to encourage us to vaccinate to save them money.
Hepatitis B Interval problems.
Hepatitis B vaccine is given in 3 doses, with the second 4 weeks after the first, then the 3rd at least 8 weeks from the 2nd and 16 weeks after the 1st.
There are vaccines that just have hepatitis B protection (monovalent vaccines) that can be given starting at birth. They can be used for all three doses.
There are other vaccines that combine the hepatitis B vaccine with other vaccines (combination vaccines). The combination vaccines are given at different intervals, depending on what is in the vaccine. They cannot be given under 6 weeks of age, but it’s still recommended to give the first dose within 24 hours of birth.
Yes, it’s confusing.
From the CDC guidelines:
A complete series is 3 doses at 0, 1–2, and 6–18 months. (Monovalent HepB vaccine should be used for doses given before age 6 weeks.)
Infants who did not receive a birth dose should begin the series as soon as feasible.
Administration of 4 doses is permitted when a combination vaccine containing HepB is used after the birth dose.
Minimum age for the final (3rd or 4th) dose: 24 weeks.
Minimum intervals: Dose 1 to Dose 2: 4 weeks / Dose 2 to Dose 3: 8 weeks / Dose 1 to Dose 3: 16 weeks. (When 4 doses are given, substitute “Dose 4” for “Dose 3” in these calculations.)
There are even additional recommendations if the mother is a known Hepatitis B carrier or if her status is unknown.
If any of the doses are given too early, they need to be given again. This is considered safe.
Live viruses need special attention.
Live viruses must be given either at the same time or at least 28 days apart. If they are given at a shorter interval, the second vaccine is presumed to not be effective and must be repeated.
This is another great reason to not alter the standard vaccine schedule your provider uses. If your child gets off track, you run the risk of him or her needing additional vaccines.
Common live virus vaccines include MMR, Varicella, MMRV, and Flumist.
Some vaccines, like the oral typhoid vaccine, cannot be given at the same time as antibiotics.
See if you know what vaccines your child needs.
To avoid vaccines that are given too soon:
Be sure that whoever is giving vaccines knows any recent vaccines and medicines your child has had recently.
Try to stay within the recommended vaccine schedule as much as possible to avoid needing extra doses.
Vaccine schedules for children birth – 6 years and 7-18 years:
Constipation is one of the most common problems that affects kids. Sometimes it’s mild and changes to diet and routines can help sufficiently. Those are of course the ideal treatments. But if it’s more severe or if kids are resistant to change, Miralax is my go-to treatment. Several parents have asked me about its safety due to what they’ve seen online. I know many more are probably worried but just haven’t asked. With all the concern, I thought I’d share some of the concerns and reasons that I still recommend it.
What is Miralax?
Miralax has been used since 2000, and since I finished my pediatric residency prior to that, I can remember the alternatives we used previously. Many of them were difficult to get kids to take due to poor taste or grittiness. When Miralax was first available, treatment of constipation improved significantly due to the tolerance and acceptance by kids. It was initially available by prescription only and expensive – thankfully both of those hurdles have been removed.
Miralax is the brand name for polyethylene glycol 3350 or PEG 3350. It is now available as an over the counter medication, so no prescription is needed. Generic versions are available. It has been used by many kids over many years, often for long periods of time, to treat constipation.
Is it a laxative?
PEG3350 is a stool softener, not a laxative (despite the name).The molecule binds to water, but is too large to be absorbed through the gut so it passes through the gut and carries the water with it. It works by increasing the water content of the stool. The more PEG taken, the softer the stool.
PEG is not a laxative and should not cause cramps. It is not habit forming. As mentioned above, it is not absorbed into the body it just goes through the GI tract and leaves with the stool.
How is it used?
PEG 3350 is a tasteless powder that dissolves in liquids. It often needs to sit for a few minutes and re-stirred to fully dissolve.
It may be dissolved in water, with a slight change to its taste, but is palatable. Be careful of adding it to drinks high in sugar (even juice), since your child may be on it for a long time, and they don’t need the added sugar. Consider making flavored water with your child’s favorite fruit. Simply put cut up fruit in water in the refrigerator for a couple hours. Infused water tastes great and is a healthy base for your Miralax mixture – or anytime your kids need a drink and don’t like plain water.
I don’t recommend adding it to carbonated beverages.
I recommend mixing a capful of powder in 8 ounces of water and titrating the amount given based on need. My office website discusses this in detail.
Why do we need medicine?
Constipation is common.
Very common. It causes pain, poor eating habits, fear of toileting, and sometimes even leads to ER trips and CT scans. It can last months to years in some kids, so it is not a minor issue when kids suffer from it.
Diet changes are hard – especially in kids!
Kids are often constipated because they have a diet that is poor in water and fiber. They need to eat more fruits, vegetable and whole grains. Many kids drink too much milk and eat too much cheese.
Changing habits is very difficult in strong willed kids. When it comes to food, they’re all strong willed! Dietary changes of course should be done so they are healthier on many levels, but if their stomach hurts all the time, they are unlikely to get out of their comfort zone with foods. Habits change too slowly to help the constipation if used alone.
I encourage first changing the diet to help constipation, but if that fails, or if it is too significant of a problem, PEG 3350 is my first choice. I have recommended it for years without any known side effects or complications, other than the kids who have frequent watery stools on it. This usually responds to continuing the medicine to release the large stool mass that has built up. Some kids just need to decrease the dose a bit.
What’s the concern?
I was quite surprised in 2015 to see that researchers were starting a study on the drug. It surprised me not only because I’ve never heard valid concerns about the safety or efficacy of the medicine (I have seen some really weird stuff online, but nothing that is valid), but also because I’ve never seen headlines that a study is starting. Usually headlines report results of studies. Why did it hit the press before the study was even done? I have no idea.
Even more interesting… it seems the study hasn’t started yet. Three years later. Not a high priority, apparently. Which fits with the low level of concern I find among general pediatricians and pediatric gastrointestinal specialists.
Yet parents still ask about the risks.
What was the proposed study?
Initial reports stated that they were going to look at the safety of other molecules in the PEG 3350.
PEG 3350 itself is a very large molecule that isn’t absorbed by the gut, but there are concerns that smaller compounds could be found as impurities in the manufacturing process of PEG 3350 or formed when PEG 3350 is broken down within the body.
The question is if these smaller compounds are absorbed by the gut and accumulated in the bodies of children taking PEG 3350.
Some families have reported concerns to the FDA that some neurologic or behavioral symptoms in children may be related to taking PEG 3350. It is unclear whether these side-effects are due to PEG 3350 since neurologic and behavioral symptoms can lead to constipation.
These guidelines basically state that not many studies are required to diagnose functional constipation after a thorough history and exam. This means that we don’t need to do expensive tests to make the diagnosis.
The common things we recommend (fiber, water, probiotics) don’t have any proof that they work. There is evidence that PEG 3350 works.
Historically once something is approved in adults, physicians start to use them in children. Companies generally don’t invest money in studies to expand uses after approval because they know that the products will be used in broader ways without the specific indication. They don’t want to spend money they don’t need to spend, which makes sense from a business perspective. It’s also more difficult to do studies in minors.
New rules encourage pediatric testing, but all the drugs previously used in children will not need to undergo this testing. Because they’ve been used for years, we rely on post-market safety data.
Are there studies in children?
Many of the news articles say that studies have not been done in children, but this isn’t true.
This 2014 research article reviews the history of PEG 3350 and compares to other medicines used in pediatric constipation. It also shows safe blood electrolyte levels while on PEG 3350 long term.
In 2001 a study was published showing safe and effective pediatric dosing.
A 2003 studyshowed safety and better tolerance than previously used medications for constipation.
If you look at the references of any of these studies, you will find more. The only side effects noted are related to diarrhea, cramping, bloating — all things that would be expected with a large stool mass blocking the new, softer, water filled stools from coming out. Once the large stool mass is out, these symptoms resolve.
For what is PEG approved?
PEG is used in many products, not just stool softeners. It is found in ointments and pills to allow them to be more easily dissolved in water. PEG can also be found in common household products such as certain brands of skin creams and tooth paste.
PEG 3350 is approved for treatment of constipation in adults for up to 7 days. Approval is based on studies available at the time a medicine is approved. Many commonly used medications are not specifically FDA approved for use in children less than 16 years due to difficulties and expense in testing drugs on minors.
How do we know it works?
There have been several studies in children and the collective experience of pediatricians around the world showing improved tolerability over other treatments for constipation because PEG 3350 has no taste, odor, or texture.
It has been shown to be either as effective or more effective than other constipation treatments. See the links to these studies above. Until children can keep stools soft with adequate amounts of water, fruits, vegetables, and fiber, long term use of PEG is well tolerated.
How long can PEG be used in children?
This is a very difficult thing to study because the longer a study follows their subjects, the more subjects are lost to follow up.
There have been studies of up to 30 months that showed safe use. Blood electrolytes, liver and kidney tests were all reassuring that PEG is safe during the study.
Pediatric gastroenterologists and general pediatricians have often recommended even longer periods of time without any known side effects.
If my child has taken PEG 3350, should I worry?
I cannot stress enough that the studies that have been done all support the safety and efficacy of PEG 3350.
After years of experience using PEG 3350 with many children, I have not seen any neurologic or behavioral problems caused by PEG 3350. I do see many kids with baseline neurologic and behavioral problems become constipated, so they often end up on PEG 3350, but if the issue is carefully assessed, the problems start prior to the treatment.
Generally if the stools are softer, you can more easily work with the behavioral issues that cause the constipation, such as loss of appetite/poor diet and failure to sit on the toilet long enough to empty the stool from the rectum.
If you decide it is time to stop the medicine, be sure to discuss this with your child’s doctor to keep them in the loop about how things are going!
It happens all the time. Kids put things in their mouth that aren’t supposed to be eaten. Parents often call after their child swallowed a toy piece, a coin, and many other things. Most of the time things will just pass — though I’m not a fan of watching the stools for the swallowed object because it just worries parents if they miss it.
Who swallows non-food things?
The biggest risk group is children between the ages of 6 months and 6 years, but anyone can be at risk.
I have seen an older school aged child swallow a magnet after putting 2 small strong magnets on either side of their tongue to look like a tongue piercing.
Even adults have been known to swallow things such as needles – sewers put the needle in their mouth if you think about it.
If you are around kids it is a good idea to know child CPR and refresh your skills every couple years.
Classes are often held at local Red Cross stations, hospitals, or fire departments.
You can also find classes by searching “CPR” and your zip code.
Know warning signs
For great information on signs and symptoms of choking and general treatment of choking, visit this KidsHealth Choking link.
Of course, prevention is key
Store medicines and cleaning products where kids can’t reach them.
Be especially alert when visiting other people’s homes – especially if they don’t have young children.
Watch kids carefully when outside.
Throw away broken toys that could have pieces break off.
Keep young kids away from toys designed for older kids.
When to talk to your pediatrician
If your child seems to put more non-food items in his mouth than other kids, he is at risk of pica.
Pica is when a person compulsively puts non-foods in his mouth. For more see the KidsHealth Pica link.
Poison Control Number – use it!
Always keep the poison control number (1-800-222-1222) stored in all your phones!
If you call me about a potentially toxic substance, chances are I will refer to poison control. They have the best database of substance risks and their treatments.
Don’t delay treatment by calling the doctor!
Things kids swallow and what to do:
Balloons are statistically some of the most inhaled or ingested foreign bodies.
One reason is they are so popular with kids. Young kids often will try to bite them.
They often are found at parties or other large crowds, where toddlers and young children are often less directly supervised.
Balloons can suffocate a child quickly if they are inhaled.
Call 911 if there is any difficulty breathing, drooling, or other signs of distress. This can mean the balloon was inhaled into the lungs, not swallowed.
If swallowed, they will pass on their own.
Keep balloons away from young children and supervise school aged kids when around balloons.
If you think your child has swallowed a battery, whether or not he appears distressed, immediately take him to an emergency room.
If there is distress, call 911.
Batteries can cause voltage burns or leak, causing acidic burns as soon as four hours after being swallowed.
X-rays will confirm if the battery is in the chest or abdomen.
Batteries usually need to be removed to prevent serious injury.
Be sure to keep all of your batteries, especially the small button batteries, safely stored away from children.
Make sure battery-charged items have the battery securely secured. Most now have covers secured with screws. If the cover is easily removed, your child is at risk!
Most of us has swallowed a bug some time in our life. You might not even know if a small one hides in your soda can and you take a big gulp.
A little extra protein, right?
Unless your child chokes, or if it has a stinger (bee, wasp) there is nothing to worry about.
If you suspect a bee or wasp was swallowed, especially if your child seems to be reacting to a sting in the mouth, or there’s sudden difficulty breathing, drooling, or choking, call 911. Serious reactions to stings in the mouth can occur.
Watch kids closely when outside, especially those under 3 years of age or kids who are known to put things in their mouth.
Buttons are generally harmless unless they get stuck or inhaled rather than swallowed.
Signs of breathing difficulty, choking, drooling, or generalized distress should alert you to bring your child to be evaluated.
Buttons are not easily seen on X-ray, which can make identification of a stuck button a little tricky, but if you suspect an issue, talk to your doctor.
Keep unattached buttons (the ones in your sewing kit) stored away from kids.
Monitor your children’s clothing and repair any loose buttons.
Cinnamon is technically a food, but the cinnamon challenge is leading kids and teens to take a spoonful, which can be very dangerous.
The challenge involves something along the lines of swallowing a tablespoon of cinnamon without water.
Ingestion of the cinnamon powder stimulates the gag reflex followed by inhalation of the powder. This causes excruciating pain due to the chemical properties of cinnamon.
It can also trigger airway narrowing and an asthma attack.
And there’s more.
Cinnamon is powdered bark. The cellulose matrix of tree bark acts like a sustained release medicine, slowly releasing a painful and damaging chemical in the lungs.
The body cannot metabolize cellulose. When it’s eaten, it gets passed into the toilet. But if it’s inhaled, our lungs can’t metabolize it.
On the surface many things seem just silly and not really dangerous. But unless they know all the risks and consequences and know it is safe, they shouldn’t do the challenge.
Don’t limit this talk to just cinnamon. Use it as an example, but we never know what the next crazy challenge will be – the next category includes a more recent challenge.
Cleaning products, laundry detergent, and other chemicals:
These are highly dangerous and you should call poison control with any suspicion of ingestion. 1-800-222-1222
Call 911 if there are signs of distress.
Cleaning products should always be stored away from children to prevent the possibility of swallowing in the first place.
Even the “green” products are usually not safe with ingestion.
And it’s not just toddlers… for whatever reason teens swallowing laundry pods has become a “thing” – talk to your teens about the risks. See the cinnamon challenge information above.
Coins are some of the most frequently swallowed objects.
These usually pass through the body without any problems, but many parents never see it come out the other end.
Since it is so common you would think there would be a consensus as to how to manage it.
When there’s distress
Of course if there is any distress, drooling, breathing difficulty or coughing, your child should be seen immediately, ideally in an ER so that an immediate surgical consult can be made if necessary.
If it was inhaled into the windpipe instead of swallowed into the esophagus or stuck high in the esophagus causing compression on the wind pipe, it may need to be removed.
When there’s no distress
As for kids who swallow coins and have no symptoms, it isn’t as clear cut what to do.
Some doctors get X-rays for all children who swallow a coin to be sure it isn’t stuck in the esophagus. About a third of those stuck eventually end up passing, but most need to be removed.
Some physicians only obtain an X-ray if there are symptoms.
Some physicians remove the ones in the esophagus immediately, others will wait up to 48 hours if there is no distress.
Generally once it reaches the stomach it will pass.
Keep coins out of the hands of kids under 3 years old, and supervise young children closely with them.
Remind kids to never put them in their mouth. Not only for the small choking risk, but eeewww… coins have been handled by many and are full of germs!
Crayons or play doh:
I used to wonder why so many things were labeled “non-toxic” — at least until I had a child of my own.
They put everything in their mouth!
These are generally safe (again, unless they choke), although it is possible that these things contain lead or other contaminants.
As with everything, supervise young children when they’re playing.
If your child frequently puts them in the mouth, it’s probably a good idea to not allow your child to play with them unless you’re consistently watching them.
Talk to your doctor about pica if they continue to put non-food items in their mouth after 3 years of age.
Dirt or rocks:
Unless your baby chokes or bites down on a rock and breaks a tooth, dirt and rocks are generally harmless.
Supervise young children when playing outside.
If your child seems to crave these and eats dirt compulsively, be sure to talk to your doctor about pica.
Energy drinks are a popular choice for many, but they contain caffeine and other stimulants that can make them dangerous for children.
Many adults drink caffeine in various forms, so mistakenly think energy drinks are safe. Learn the risks!
Risks from energy drinks
They can lead to dehydration because caffeine is a diuretic.
Energy drinks also can increase heart rate and blood pressure.
They can increase shakiness, anxiety, insomnia, and headaches.
Routine energy drink consumption has been shown to increase the risk of obesity and Type 2 Diabetes, due to the high sugar content.
People build a tolerance to caffeine, leading to increased consumption over time.
Teens are more likely to take dangerous risks when high on caffeine. This could result in injury or legal trouble.
Ingredients in energy drinks can interact with other medications one is taking.
Call poison control if you suspect problems from energy drinks
If you drink energy drinks, keep them away from your children.
Talk to teens about the risks of energy drinks. There are deaths reported in teens who drink energy drinks and then participate in sports or alternate alcohol with energy drinks.
Grass or plants:
Unless the grass was recently chemically treated or if the plant is poisonous, there is little to worry about here.
If you’re unsure about a plant being poisonous, contact poison control.
If there is choking, do CPR and call 911.
Contrary to popular belief, the occasional swallowed gum does not stay in your gut for years.
It isn’t digested like other foods, but unless it gets stuck along the way, it finds its way out just like all your other food.
Hand sanitizer in small amounts, such as putting fingers in the mouth after rubbing sanitizer on the hands, is generally safe.
Larger amounts can be dangerous and you should call poison control if you suspect ingestion.
Keep hand sanitizer away from young children and talk to school aged kids about risks.
Be alert of the sanitizer hanging from your diaper bag or purse!
A single magnet is not a worrisome as multiple magnets, but since it often is not known exactly what a child swallows, it is always recommended to take your child to be evaluated if there is a suspicion of swallowed magnets.
They will need X-rays and if there are multiple magnets, they must be removed to prevent perforation of the gut.
Keep all magnets away from young children.
Talk to older kids about the risk of swallowed magnets and be sure they understand that they can never put one near their mouth!
Medicines, vitamins, supplements
If your child swallowed (or potentially swallowed) a medication or supplement, call the poison control number ASAP.
Have the bottle with you so you can answer their questions.
Make sure medicines and other pills are kept away from kids.
Talk to Grandma about either removing them from her purse or putting her purse out of reach when she’s visiting.
Some kids never leave their parent’s side when out and about, but others wander without concern and are at risk of getting lost. I’ve had one of each, so I know first hand how scary it is to have a wanderer. Many parents worry that their kids will be abducted, but the large majority of lost kids leave on their own accord. Usually there’s no foul play and they can be found relatively quickly (though it seems like an eternity for a worried parent). What can you do to keep kids from wandering and getting lost?
Many times that parents realize their kids are missing, the child hasn’t made the same realization. Parents might be scared to death, but the child is fine – they are often enjoying an adventure and completely unaware of the problem.
Why do they wander?
Distraction and fun
Most of the time they have no clue what they’re doing, especially if they’re too young to really comprehend rules. They aren’t afraid if they’re focused on something else, which can be anything that gets their attention.
It doesn’t take much to get a child’s attention, especially if you’re at a new place. The new place is also riskier because if they do get separated, they don’t know where they are or where to go for help.
Sometimes kids just want to do something fun because they’re bored. How many kids decide to play hide and seek while shopping? I’ve seen many crawl under clothing racks…
Small children can dart between people in large groups, making it hard to keep up with them without pushing and shoving others out of the way. They don’t realize when they’re focused on something that you’re not right there. Despite saying “excuse me,” I felt inconsiderate plowing through crowds to keep sight on my runner. (She was more than a wanderer…)
Parents get distracted too
Maybe you’re comparison shopping to decide which brand to buy. At some point you have to pay and talk to the cashier.
When your phone buzzes, it’s easy to answer a quick text. Studies show many parents spend a lot of time on their phones when they’re with their kids.
If you hear another child’s cry, do you look in their direction to be sure they’re okay?
And if you have more than one child, you can only really watch one at a time…
It only takes a second to look away from your own child for them to bolt and disappear.
A kid’s view
Kids don’t worry about wandering and getting lost. They get bored or get distracted.
I know one child who was lost at his brother’s sporting event. He decided he was tired and wanted to lay down, so he made it to the family vehicle and took a nap inside.
It all made sense to him, and he didn’t understand why all the parents (it was his brother’s game, so the whole team was looking for him) were upset.
We recognize that a small child roaming through a parking lot is dangerous, but he thought it was reasonable to nap in his familiar seat. He figured his parents would go to the car at the end of the game and find him.
Kids don’t think like adults. We need to talk to them about rules.
“Stranger danger” has a nice ring to it. It’s catchy to say. It’s commonly taught to kids.
But it isn’t effective or safe.
The large majority of strangers are good people. If a child is lost, they shouldn’t feel afraid to talk to the right stranger. I’ve heard of kids refusing to talk to caring adults, which delays reuniting them with their families.
The large majority of abducted (and abused) kids are victims of people they know – not strangers.
talk to kids about boundaries & rules
Kids should never be alone with an adult other than the “safe” people you’ve identified with them. This helps to protect them from predators they know.
They should know to never leave with a person unless that person knows a code word. Even if that person knows their name (it’s easy to listen and learn a kid’s name, or it might even be printed on their shirt or backpack) they shouldn’t leave with that person unless it was pre-arranged or they know a special code you’ve discussed.
All kids who are potty trained should know that there are places on their body that are private. Private mean no one should look or touch there unless you’ve given permission for that person. Permission should be given if they need help toileting (including wiping), bathing, or when it’s part of a medical check up. These private places include anything a swimsuit or underwear would cover.
See the bottom of the blog for resources on talking to kids about these big topics!
7 Ways to Keep Kids from Getting Lost
Preparation is key!
Talk to your kids about what they should do if they are separated from you.
A lot will depend on their age, maturity level and where you’re going.
If you know the place you’re going has a lot of distractions and crowds, such as an amusement park, you will need to plan differently than if you will be in a neighborhood park that is familiar or a family gathering where they know lots of people.
When you’re out and about, it goes without saying that someone needs to be responsible for watching the kids.
This is especially true if you’re going with a group. Sometimes there are so many adults, it’s easy to think someone else is watching a child, but no one is. Make it clear who is responsible for watching each child.
If there are a lot of kids for each adult to watch, have the kids pair up with a buddy. They should not leave their buddy. Schools use this system for field trips and it helps keeps track of the kids.
Remind kids that they should never be alone with an adult, even one they know, unless it’s one of their safe adults. (A safe adult is someone you trust wholeheartedly.) There’s safety in numbers!
For your own safety and to avoid mistaken intentions, never be alone with a child who is not your own unless you have permission from their parent. Having two adults around in restrooms and other private areas is especially important!
2. Give kids identifying information
Until kids are old enough to know your phone number (and be able to tell it clearly to a stranger), have them carry it around in some manner. They should know that they can pull it out when needed.
You can make a bracelet with your number. Get number beads from a craft store and kids can help string them!
Put contact information on dog tags so they can wear it as a necklace. Even boys think this is pretty cool.
There are places to make customized temporary tattoos, or you can just use a permanent marker. This isn’t my first choice, but in a pinch, we all have markers.
3. Be ready to identify
I’m that parent who didn’t remember what I dressed my kids in most days. If they were appropriately dressed for the weather, I didn’t really care. But it does matter if you’re looking for a lost child.
If a child is lost and you’re stressed, it’s especially hard to recall what they were wearing.
In today’s world of everyone carrying a phone with photo capabilities, it’s easy to snap a picture.
Take a picture of your child before going to crowded areas. This photo will not only be recent, but will also show what clothing your child has on, which makes it easier to find your child.
4. Be prepared for boredom, hunger, and fatigue
When kids are tired, sick, hungry, or bored, they’re more likely to act up or try to make it fun.
Plan the trip around nap times as much as possible. Bring a stroller to let a tired child rest if needed.
Ideally we’d all stay home when sick. Bringing kids to public areas when they’re sick spreads germs.
If they will normally eat during the time of the outing, bring along something to eat.
Make sure the snacks are not going to leave a mess.
Don’t include nut products, since leaving residues around a public place could be life threatening to another child. (There are many other food allergies, so ideally you will wash their hands and wipe surfaces after any foods.)
When you know the places you are going are not kid-friendly, try to make it into a game or at least get the kids involved.
The grocery store can be a place to talk to kids about choosing healthy foods. You can do simple math with them by figuring out how many apples you need for the family for the week or by choosing the better deal among differently sized packages.
If you know the kids will have to stay in one place for a while, such as waiting at the DMV, bring books, small toys or games to keep them occupied.
Practice with your kids what they can do if they’re separated. Their risks and abilities change as they get older, so you need to continue the conversation and adapt the plan over the years.
I sometimes would covertly watch my daughter when she ran ahead to see how long it took her to realize I wasn’t right behind her. I wanted to see what she would do when she did figure it out. By preschool she was a pro and knew what to do. She would yell my name or ask another child for help, but at least she stopped where she was and didn’t continue to run further away.
Adults look, kids stay put
I always suggest teaching kids to stay put if they realize they’re lost, unless they’re not in a safe place. If they’re in a street or other unsafe place, they should go to the closest safe location.
Kids should NEVER leave the building or area to look for you. You can teach older kids to go to the front of the store (or find a person in the uniform of the place you are) when you think they’re capable of doing this. Younger kids should just stay put.
Remind them that you will always look for them, and if they stay in one place it’s easier to find them. If they keep moving, they might go to a place you’ve already looked but left, so you won’t find them.
Remind them that it’s okay to yell for you by name or whatever they usually call you, even if they’re in a place that’s usually quiet.
When lost, it’s okay to ask for help. This is why I don’t want kids to be taught stranger danger.
They should know that if an adult approaches them when they’re not lost, they should be cautious. If they’re at a park and an adult asks for a child’s help looking for their dog, that’s not right. Adults can ask other adults for help. They shouldn’t ask kids for help.
If an adult is offering to help when a child is lost, usually that’s okay. Yes, it’s possible that they’re taking advantage of the situation, but how likely would it be that a person of that caliber would be right there when your child is lost? Most people are good.
Kids should be told to give your phone number to a person who’s trying to help. It’s okay to give their name to a person who works at the place you are visiting. It’s confusing because kids are taught to not give their name and personal information to strangers, but it can help find parents names are shared.
Kids should be taught that they should not leave the area, especially with a strange adult. It’s okay if they help the child find the front of the store or a worker, but they should NOT take the child outside the building or park.
Ask another child for help
That child can then ask the adult they’re with to help your child.
Kids are generally safer to talk to and not as threatening to a child who’s already scared.
The other adult can call your phone if your child knows or is wearing your number. (Pay attention to your phone when looking for your child and answer calls from unknown callers!)
Ask a worker for help
Kids can also look for people wearing the uniform or nametag representing the place you are.
Point out what people wear when working at the location you’re visiting. Whatever it is, be sure your child knows what to look for.
We used to stop at the front of the store routinely so my daughter could be reminded what the cashiers wore. She could talk to someone with that uniform if she was lost.
6. Meeting place
Elementary school aged kids can learn where to meet you if they get separated when they show enough maturity and confidence.
Point out a customer service desk, a landmark at a park, or an easily found place where you are going. You can both go there if you get separated.
By middle school many kids like to be able to shop or play at a park with friends. If your child displays the maturity to do this, then it’s a great way for them to develop independence. Be sure that they know a time and place to meet and how to contact you if they need you before that time.
I know “restraints” sounds so negative, but think about it.
It’s for safety, not punishment.
We restrain kids in the car because we know it can help to save their lives.
Not only can toddlers and preschoolers wander and get lost, but they can easily get injured when they’re not supervised.
Shopping carts and strollers
If your toddler or preschooler runs around, he’s not safe. If you strap him into a shopping cart or stroller, they’re safer.
Be sure to use the straps appropriately. They can keep kids from climbing or sliding out.
Our stroller just had a lap belt. The newer ones with shoulder straps would have prevented the time my daughter jimmied out of the lap belt and onto the concrete head first. I was pushing her in the stroller, trying to keep up with my son who was running ahead. I was unaware she was climbing out because I had my eyes on my son. She had quite the goose egg!
I also have become a fan of leashes for young kids. I know many people think they’re cruel and only appropriate for animals, but I have had great experiences with them.
As mentioned above, my daughter was a runner. I lost her more times than I want to admit. She hated being strapped in a stroller – as I shared above. Of course she often refused to hold hands because she wanted freedom. Family outings that should have been fun quickly became miserable.
When I first got the leash my husband was horrified.
My kids loved it.
It was a cute monkey backpack with a leash. They loved taking each other for walks around the house and even fought about who would wear it. Since it was a backpack, they could carry favorite toys inside.
In public areas my daughter would wear it happily. When my husband saw how my daughter was so much happier having “freedom” while being leashed to us in public, he was sold on the idea.
Warning: if you use one, be ready for judging looks. That’s okay. If they have a runner, they’ll understand. If not, they have no idea.
Leash and book suggestions
I’m an Amazon Associates Member. I do get a small amount of money if you purchase from the following links, but there is no increased cost to you. As always, I only link to products that I recommend regardless of where you purchase them.
These wristband harnesses are great because they allow roaming while being safe, but do not look as much like a leash. There are two sizes, which can allow a child to go a bit farther than many of the backpack styles. It’s basically like holding hands from a distance!
I suspect you’d get fewer evil looks from strangers by using the wristband, but young kids might actually prefer the backpack styles because they’re cute and they can carry “stuff” in them.
I like these because they’re insulated for food storage in addition to having a strap for safety.
Going to Disney? I can see these popular there and for any Disney fan. I lost my 3 year old briefly several times on one Disney trip…
This monkey is similar to the one my kids loved. They’re also backpacks, so they can store a few of their favorite things inside. There are many cute designs.
Concussions are relatively common. Fortunately there have been campaigns to increase awareness, so more kids are being properly identified. There are still many myths related to concussion that need to be clarified.
Common myths and misinformation about concussions:
1. A normal head CT means no concussion and a full return to play is okay.
Concussions are not diagnosed by CT. Brain bleeds and masses can be seen on CT, but the damage done to the brain during a concussion is not seen on a CT.
Concussions are diagnosed based on symptoms, such as headache, confusion, lack of coordination, memory loss, nausea, vomiting, dizziness, ringing in the ears, sleepiness, and excessive fatigue. Not all symptoms need to be present to make the diagnosis. Some symptoms develop over time and are not present at the time of injury.
A CT scan is usually not needed with head injuries. They involve radiation so are not without risk themselves. Unless there are signs of a possible bleed in the brain, skull fracture, or the type of injury suggests the need for a CT, a CT scan is not needed in the evaluation for concussion.
2. A minor hit to the head never causes concussions.
The force of a hit does not determine the severity of the injury.
It’s actually the force of the head moving back and forth, not an actual hit, that leads to changes in brain cells and chemical changes in the brain. A jolt to the body can also cause a concussion if the impact is strong enough to cause the head to forcefully move.
Some people with more significant problems initially also seem to heal more quickly than others with more mild injury.
It is very hard to predict how long it will be until all symptoms are resolved.
The most important thing is that if you have symptoms of a concussion, your brain needs rest and you should be seen by a doctor who is up to date on current treatment protocols for concussions.
3. After two weeks you can return to play without further testing.
Sadly I’ve had more than one patient who was given this advice from a medical professional, whether on the sideline at a game or in an emergency room or urgent care.
Although most concussions resolve within 2 weeks, not all do and returning to play before the brain is healed can lead to a more serious condition called “second impact syndrome.” Second impact syndrome is a very rare condition in which a second concussion occurs before a first concussion has properly healed, causing rapid and severe brain swelling and often catastrophic results, including death.
After a concussion clearance to return to play should only happen when the child, teen, or adult is re-examined and found to be symptom free.
Returning to play is done in a stepwise fashion, with each step lasting at least one day and only progressing to the next step if symptoms don’t resume. This starts with light exercise when there are no symptoms at rest, then progresses to moderate activity followed by heavy activity without contact, then full practice with contact (if the sport is a contact sport) and finally full competitive play if each step can be done without return of symptoms. If symptoms return, you back up to lighter activity.
Returning to play too quickly can prolong healing time and even lead to long term consequences.
Do not return to any activity that causes symptoms to worsen!
4. If a coach doesn’t recognize the concussion, it’s minor enough to return to play.
Coaches cannot see everything that happens on a field. If you had a head injury, tell your coach.
Even if you’re the star player.
You will do your team a favor if you take time to heal and can play again versus stay in the game and get more severely injured and are then out for good.
If there is any chance of concussion, you should not return to play at all that day or until you are cleared by a doctor who understands concussions.
5. IMPACT testing is necessary.
IMPACT testing is a computerized test that measures neurocognitive functioning.
Neurocognitive testing can be done with other testing methods, but IMPACT testing is a specific computerized program.
If a neurocognitive baseline is done at least every 2 years, it can be compared to the same test after a concussion to check on status. Testing should only be done by a professional trained to perform and interpret the test.
Neurocognitive testing is one tool to help manage concussions and determine when it is safe to return to play, but at this time concussions are diagnosed based on symptoms and physical exam, not this testing.
6. Complete bed rest until all symptoms are gone is best.
Social media has allowed the sharing of misinformation about many things, especially medically related things. When the specifics of something are unknown to a person, pretty much anything that’s said can sound reasonable, so people believe what they hear. This happens with many things, such as vaccine risks, chelation, and vitamin K. I want to tackle 7 Vitamin K Myths.
Refusing Vitamin K
I am especially frustrated when parents refuse to give their newborns vitamin K after birth. Since 1961, the American Academy of Pediatrics has recommended giving every newborn a single shot of vitamin K given at birth.This is a life saving treatment to prevent bleeding.
Vitamin K works to help our blood clot. Insufficient levels can lead to bleeding in the brain or other vital organs. Vitamin K deficiency bleeding or VKDB, can occur any time in the first 6 months of life. There are three types of VKDB, based on the age of the baby when the bleeding problems start: early, classical and late. Unfortunately there are usually no warning signs that a baby will have significant bleeding, so when the bleeding happens, it’s too late to do anything about it. Why parents don’t want to give this preventative life saving treatment is usually based on incorrect information.
This is a matter of a fairly low risk of bleeding if you don’t give vitamin K: 250-1700 per 100,000 within the first week, and 4-7 per 100,000 between 2 and 12 weeks. You might notice that the number is variable – it’s hard to study since the large majority of babies have gotten vitamin K over the years and the risk is low even without vitamin K. However, when there is bleeding it has significant consequences: lifelong disability or death. And we also know that there’s very low risk from the vitamin K and it works very well to prevent bleeding. So why take the chance of not giving it?
Conspiracy Theories, Misunderstandings, and Science
This is not a governmental conspiracy to somehow kill children. It’s a world wide attempt to help children survive and thrive.
All newborns should be given 1 mg of vitamin K intramuscularly [IM] after birth [after the first hour during which the infant should be in skin-to-skin contact with the mother and breastfeeding should be initiated]. (Strong recommendation, moderate quality evidence)
Science is hard to understand
Most people look at scientific information and can’t make heads or tails of what it means.
That coupled with the fact that things we read that make us react emotionally (such as fear that something will harm our child) makes us remember and associate with the information that created the emotion, whether it is right or wrong. This can lead parents to make dangerous decisions for their children while trying to do the right thing.
I’m going to attempt to de-bunk the most common concerns I’ve heard because the best way to combat misinformation is to help explain the facts as we know them.
1. If every baby’s born with too little vitamin K, that’s the way we’re supposed to be.
Babies are born with very little vitamin K in their body. If they don’t get it with a shot, they need to either eat it or make it. Breast milk has very little vitamin K and babies won’t be eating leafy greens for quite awhile. Formula does have it, but it takes several days for vitamin K to rise to protective levels with formula and the highest risk of bleeding is during that first week of life. (Of course if you’re using this argument because you want babies to be all natural, you probably won’t be giving formula at this point.)
Bacteria help us make vitamin K, but babies aren’t colonized at birth with these gut bacteria.
Just because they’re born that way doesn’t mean they’re supposed to stay that way. Inside the mother the baby is in a very different situation. They don’t breathe air. A fetus doesn’t eat. They don’t have gut bacteria. Their heart has a bypass tract to avoid pumping blood to the lungs. This all works well in utero, but must change once they leave the womb. Change takes time, and during this time they are at risk. Why not minimize the risk if we know a safe way to do it?
2. The package insert has a big warning at the top that it can kill.
There are many reasons why we should not use the package insert of a medicine or vaccine to make healthcare decisions. These have been discussed before so I won’t go into all the details but please see these great blogs on how to read and use package inserts:
Reactions to IV (intravenous) vitamin K are much more common than IM (intramuscular) injections. The difference is anything given by IV goes directly into the bloodstream and back to the heart. But we don’t give vitamin K by IV to newborns.
IM injections go into the muscle, allowing very slow absorption of the medicine. This not only decreases reactions to the injected vitamin, but also helps the level of vitamin K stay elevated for a prolonged time after a single injection.
Many years ago there was a small study that suggested vitamin K led to childhood cancers. This issue has been extensively studied since then and no link has been found.
Vitamin K does not cause cancer.
Rates of cancer have not increased in the years since vitamin K has been given to the large majority of newborns worldwide. This is reported in the Vitamin K Ad Hoc Task Force of the American Academy of Pediatrics report Controversies Concerning Vitamin K and the Newborn.
4. Bleeding from vitamin K deficiency is rare or mild.
In the US bleeding from vitamin K deficiency is rare because most babies get the vitamin K shot soon after birth. In countries where vitamin K is not used routinely, bleeding is not rare at all. Some communities of the US where vitamin K is being refused by parents are seeing an increase in newborn bleeding.
Early VKDB occurs within 24 hours of birth and is almost exclusively seen in infants of mothers taking drugs which inhibit vitamin K. These drugs include anticonvulsants, anti-tuberculosis drugs, some antibiotics (cephalosporins) and blood thinners to prevent clots. Early VKDB is typically severe bleeding in the brain or gut.
Classic VKDB typically occurs during the first week of life. The incidence of classic VKDB ranges from 0.25-1.7 cases per 100 births.
Late onset VKDB occurs between 2 and 12 weeks usually, but is possible up to 6 months after birth. Late VKDB has fallen from 4.4-7.2 cases per 100,000 births to 1.4-6.4 cases per 100,000 births in reports from Asia and Europe after routine prophylaxis was started.
One out of five babies with VKDB dies.
Of the infants who have late VKDB, about half have bleeding into their brains, which can lead to permanent brain damage if they survive. Others bleed in their stomach or intestines, or other vital organs. Many need blood transfusions or surgeries to help correct the problems from the bleeding.
5. It’s just as good to use oral vitamin K.
Early onset VKDB is prevented well with the oral vitamin K in countries that have oral vitamin K available, but late onset VKDB is an issue.
Children with liver or gall bladder problems will not absorb oral vitamin K well. These problems might be undiagnosed early in life, putting these kids at risk for VKDB if they are on an oral vitamin K regimen.
Getting the oral form isn’t easy
There is no liquid form of vitamin K that is proven to be effective for babies in the US.
That is a huge issue.
Some families will order vitamin K online, but it’s not guaranteed to be safe or even what it claims to be. This is an unregulated industry. It is possible to use the vitamin K solution that is typically given intramuscularly by mouth, but this requires a prescription and the taste is questionable, so baby might not take the full dose.
It would be an off-label use so physicians might not feel comfortable writing a prescription. The other issue that might worry physicians is with compliance in remembering to give the oral vitamin K as directed, since most studies include babies with late onset bleeding who had missed doses.
Vitamin K in food
Most of us get vitamin K from gut bacteria and eating leafy green vegetables.
Newborns don’t have the gut bacteria established yet so they won’t make any vitamin K themselves. They may get vitamin K through their diet, but breastmilk is very low in vitamin K. Unless baby is getting formula, they will not get enough vitamin K without a supplement.
It is possible for mothers who breastfeed to increase their vitamin K intake to increase the amount in breast milk, but not to sufficient levels to protect the baby without additional vitamin K.
What do other countries do?
Many countries that have used an oral vitamin K protocol, such as Denmark and Holland, have changed to an intramuscular regimen because the oral vitamin K that was previously used became no longer available.
Australia and Germany: 3 oral doses of 1 mg vitamin K are less effective than a single IM vitamin K dose. (In 1994 Australia changed to a single IM dose and their rate went to zero after the change.)
Netherlands: A 1mg oral dose after birth followed by a daily oral dose of 25 mcg vitamin K1 may be as effective as parenteral vitamin K prophylaxis.
Sweden: (a later study) 2 mg of mixed micellar VK given orally at birth, 4 days, and 1 month has a failure rate of one case of early and four cases of late VKDB out of 458,184 babies. Of the failures, 4 had an undiagnosed liver issue, one baby’s parents forgot the last dose.
Oral Vitamin K vs injectable (IM) Vitamin K
When vitamin K is given IM, the chance of late VKDB is near zero.
Oral vitamin K simply doesn’t prevent both early and late bleeding as well. This is especially true if there is an unknown malabsorption disorder, regardless of which dosing regimen is used.
6. My baby’s birth was not traumatic, so he doesn’t need the vitamin K.
Birth trauma can certainly lead to bleeding, but the absence of trauma does not exclude it.
Late vitamin K deficient bleeding (VKDB) cannot be explained by any birth traumas since they can occur months later.
7. We’re delaying cord clamping to help prevent anemia and bleeding. Isn’t that enough?
Delayed cord clamping can have benefits, but decreasing the risk of bleeding is not one of them.
There is very little vitamin K in the placenta or newborn. Delaying the cord clamping cannot allow more vitamin K into the baby.
Still not convinced?
Read stories about babies whose parents chose to not give vitamin K: