Keeping kids safe

The nurses, pharmacists and doctors who staff the 24-hour Poison Control Center (PCC) hotline at Children’s Hospital of Philadelphia handle many calls from parents with small children who have ingested or been exposed to potentially dangerous substances in the home. Poisonings can cause injury and even death. Some basic lessons can help teach kids to avoid poisonings.

This manual, written by the Poison Control Center team, includes lesson ideas and activity sheets for preschool and elementary school students. Our goal is to make it second nature for kids to think twice before eating or drinking substances around the home, garage and yard, and to always ask their parents or another adult first. The Poison Control Center team cares about the safety of every child. We hope you find this manual useful in helping to keep your students safe.

What is the Poison Control Center?

The Poison Control Center was established in 1986 as an independent nonprofit organization. In 1993, the center became a division of Children’s Hospital of Philadelphia. The PCC serves the public and healthcare providers in the Pennsylvania counties of Berks, Bucks, Carbon, Chester, Columbia, Dauphin, Delaware, Lackawanna, Lancaster, Lebanon, Lehigh, Luzerne, Monroe, Montgomery, Northampton, Northumberland, Philadelphia, Pike, Schuylkill, Susquehanna, Wayne, Wyoming and York, and the three counties of the state of Delaware. The Center operates under the strict national standards of the American Association of Poison Control Centers and has been certified as a regional poison control center since 1987.

The Poison Control Center embraces six missions within its region:

• The provision of a 24-hour daily poison information public health hotline, free of charge.
• The provision of epidemic surveillance for health threats to the public.
• The provision of expert toxicology information to public health, governmental and news information agencies.
• The provision of poisoning prevention education to the public.
• The provision of poisoning prevention, evaluation and treatment education to healthcare professionals.
• The provision of medical toxicology consultation to healthcare providers treating poisoned patients.

What happens when you call the Poison Control Center?

When you call the hotline, a registered nurse, pharmacist or physician who has specialized training in toxicology answers the phone. The specialist assesses the seriousness of the poisoning exposure based on the substance, time of exposure, the patient’s symptoms and the potential for early intervention. This information is needed for the specialist to provide the appropriate treatment recommendations.

We ask for your name and phone number so we can follow up by calling back to check on the patient. Follow-up is performed for each poisoning exposure that has resulted in symptoms or when there is the likelihood that the patient will become symptomatic. The staff uses a state-of-the-art information retrieval system called Poisindex that lists more than 600,000 household products, chemicals and medications, as well as other references.

The Poison Control Center responds to more than 200 calls a day. The majority originate in the home and are made by the parent or relative of a small child. The workplace is the second most common site of a poisoning exposure.

For parents: Calling the Poison Control Center

What to do in a poisoning emergency?

1. First of all, remain calm!
2. Do not give anything by mouth until you have spoken to the Poison Control Center.
3. Call the Poison Control Center (1-800-222-1222). The specialist will instruct you on how to handle the exposure. When you call, have the following information available:
   • Your name and phone number
   • Age of the poisoning victim
   • Name of the product involved in the poisoning
   • Amount involved
   • Time the poisoning occurred
   • Any symptoms the poisoning victim is experiencing
4. Follow the instructions given to you by the Poison Control Center.
5. DO NOT rely on antidotes or home remedies listed on first-aid charts or product labels. They may be out-of-date and may cause more damage than the poison you are trying to treat.

For parents: Keeping children safe from poisoning

Awareness is the key to preventing poisonings. The first step in preventing poisonings is the recognition that any item has the potential to poison when used inappropriately.

1. Clean out medicine cabinets and discard all outdated medications properly. Contact your poison control center for up-to-date guidance on how to safely dispose of medications.
2. Always read the product label before using the product.
3. Keep household products in their original container. Keep labels intact and readable. Never keep household products in cans, cups or soda/juice bottles.
4. Store products out of the reach of children and pets.
5. When called to the phone or door while using hazardous products, make sure that the child or product is taken with you.
6. Read and follow all label instructions for the proper use of each product. NOTE: First-aid treatment information on product labels is often inaccurate and outdated and may be dangerous. Always call the Poison Control Center at 1-800-222-1222 for up-to-date information.
7. Purchase medications and household products in child-resistant containers when possible.
8. Never take medicines in the dark. Always read the label before taking medication. Never take medicine that has not been prescribed for you.
9. Never refer to medicine as candy.
10. Label all indoor and outdoor plants with their botanical and common names. This will help determine what to do if a plant is eaten.
11. Teach children to seek permission from a parent or caregiver before eating or drinking anything.

Poisoning primer for educators

What is a poison?

A poison is any substance — solid, liquid or gas — that may injure or impair health, or even cause death when taken into the body or put onto the skin. Poisons come in all kinds of colors and shapes. Some are odorless and tasteless. Sometimes things that

smell or taste good may be poisonous. Almost any substance can become a poison when used inappropriately or in excessive amounts, particularly in small children.

Poisons are everywhere.

In most homes, poisons can be found in almost every room. (See “Potential poisons in the home” below.) Most children and many adults think of poisons as very deadly substances that are mysterious, quick-acting and impossible to trace. They rarely consider cigarettes, perfume, shampoo, plants, vitamins with iron, and many other common household products as poisons.

Labels can be misleading.

People tend to think anything sold over the counter must be safe. Others assume if a product is not labeled “poison” it must be harmless. Most product labels, but not all, contain adequate information concerning use, storage and potential hazards. However, many people do not read the label carefully or at all. Caution, warning, danger, flammable, corrosive, hazardous, fatal, caustic, harmful and poison are examples of signal words that alert the user to potential hazards.

Plants can be poisons.

Plants are a common cause of potential poisoning in children under 5. Houseplants, yard shrubs, wild berries, trees and mushrooms are all attractive to children. Children should be taught not to put twigs, grass, berries or mushrooms in their mouths.

There are many ways to be poisoned.

Children can be poisoned through:

• Ingestion — eating or drinking something toxic
• Absorption — splashing or spilling something on the skin or in the eye
• Inhalation — breathing dangerous or irritating fumes
• Injection — being bitten or stung by insects, snakes, spiders and even some types of fish

Potential poisons in the home

• Whole House: smoke (house fire), carbon monoxide (house fire or faulty furnace/chimney, hot water heater, gas oven, etc.)
• Bathroom: air freshener, antiseptics, aspirin, baby powder, deodorant, hair dye/perm, medicine, mouthwash rubbing alcohol, shampoo, tile cleaner, toilet bowl cleaner
• Bedroom: aftershave, cologne, cosmetics, medicine, nail polish, perfume
• Living room: cigarettes, flowers/plants, furniture polish, mothballs
• Garage/basement: antifreeze, charcoal lighter fluid, fertilizer, gasoline, kerosene, motor oil, paint thinner, pesticides, turpentine, windshield washer fluid
• Outside: berries/plants, garden supplies, mushrooms

Children: At risk for poisonings

Young children rarely understand that they could poison themselves. Small children, especially ages 1 to 5, are curious about the things around them, and have a great tendency to explore the world by putting everything in their mouth! To make matters worse, some poisonous substances look just like common foods or beverages, and may come in pretty packages that make children more attracted to them. For example, they may mistake the shiny crystals of a drain cleaner for candy, or pellets to kill insects or rodents as the funny-looking vitamins they take each day.

How do poisonings happen?

• Many poisonings happen as a result of children imitating their parents or caregivers. Children are great imitators; they want to gargle with mouthwash or put gasoline in the lawn mower, but they don’t understand that gasoline and even large amounts of mouthwash can hurt them.
• Improper storage of products is a frequent cause of poisoning in children (and even occasionally in adults). Many poisons are improperly stored where children can easily reach them, such as underneath the sink or on a table. It is dangerous to store products such as gasoline, furniture polish or cleansers in food containers.
• Improper use or combining products is another cause of poisoning. Mixing household products may create toxic fumes. The combination of bleach and ammonia creates a poisonous gas (chloramine gas) that can cause respirator y problems. The use of varnishes or paint strippers in poorly ventilated areas can cause headaches, nausea, vomiting and other serious conditions.
• Taking medicine without reading the label, increasing dosage or taking a friend’s medication can have very serious consequences. When taking medication, it is important to read the label in a well-lighted area. Many have been poisoned when they have ingested or administered medication in the dark and later discovered it was not the proper medication.
• Anything in a spray can should be considered a potential poison. It is important to check the position of the opening before spraying aerosols in order to avoid eye or skin injury. Many aerosols can cause damage to the delicate tissues of the eye.

When do poisonings occur?

Poisonings can happen to anyone at any time. Most poisonings occur when household products are in use. It is not uncommon for a parent to leave a poisonous product unattended while cleaning, after the doorbell or telephone rings. Remember, it only takes a minute for a child to get into a poisonous substance. Poisonings also occur in times of stress, such as during a household move, if there is an illness or death in the family, or during the holidays. Poisonings also occur before meals when youngsters are hungry and parents or caregivers are preoccupied.

Keeping kids safe: Educational interventions

An attempt can be made to teach young children to avoid poisons, especially those that sometimes look like things we eat or drink. Unfortunately, there is little firm evidence that preschool children can reliably learn to avoid dangerous substances, and so the primary responsibility for prevention and early recognition of childhood poisonings falls to parents and, perhaps, older siblings.

Still, we offer here some approaches that have been used by poison centers throughout the country to educate preschool children about this hazard. We have also provided similar exercises for older children who may have preschool-age siblings. Lastly, and perhaps most importantly, we provide materials to send home with each young child for their parents in an effort to take poison prevention education into every student’s home.

Teaching children about poisons

When teaching about poisons, emphasis should be placed on the concept that people cannot always tell a poison by the way it looks, smells or tastes because:

• Some things may look like candy, but they are medicine and can be poisonous. Explain how easy it is to mistake medications for candy because they may look much alike. (“Just because something looks good does not mean it is good to eat.”) Emphasize that while medicines administered by a parent or other trusted adult are obviously appropriate, taking them under any other circumstance is very dangerous.
• Even things that smell and taste good may have poison in them. Just because something smells or tastes good does not mean that it is good to eat or drink. Products such as scented lamp oils that look like soft drinks can poison when ingested and can even be harmful when spilled on the skin.
• There may be something other than a soft drink in the soda bottle or plastic milk carton. Children associate cups, soft drink bottles and drinking glasses with food and drink. Several serious poisonings have been reported when lighter fluid, intended for outdoor barbecue fires, has been poured into such containers and mistakenly swallowed by small children.

This information is also available in a downloadable format and includes activity sheets for school-aged children.