Use the correct medicine device for children, never a kitchen spoon

photo of kid getting medicine

© Wanchai Yoosumran | Dreamstime.com

A “spoonful of medicine” has long been the prescription for making sick children well. But “spoonful” is a highly inaccurate description and can lead to dangerous dosing errors when parents administer medicine to their children.

According to a study published in the Journal of Pediatrics, more than 40 percent of parents have made dosing errors and they are more than twice as likely to make mistakes when using teaspoon or tablespoon measures than when using millimeter measurements. The rate of potentially dangerous outpatient medication errors for children is three times that of adults due to the complexity of weight-based dosing, inaccurate measuring devices, incomplete instructions and inadequate education for care givers about the medication.

It’s difficult for parents when pharmacies put a teaspoon measurement on the package, but then supply an oral dosing syringe that’s marked in milliliters. Parents have to do a complicated math conversion that must also take their child’s weight into consideration. Because pharmaceutical companies base their dosing on weight (mg/kg), the dosage for each child will be different. The physician or pharmacist needs to calculate the correct dose and then educate parents or other care givers on how many milliliters to give to the patient.

It is also very important for parents to use the correct dosing device: an oral syringe, dropper or dosing spoon. Kitchen spoons come in many sizes and shapes and are not accurate for dosing medications. Their use should be discouraged by doctors and pharmacies.

In addition to correct dosing, there are a number of other things parents need to consider in order to safely administer their children’s medicines at home:

  • What time should the medicine be given? How often and for how long?
  • How should the medicine be administered: by mouth; inhaled; inserted into ears, eyes or rectum; or applied to the skin?
  • Should the medicine be taken with or without food?
  • How and at what temperature should the medicine be stored?
  • What are common side effects or allergic reactions?
  • Are there interactions with other medications your child may be taking?
  • What happens if your child misses a dose?
  • Do your doctor and pharmacist have your child’s correct current weight?

Remember that kids are not just miniature adults and are often more sensitive than adults to certain drugs. Getting the dose even slightly wrong can lead to serious problems. If unsure of dosing instructions, parents should always check with their pharmacist or their pediatrician!

Masoomeh Khamesian, Pharm. D. is the director of pharmacy for Howard County General Hospital. She is also a mother of two children and three step children.

 


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Six clues to observe in your child if he takes in too much water

secondary drowning photo

It’s every parent’s worst nightmare. One second your toddler is happily swimming in the backyard or neighborhood swimming pool. You look away for a few seconds and, when you turn back to the pool, he is struggling under water and then gasping at the surface for air. You get him out of the water immediately and, after a few minutes, hours or even up to two days, he seems no worse for his frightening experience. But suddenly he starts to have strange symptoms that require an emergency hospital visit.

A swimmer may inhale a lot of water or take in a rush of water after jumping off a high surface or coming off a water slide. A toddler can slip into water that is over his head. It only takes a few seconds in the water – just enough time for the water to get past the vocal chords before the body can react.

The majority of children, or anyone for that matter, who suffer the effects of secondary drowning, will survive. But a small percentage could have permanent brain damage and others may even die.

It is a rare condition – the syndrome occurs in less than one to two percent of near-drowning victims–but its onset is usually rapid and is characterized by a period of one to 24 hours of respiratory well-being. The swimmer seems fine at first, but water left in the lungs begins to cause swelling and diminished oxygen exchange to and from the blood. As the blood oxygen level drops, oxygen flow to the brain and other vital organs is reduced. Inhaling pool water can cause an additional condition called chemical pneumonitis, inflammation of the lungs due to harmful chemicals. An interesting observation is that children who develop secondary drowning syndrome after immersion in fresh water have a higher rate of survival than those who take salt water into their lungs.

Common symptoms of secondary drowning are persistent cough, shortness of breath, chest pain, lethargy, fever and unusual mood change. These signs can be difficult to spot in young children who are normally tired and fussy after a day a long day in the water. If symptoms are diagnosed early on, a physician can administer oxygen and remove fluid from the lungs. If not treated, the syndrome can progress to pulmonary edema (swelling) with a frothy pink discharge from the nose and mouth; partial or complete lack of oxygen supply to the brain, which can cause serious cognitive, physical and psychological impairment; respiratory and cardiac arrest; and death.

It sounds very scary, but none of this means parents should needlessly worry or forego the joys of family summer vacations at the beach or long days at the swimming pool. Just remember that vigilant monitoring of children when near the water is extremely important and water safety is the best prevention. If your child does have a near drowning experience, you should observe him or her in the following days and know what to look for. If you see any signs of secondary drowning, immediately take your child to an emergency department. Time is a critical factor in treatment – it could save your child’s life.

Dr. David J. Monroe is the director of the Children’s Care Center at Howard County General Hospital.

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5847802511_e74b43baa7_bLadies and gentlemen, boys and girls, gather your glitter and wave those rainbow flags proudly- LGBTQ pride month is upon us yet again! Pride events are annually recognized in honor of the struggles and victories of the lesbian, gay, bisexual, transgender, queer (LGBTQ) community; the most significant of these struggles being the Stonewall riots that took place in Manhattan, NY in 1969. Thanks to the brazen courage of the activists and political renegades who set the modern day gay and lesbian movement into motion (such as Del Martin, Phyllis Lyon, and Harvey Milk), many of us have claimed the right to live every beautiful shade of our lives out in the open and crave to celebrate that simple fact with our fellow human beings.

While many of us are lucky enough to live in countries where being ourselves and loving whom we choose is possible, sadly, not all of us are so lucky. When there are men, women, and youth still being persecuted, imprisoned, and/or murdered in many parts of the world for how they identify, for whom they choose to love, and for how they choose to express themselves, the concept of pride takes on a bigger significance. Currently, the International Lesbian, Gay, Bisexual, Trans, and Intersex Association provides information regarding LGBTQ rights (or lack thereof) within the international realm. For instance, their website features a color coded world map that denotes countries where homosexuality can fetch up to 10 years imprisonment or even death.

The psychological and emotional stress of knowing one’s life is threatened by the laws and beliefs of one’s own country can scar a person in unimaginable ways. When we consider personal health and well-being, mental and emotional health are significantly important components to that puzzle. Living in a society with legally established modes of discrimination can affect a person, and may lead to anxiety, depression, self-harming behavior, or suicide. According to an article published by the National Institutes of Health (NIH), titled Prejudice, Social Stress, and Mental Health in Lesbian, Gay, and Bisexual Populations: Conceptual Issues and Research Evidence, the prevalence of mental disorders in the LGBTQ community are precipitated by stigma, discrimination, experience of prejudiced events, expectation of rejection, concealing (i.e “being in the closet”), and homophobia (especially internalized forms).

A loving, honest, and safe environment should begin at home first and foremost. Life gives us each our fair share of challenges, and tests our will, our strength, and our well-being over the course of a lifetime. LGBTQ identified individuals must face even greater challenges when they are exposed to discrimination at home and within the society they live in from very early on. Imagine, just for a second, how you might respond in a world that did not fully accept you for something about yourself that you could not change. Sometimes all it takes is a compassionate heart, and the ability to put ourselves in someone else’s shoes, in order to gain some sense of another’s struggles from beyond the confines of our own perspectives.

There are various kinds of support available to LGBTQ individuals, and their allies, located in the US, and the Washington/Baltimore area in particular. Organizations, such as Chase Brexton, Human Rights Campaign, Whitman Walker Health, Equality Maryland, and the Fenway Institute’s National LGBT Health Education Center, are prepared to provide LGBTQ individuals with health and/or legal resources. Knowing that there are professionals and organizations equipped with the skills to serve the LGBTQ community is effectively beneficial, and lends great peace of mind.

Pride is a chance to collectively celebrate with members of an extended family and allies, with courage and love, knowing that we are each part of one human family. We have the honor of gathering and celebrating, as we fondly remember those who fought relentlessly so that we may be where we are today and have the rights we are entitled to. To my fellow LGBTQ family, and strong allies, I say, let us continue showing one another love, respect, and support. Life may be hard, but it’s most certainly short. Let’s embrace ourselves even more fully and celebrate all that we are, and all that we have yet to achieve. Happy Pride!

When Jinelee De Souza isn’t channeling her inner super-heroine at Howard County Library System as an Instructor & Research Specialist, she’s doing so at the gym, during impromptu photoshoots with her bff, and everywhere in between.

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Sexual harassment takes many forms and it can come from co-workers or strangers on the street. But what do you do when your customers harass you? Share your comments below.

Last month I regaled you, dear reader, with some challenges of working in the public service realm, specifically some of the harassment (intentional or not) that can come from customers/clients/patrons/vendors. I did not, however, get to talk about any potential solutions or coping mechanisms. This month, I’ll try to explore those (though I am no expert).

First and foremost, a company or organization may not even realize that there is a problem unless the employee brings it to their attention, which a lot of employees are hesitant to do since harassment from customers doesn’t fall under the traditional definitions/policies. This great article from Work It, Richmond discusses how employers, once aware of the problem, should let the customer/client know that a behavior is unacceptable. Some businesses are even making their in-house harassment policies available for customers/vendors/business partners to openly read; therefore, people who do business with a particular organization will already know what behaviors will not be tolerated and what consequences they may face (such as being banned from that organization). Companies/organizations should support employees who are made to feel uncomfortable, but sometimes an employee may not even know that she/he is being harassed.

Equal Rights Advocates provides a clear description of different types of sexual harassment, including the tricky nonverbal types. They state, “To be illegal, sexual harassment must be unwelcome. Unwelcome means unwanted. For this reason, it is important to communicate (verbally, in writing, or by your actions) to the harasser that the conduct makes you uncomfortable and that you want it to stop.” So even without involving the company, an employee has the right communicate a wish for the harasser to stop certain behaviors. Sometimes communicating this type of information may be difficult. There are plenty of resources to help, such as Deal with Difficult People: How to Cope with Tricky Situations and People; Perfect Phrases for Dealing with Difficult People: Hundreds of Ready-to-Use Phrases for Healing Conflict, Confrontations, and Challenging Personalities; and Dealing with Difficult People.

Of course all of these “solutions” puts the onus on the employer or the employee. What about the harasser? Sadly, some people may not recognize that they are acting in an abusive way unless they are informed of it. Even more sadly, some people may not care. Not to oversimplify, but I’d challenge people to put themselves in the position of the worker. I put this challenge to myself and came up with a list of things I will not do to someone who is my “captive audience” on a public service desk:

  1. I will try to only discuss topics that deal with the workplace in which you are working.
  2. If we do engage in “small talk,” I will keep it to a minimum and be sensitive to the fact that you are at work and have limited time for chit-chat.
  3. I will try to avoid asking questions that require you to reveal personal information.
  4. I will not comment on your appearance, good or bad.
  5. If I am overcome with a desire to be your friend or try to get to know you on a personal level, I will ask you politely if you wish to get together sometime outside of work, and then drop it completely if you tell me “no thank you,” without trying to wheedle or press you for more information.

I’d love to know if anyone else has any suggestions/modifications to add to my list. I do think these would make a nice basis for anyone trying to be considerate of those working in a public forum.

Recovering from an abusive situation at work and regaining a sense of comfort in your workplace is a whole other undertaking, an important one–one that, hopefully, a human resources department can provide some help with. There are some resources that might be helpful, such as Real Happiness at Work: Meditations for Accomplishment, Achievement, and Peace; The PTSD Workbook; The Body Keeps the Score; and Anxiety and Avoidance: A Universal Treatment for Anxiety, Panic, and Fear, just to name a few. Also, seeking counseling and guidance from a professional would be wise.

Joanne Sobieck-Lingg is glad to blog about her many, disparate interests (though expert in none, except maybe parenthetical asides). In past lives, she was a writer, proofreader, editor, project manager, teacher, and even co-coordinator of a certain health blog. She has been happily ensconced among the fiction and teen books at the Central Branch of HCLS since 2003.

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I love to travel. One of my favorite things is to plan a trip—whether to visit new places or to see friends and family. But I have to admit traveling with a disability and health issues can be a little complicated. Even domestically there are lots of barriers to navigate, but many more potential issues for international travel.

My travel wish list is long and constantly growing. Although I use a wheelchair and have accessibility concerns, I have done pretty well with seeing many parts of the continental U.S., some Caribbean destinations, and a few spots in Europe.

I’ve pretty much mastered domestic travel with the ability to fly, train, or bus. Usually I prefer to travel with my motorized wheelchair so I can be independent. But if I have a companion, such as my husband, to push my manual wheelchair I can travel by car and have some more flexibility on travel arrangements. My motor is great, but it requires accessible vehicles and buildings, which is not always a reality of my travel destination.

One thing I’ve learned about travel and health and disability issues is that usually there’s a solution to every problem. It may be difficult and require a change of plans, but you can still go many places and see a lot. I don’t view my disability as a limiting factor, rather as an incentive for creative thinking.

I have a family member who travels with oxygen and I recently began taking an injectable medication requiring refrigeration. Even for these details, there are solutions. For my medication, I have a little carry case with a cold pack. Oxygen can be rented nationwide or a travel-size machine can be used.

Planning an accessible trip requires a willingness to be persistent on the details. For example, I require a certain type of accessible hotel room, so I reserve it in advance. and later double check (and sometimes triple check) to confirm the details. I have a checklist for flight/travel method, hotel, local travel, and destinations.

The Internet is very helpful for research, but sometimes I have to delve deeper and send out emails or make calls. One great change is that more places are increasingly aware of accessibility needs and have made updates. How fantastic when I was planning a visit to Rome and learned the Colosseum had an elevator! You’d be surprised at how welcoming people can be and willing to accommodate different people with disabilities and health needs.

International travel is still challenging because the U.S. has better accessibility laws. Most places abroad don’t have basic requirements like ramps or elevators. Modern construction will often make things more accommodating, but it’s hard to rely on. I’ve been to a few European cities and the accessibility was mixed. But with some research and tenacity, there’s a lot to see and do while working around these barriers.

No matter the disability or health challenge, travel is very possible. For me, travel opens my eyes to new perspectives and brings me many joys of discovery and adventure. See you on the road!

Kelly Mack lives in Washington, DC, and works for a marketing communications firm.

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1196478322_fa47d6c732_oThe Occupational Safety & Health Administration (OSHA) states, “Workplace violence is any act or threat of physical violence, harassment, intimidation, or other threatening disruptive behavior that occurs at the work site.” Most people think harassment only connotes sexual behavior, and another term “workplace bullying” has been adopted to create awareness of additional threatening behaviors. A lot of people also think harassment or bullying can only take place among coworkers. I’d like to focus a moment on just some of those threatening and disruptive behaviors in a public service forum and how they can manifest among clients/customers.

Wow, Joanne, great topic—way to greet spring, Captain Bring-down. Sorry, maybe the cold, extra-long winter had me lingering in some dark places of the mind, but I don’t want to discuss seasonal allergies, sunblock, or even SAD right now.

There should be a certain expectation of safety and comfort in one’s workplace (check out #3 on this list from Harvard Business Review; actually, check out all 12—it’s a good list).

However, working in the public sphere can be challenging in ways that working in corporate settings are not; workplace bullying is not just a potential problem among employees. One of the biggest challenges is the “ownership” your customers can sometimes feel they have over you. I like that I have regular customers, people who have come to trust me or feel they know me a bit over my 10+ years at HCLS. I do get a little uncomfortable when customers ask personal questions or reveal something overly personal about themselves. But mostly, I handle these situations as politely and gently as I can without too much worry.

So how do we regain comfort in an extremely tricky situation? How do we prevent the potential health problems caused by harassment when the harasser is not a fellow employee and not subject to the same rules? I will explore solving it in next month’s post.

Joanne Sobieck-Lingg is glad to blog about her many, disparate interests (though expert in none, except maybe parenthetical asides). In past lives, she was a writer, proofreader, editor, project manager, teacher, and even co-coordinator of a certain health blog. She has been happily ensconced among the fiction and teen books at the Central Branch of HCLS since 2003.

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