Window Blind Cords

Toddlers and cords don’t mix.  That is the message from a recent study published in the journal Pediatrics.  The study examined injuries in children<6 years of age caused by window treatment cords.  This has been a well known hazard among pediatricians, manufacturers, and safety engineers for many years.  Unfortunately, however, and despite numerous product modifications over the years, the rate of occurrence has not changed too much.

Between 1990-2015 there were almost 17,000 cord related injuries treated in US Emergency Departments.  Fortunately, the large majority–93%–were minor injuries that were treated and the patients discharged. Mostly children were just struck by hardware when they pulled too vigorously on the cord.  However, that doesn’t tell the whole story.  12% of all injuries were entanglements, 80% of those involved the neck.  as a result, there were 761 hospitalizations and, worst of all, 271 deaths in that timeframe.  The greatest risk was in 1-4 years but serious injuries were reported up to age 9.

These deaths occurred often during nap time when the child was, obviously, left unsupervised and became entangled in a blind cord close to the crib or bed.  Of course, naturally inquisitive kids often cannot resist experimenting with a newly discovered object, so the fact that that window treatment “has always been there” provides no safety assurance whatsoever.  As, in this scenario, the child’s neck is entangled and she is strangling, the danger is silent.  It is entirely possible that one would not even hear it over a room sound monitor.

Numerous technical innovations have been tried but, as we can see, they have not had much impact.  So what to do?

  1. Examine all window treatments front, side, and back for accessible cords.
  2. Use cordless or inaccessible cord window coverings only.  This goes for grandparents home as well, as seniors often find the old pull cord products to be easier to operate.  Where possible switch to shades.
  3. Use open cord pulls–no loops (cut them if possible)
  4. If you have such products and replacement cost is an issue, at least do so in the child’s bedroom and play area if possible.
  5. If cost is prohibitive or replacement is impractical, keep blinds pulled all the way to the top and wrap up all cords and place out of reach whenever the child is in that room.  Try to never have such products used near the child’s crib or bed.

New safety initiatives under review by the American National Standards Institute should result in >80% of window coverings sold in the US and Canada to be cordless or cord inaccessible by the end of this year.  But there is no substitute for awareness and caution.  As always, the buck stops with us parents.

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More on Cautious Use of Medicines

OK, back to one of my favorite themes: don’t over treat.  A recent study reviewed almost 800,000 infants receiving either antibiotics or antacids during the first 6 months of life.  They found a significant increased risk of allergic diseases in those children.  With respect to antacids, both “H2 blockers” like ranitidine (zantac) as well as “PPI’s” like omeprazole (prilosec) were associated with food allergies as well as chemical risk factors like elevated allergy antibodies (IgE) in the abdominal cavity.  There was a comparable increased risk with antibiotic treatment in this age group.  In that instance there was a 9-51% increase in problems like eczema, hives, contact dermatitis, drug allergies, anaphylaxis, and eye allergies.  The incidence of asthma increased > 2 fold and hay fever > 75%.

Significantly, this information corroborated the findings of other similar studies.  Numerous mechanisms have been proposed as the likely cause of such observed phenomena, all basically involve altering the natural bacteria colonization of the GI tract in some way specific to that particular drug.  In addition, animal models (mice) have been shown to produce similar outcomes.  So there is a large and growing body of evidence to support a more conservative approach to the use of these drugs in this age group, as I’ve discussed previously.

Now, a word of caution (as always). This shows an association, not necessarily a cause. Perhaps the symptoms that caused the infants to have the antacids prescribed were early and nonspecific demonstration of GI problems and allergies which was only clearly diagnosed later.  Likewise with antibiotic treatments in this age group: perhaps these infants were already more susceptible to respiratory infections requiring antibiotic treatment because of their allergies so they received prescriptions earlier and/or more frequently compared to children who did not go on to be diagnosed with those problems.  In other words, based on this data we have not clarified which is chicken and which is egg here, so to speak.  Did the medicine cause the problem or was it merely earlier evidence of which children were born with those conditions already?  There may be very good reasons why some of these children needed these medicines as infants.  But there are definitely risks with these drugs and in particular in this tender, delicate age group, so we must respect that and always act with caution.  I encourage my patients to call me so we can discuss proper use (and improper MISUSE) of these drugs in their babies (as well as in “children of all ages.”)

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