Q&A: holiday poison safety with Ann Slattery of Children’s of Alabama Regional Poison Control Center

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Tis the season in Birmingham, and that means you should be aware of new poisons potentially entering your home. Ann Slattery, a clinical toxicologist and director of the Regional Poison Control Center at Children’s of Alabama in Birmingham, sat down with Bham Now to talk about keeping your family safe during the holidays.

Holiday Plants and Arrangements

Bham Now: Let’s start with plants. Which ones should we be concerned about over the holidays?

Slattery: Toxic holiday plants include mistletoe berries, amaryllis, azaleas and Jerusalem cherries, also called Christmas peppers, which look like little cherry tomatoes and are very dangerous. Holly berries can cause GI (gastrointestinal) upset. If it’s two holly berries, we’re not that worried about; if it’s 10 berries, it can cause an upset stomach.

Bham Now: What about poinsettias?

Slattery: Poinsettias are not the poisonous plant everyone thinks they are. You’d have to eat 500 leaves before you got an upset stomach. In 1918, there was a case of a poisoning, not in the mainland of the U.S., but it is believed the plant was misidentified. It does have a sap that can be stinging or irritating to the eye. We do not consider it a dangerous plant.

Note: For all questions pet related, Slattery directed me to the  ASPCA’s Animal Poison Control. That web page says that, in cats, dogs and horses, the sap can irritate the mouth and stomach and sometimes cause vomiting, but poinsettias are “generally over-rated in toxicity.”

Prevention

Slattery: Our main statement at the Regional Poison Control Center is out of reach, out of sight. Be aware, people are bringing in all these plants to decorate with pretty berries that are colorful and attractive to children. Senior citizens are sometimes confused and attracted to the pretty berries, too.

Opt for nontoxic plants like Christmas cactus, poinsettias, winter begonias and Christmas kalanchoe—that is my favorite plant to buy people over the holidays.

Slattery

What to do (and not do to) if exposed

Slattery: If a toxic plant is ingested, do not induce vomiting. Do not do a “blind sweep” of the mouth on a child of any age (that’s sticking a finger in the mouth to check for objects without looking; you could push whatever is inside in further.) Instead, open the child’s mouth and look at the roof of the mouth to check if a piece of plant is stuck there. If it is, it could later fall and the child could choke on it.  Then offer small sips of water, and call the Regional Poison Control Center at Children’s of Alabama at 1-800-222-1222.

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Toys, Devices and Singing Cards

Bham Now: Let’s talk about toys. What should we look out for?

Slattery: Button batteries are a major hazard. They’re found in some toys, as well as decorations, singing greeting cards and devices, such as hearing aids and pedometers. The 20 millimeter size, which is a little smaller than a quarter, can get lodged in the esophagus and burn very quickly, within two to three hours.

Children might stick the smaller size button batteries, found in penlights and hearing aids, in their nose or ears and, again, they can burn. 

Slattery: Magnets are another major hazard found in toys. Larger ones can be a choking hazard, but smaller, easy-to-swallow ones the size of a pea are very dangerous, too. If one magnet is ingested, it will probably pass uneventfully, but we do recommend calling poison control. Then, normally, they will x-ray to determine the location.

If a magnet and a button battery are swallowed together—or a magnet and a coin, or two magnets—it can be life threatening. The magnet can draw the other metal object, or the two magnets can attract each other. This can damage the GI (gastrointestinal tract) and even pinch off the intestines.  

Slattery

Prevention

Slattery: Toys are usually labelled for appropriate age ranges. However, keep in mind that even if you follow the age range on the box for one child, there could be younger siblings in the home who would be in danger if they got a hold of it.

What to do if exposed

Slattery: If a magnet or button battery is ingested, call the Regional Poison Control Center at Children’s of Alabama at 1-800-222-1222.

Houseguests (and  Their Medications)

Bham Now: Let’s talk about houseguests next. What dangers might they bring into the home over the holidays?

Slattery: You, as a parent, probably have a childproof home, with all your medications up and out of reach in lockboxes. But if you’ve got relatives coming in, they’ve got medicines in their purses and suitcases.

A lot of poison centers warn about the dangers of Grandmother’s purse. She might have candy, so children want to go in there, but she also might have hand sanitizer, medications and all these other toxic things in her purse. 

Slattery

There’s no such thing as childproof closures or tops. Everything is child resistant. Just because you have a child-resistant closure on your medication does not mean a 2 or 4 year old can’t open it. By law, it means a 2 or 4 year old can’t open it in 10 minutes. If you give them enough time, they can probably open it. 

Twenty-nine percent of people age 65 and over can take up to five medications a day. That’s hard to keep straight, so they’ll put them in pill planners, and the majority are not child resistant.

Slattery

Prevention

Slattery: When you have company come, make sure that you give them a place to put their medicines up and out of reach. Give them a secure drawer and make sure it’s closed, or make sure the child is not getting access to that room.

It goes both ways. When you go to another person’s home, you need to be aware. Look around. Do they have child locks on their drawers? Do they have cleaning products under their sink that the child can access?

What to do if exposed

Slattery: Call the Regional Poison Control Center at Children’s of Alabama at 1-800-222-1222.

The Holiday Feast … Left Out Too Long

Bham Now: What should we look out for when it comes to holiday foods and potential sources of food poisoning?

Slattery: The holiday meal can stretch over an hour. The old adage is don’t leave food out for more than two hours because bacteria can grow, and toxins can be produced. 

When it comes to large quantities of food, you want to put it in smaller containers. If you take that big casserole or that half uneaten turkey and stuff it in the refrigerator, the temperature is going to remain at room temperature for a while. You need to put it smaller containers to make sure it will cool quicker.

What to do if exposed

Slattery: If you suspect food poisoning, call the Regional Poison Control Center at Children’s of Alabama at 1-800-222-1222, and we can help sort it out.

There are many different types of food poisoning that come with a different onset of symptoms, and what you vomit may not be what caused the food poisoning.  For example, there’s E. coli O157, which you can get from undercooked beef, and those symptoms can take days to show up. Then there’s a type of food poisoning that shows up in one to six hours and lasts six to 10 hours. Others can last one to three days and can be very harmful. 

The early symptoms of carbon monoxide poisoning can be headache, nausea and vomiting, and drowsiness. Sometimes that can be misconstrued as food poisoning.

Slattery

Carbon Monoxide

Bham Now: Let’s talk more about that. What can we do to prevent carbon monoxide poisoning?

Slattery: If you’re in a home that has a gas or wood fireplace, gas appliances, a gas hot water heater or a garage that’s connected to the house, make sure that they have a carbon monoxide detector. It’s very important.

Alcohol, Cigarettes and E-liquids

Bham Now: Around the holidays, we’re celebrating, and the alcoholic beverages come out. What are the dangers there?

Slattery: We always worry about unfinished alcoholic beverages during the holidays. If say, there’s orange juice with vodka and it’s left out, the next day, the kids are the first to get up and they think it’s orange juice. That’s very dangerous. 

What would harm an adult, the amount per body weight, is much less in a child. It’s not just that the amount is less, but children have problems with less per their body weight than adults. Alcohol can drop a child’s blood glucose and body temperature. It can be very detrimental.

Slattery

Slattery: Another thing to be aware when we’re celebrating is possible cigarettes. Three cigarette butts can be toxic. One cigarette if ingested can be toxic if retained by a child.

Bham Now: What about e-cigarettes or vaping devices?

Slattery: Yes, the liquid that goes in those cartridges is very toxic. It takes less than an eighth of a teaspoon in some of the concentrations to be life threatening to a child.

What to do if exposed

If a child ingests alcohol, a cigarette (or cigarette butt) or an e-liquid, call the Regional Poison Control Center at Children’s of Alabama at 1-800-222-1222.

Related story: 3 things Birmingham needs to know about the teen vaping epidemic, including ‘JUULing’

Holiday Decorations

Bham Now: On a final note, do our holiday decorations present any dangers?

Slattery: In general, your ornaments should be safe in terms of toxicity, though there’s always the chance that if it’s from a foreign country it could contain lead. 

We really worry about ornaments more as choking hazards and causes of injury. Tinsel, which is made out of mylar, is a choking hazard. If a glass ornament shatters, the pieces could cut a child’s tongue, lips and esophagus.

The old-fashioned bubble lights contain a chemical that is dangerous, so if they were to break, you would not want a child around. Keep those high enough so that a child can’t break them or touch them.

The propellent in the spray snow that you put on your windows could cause an injury. Once you spray it on the window and the propellent evaporates, it’s basically nontoxic. It’s the same for flocking on Christmas trees, though a big hunk of it could be a choking hazard, just like a small branch might be. 

Prevention 

Slattery: When it comes to ornaments and decorations on the tree, measure where your child’s hand can reach and put everything above that. You want to keep decorations high enough that children are not biting, sucking or choking on them. 

Parents can use common sense. Sturdy ornaments that don’t have small pieces that could pose a choking hazard are okay. The newer lights do not get hot like the old lights used to, so they are not going to burn.  

What to do 

• Exposure to a poison (ingestion, on the skin, inhaled or in the eye) occurs: call the Regional Poison Control Center at Children’s of Alabama at 1-800-222-1222.
• A child is choking or loses consciousness: call 911.
• There’s active bleeding: go to an emergency room.
• A child swallows a potential hazard, such as a sharp object: call their pediatrician for guidelines.

About the Regional Poison Control Center

The Regional Poison Control Center (childrensal.org/rpcc) at Children’s of Alabama has been serving the people of Alabama since 1958, offering free and confidential poison information and treatment recommendations to the public and health care providers 24 hours a day. Call the 24/7 hotline 1-800-222-1222 for poison advice for all ages.

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