AAP Statement on Falls in Children

The Committee on Injury and Poison Prevention of the American Academy of Pediatrics (AAP) has issued a statement on children falling from heights. The AAP statement appears in the May 2001 issue of Pediatrics.

According to the AAP committee, falls of all kinds are the second leading cause of death from unintentional injury in the United States. While falls in children are rarely fatal, fatalities occur primarily when children fall from higher than two stories or when the head of the child hits a hard surface, such as concrete. The purpose of this statement is to review the epidemiology of falls from heights in children and to suggest strategies for prevention.

The AAP committee recommends that physicians give the following anticipatory guidance about prevention of falls from heights to parents of children who live in multiple-story dwellings:

• Supervise small children at all times, especially if windows are open.

• Install locks on windows to prevent sliding windows not intended for egress from opening more than 4 in.

• Open double-hung windows from the top only.

• Fixed guards, commonly used to prevent intrusion, should not be used, because they may prevent egress in the case of fire.

• Install operable window guards on second- and higher-story windows (unless prohibited by local fire regulations). Window screens are designed to keep insects out, but because they are not strong enough to keep children inside, they will not prevent falls from windows.

• Discourage or prohibit children from playing on fire escapes, roofs and balconies, especially those that are not adequately fenced with vertical bars that have openings of 4 in or smaller. Encourage the use of ground-level safe play areas, such as public parks and playgrounds. Ideally, these areas have been inspected and found safe by a nationally certified playground inspector.

• Avoid placing furniture, on which children may climb, near windows or on balconies.

Noninvasive Glucose Monitoring System

The U.S. Food and Drug Administration has granted marketing approval for the GlucoWatch Biographer, a prescription device that monitors glucose levels in adults with diabetes. The GlucoWatch Biographer provides glucose readings automatically and noninvasively up to three times per hour.

According to the manufacturer, the noninvasive device measures glucose collected through the skin, not from the blood. Glucose levels are measured and displayed automatically as often as every 20 minutes for up to 12 hours. The GlucoWatch Biographer also creates an “electronic diary” that stores up to 4,000 values that can be reviewed instantly to help detect trends and track patterns in glucose levels. Patients can set per sonal glucose alert levels so that an alarm sounds if readings are too high or too low, or if glucose levels decline rapidly.

The device uses an extremely low electric current to pull glucose through the skin. The glucose is then collected and transformed into an electric signal that is converted into a glucose reading.

The manufacturer stresses that the GlucoWatch Biographer is not intended to replace the common fin-gerstick testing method, but rather should be used together with blood glucose testing to provide more complete, ongoing information about glucose levels.

More information on the Gluco-Watch Biographer may be obtained by calling 866-GLWATCH (866-459-2824), or online athttp://www.glucowatch.com.

ISMP Warning About Dose Abbreviations

In response to a steady stream of reported errors caused by misinterpretation of a handful of dangerous dose expressions and abbreviations, the Institute for Safe Medication Practices (ISMP) has repeatedly recommended abandoning their use, according to the May 2, 2001 issue of “ISMP Medication Safety Alert!” The ISMP stresses that it is equally important to avoid use of these dangerous abbreviations and dose expressions in other communications, such as computer-generated labels, medication administration records, labels for drug storage bins/shelves, preprinted orders and protocols, and pharmacy and prescriber computer order entry screens.

The following are examples of dangerous abbreviations or dose designations:

• Use “mcg” instead of “μg” when writing “microgram,” because μg is sometimes mistaken for “mg” when handwritten.

• Do not use “qn” (nightly or at bedtime) or “qhs” (nightly at bedtime), which can be misinterpreted as “qh” (every hour). Instead, use “nightly.”

• When writing drug names and dosages, sometimes the name letters and dose numbers run together. For example, “Inderal 40 mg” written as “Inderal40 mg” may be misread as “Inderal 140 mg.” Always use a space between the drug name and dose and the unit of measure.

• If a zero is not used before a decimal dose, the dose may be misread as a whole dose. For instance, writing “.5 mg” when “0.5 mg” is intended, the dose may be misinterpreted as “5 mg.” Always use zero before a decimal when the dose is less than a whole unit.

For more information about medication safety, see the ISMP Web site athttp://www.ismp.org.

SmokeLess States Issues Statement on Women and Smoking

SmokeLess States, a national tobacco prevention and control program supported by the Robert Wood Johnson Foundation with direction and technical assistance provided by the American Medical Association, has released a statement in response to “Women and Smoking: A Report of the Surgeon General.”

The Surgeon General's report states that smoking-related deaths among women have more than doubled since 1965. Lung cancer was once rare among women, but has increased 600 percent since 1950. As of 1987, lung cancer surpassed breast cancer as the leading cause of female cancer death in the United States.

According to SmokeLess States, the trends of smoking among girls and women in the United States, described in the Surgeon General's report, can and must be reversed through implementation of proven strategies to reduce tobacco consumption. SmokeLess States fully supports the Surgeon General's recommendations for preventing and reducing smoking among the female population as follows:

• Science-based smoking cessation interventions should be put into widespread clinical practice.

• Comprehensive tobacco prevention programs should be enacted. Proof exists that science-based tobacco control programs have successfully reduced smoking rates among females.

• Females of all ages should be encouraged to quit, because quitting results in immediate health benefits for light and heavy smokers.

• The public should be made aware of the dangers of lung cancer and other smoking-related diseases to discourage tobacco use.