Of the 10,000 annual calls to the poisons centre, 40% concern children aged under five, writes SHEILA WAYMAN
THE FIRST sign that something was wrong was when one of Lorna O’Callaghan’s young children wandered into the bedroom on a weekend morning complaining about sticky pyjamas, because the Calpol had spilled.
She and her husband leapt out of their bed to discover that Ronan, then aged four, and his sister Tara (three) had managed to open not only the bottle of Calpol but also a bottle of Nurofen, both of which had been on top of a chest of drawers on the landing, and to drink the entire contents.
“We couldn’t get a reliable account as to who had drunk what. They both looked guilty and blank.”
Prudently, O’Callaghan had saved the number of the National Poisons Information Centre’s helpline in her phone and so she rang it immediately.
“They did the calculations on the children’s ages, weights and the two bottles that were almost full. They had to calculate on the basis that one of the children could have drunk both bottles,” she explains.
For Tara that could have been a dangerous amount but for Ronan, who was bigger, it would probably be okay. However, she was advised to take them both to the children’s hospital in Crumlin, where Tara had blood tests and the two of them were kept under observation for six hours. Both of them were fine.
“It gave us a dreadful fright,” says O’Callaghan, who had never thought the children would be able to remove what she believed were child-proof tops on the bottles. “It was a salutary lesson for the two of us and everything has to be up high now.”
It is the sort of scenario that the information officers who operate the helpline run by the National Poisons Information Centre deal with frequently.
Of the almost 10,000 calls that are made to the centre each year, by the public and healthcare professionals, more than 40 per cent concern children aged under five. About half of these inquiries involve the accidental consumption of medicines, the majority of which are paracetamol; the second biggest category for incidents among the under-fives is household products.
Yet Ireland remains one of three countries, out of 24 reviewed by the European Child Safety Alliance in 2009, that has no national legislation for child-resistant packaging for either medicines or household cleaners – although there is a European directive covering household products here. The other two countries without such legislation are Greece and Cyprus.
The director of the poisons information centre, Dr Edel Duggan, would like to see the law changed here – and then enforced – although she is satisfied that pharmacies follow best practice by not selling single-dose tablets unless they are in child-resistant containers, or in blister packs that are also considered child resistant.
“I think the legislation would be great but whether we would see a significant reduction in incidence of child poisoning, as was the case in other countries when the legislation was introduced, remains to be seen,” says Duggan, who stresses that “child-resistant” packaging is not “child-proof” – it is a design that delays rather than prevents access by children.
The argument against all medicines being sold in child-resistant containers is that elderly people won’t be able to open them, she explains. “The danger is that they get somebody else in to open it and then they leave it open because of the difficulty.”
Operating out of cramped offices at the back of Beaumont Hospital in Dublin, the poisons information centre not only runs a helpline for the public and another for medical personnel, but also aims to raise public awareness through booklets and its website, poisons.ie. This week it is introducing an initiative targeted at children aged under five and their parents.
Say No to Poisons is the title of a programme devised for use in childcare centres. It will be launched on Friday by Minister for Children Frances Fitzgerald at Early Childhood Ireland’s annual conference in Ballsbridge.
It was piloted at the VEC childcare centre in Carlow, where children were initially asked if they knew what poison was. Some had no idea, others suggested “something black and dirty”.
Two stories from the workbook were then read to the children, one of which explains how a little girl called Amy tasted a cleaning product when her mother went to answer the door, and became ill.
“They were very engrossed and it really hit home with them,” says Martina Osborne who helped to develop the programme and works as a manager with Carlow VEC.
“The main message of the book is that you should always ask your mammy, daddy or whoever is minding you whether something is safe to eat or drink,” she explains. “They seemed to get that message and on subsequent days in the creche they were asking if things were safe to eat.”
The poisons information centre logs every call it gets and follows up the more serious cases. In a preliminary report for last year categorising 1,111 queries about household products, liquid detergent sachets/capsules top the list.
“That would be an area of concern for us – they are colourful and children are attracted to them. They dissolve when they are wet,” Duggan points out.
When handled by a child with sticky hands they are liable to start disintegrating, splashing into the child’s eyes causing injury. Or if the child eats some of the contents, it can cause symptoms such as vomiting and drowsiness.
“Be careful of them – have them locked away,” warns Duggan, who is an anaesthetist at Beaumont and has specialised in medical toxicology. She is allocated one day a week for her work as director of the centre.
In about 80 per cent of cases, the centre can advise callers about on-the-spot treatment but for the remaining, more serious incidents, a visit to the GP or hospital is recommended.
“We can prevent people going to the emergency department when it’s not serious and on the other hand when it is serious, minutes matter and we can help the medical profession in determining what has been taken and in deciding the best treatment.”
There are antidotes for paracetamol, as well as for iron, cyanide and other substances, that can prevent damage to the liver, but for the majority of poisons there isn’t an antidote and supportive care is required.
Since Duggan, the mother of an 11-month-old boy, took over as director in 2010, she has been amazed by the number of people who say they would have loved to have known about the centre, two, five, seven years ago, when “such and such” an incident occurred, and she hears stories of what happened to their child.
What she and her staff aim to do by raising prevention awareness is to reduce the number of parents and children who learn the hard way, sometimes with tragic consequences.
The National Poisons Information Centre helpline is 01 809 2166 and operates 8am to 10pm seven days a week. For more information, see poisons.ie
WHAT TO DO IF YOU THINK YOUR CHILD HAS BEEN POISONED
Stay calm but act quickly.
Take the poison away from the child.
If it was eaten, make the child spit it out and run your fingers around the mouth to flick out any remaining bits.
Never make your child vomit.
If a chemical has splashed into the eyes, wash them with tap water for 15 minutes.
Wash any skin that was in contact with the poison with soap and water.
Call the National Poisons Information Centre on 01 809 2166.
Take the product container with you to the telephone, GP or hospital.
Source: National Poisons Information Centre
'BAD JUICE': THE DRINK WAS A TOXIC, RESIN HARDENER BEING USED ON WORK IN THE HOUSE
IT ONLY took a few seconds, when the adults’ backs were turned, for three-year-old Thomas to pick up a Ribena bottle he found on a kitchen bench and take a swig.
Having just stepped out into the yard with visiting workmen, Brenda heard her son cry and looked inside to see him putting the bottle back saying, “I want juice, this is bad juice.”
Unfortunately for Thomas it wasn’t “bad juice” but a toxic, resin hardener that was being used in work on the house and which had been taken out of its original container and put into the small bottle with a sports cap. Having finished fibre-glassing work on a balcony upstairs, workmen had come into the kitchen, tea was made and the bottle was laid on a bench.
Brenda, who was a nurse, quickly felt around Thomas’s mouth and found strong-smelling, sticky stuff. He wasn’t complaining or crying at that stage “but she knew where it was going”, explains her husband, Robert.
She rang the GP and within minutes her father, who had just walked in the door, was driving her and Thomas to the surgery, more than six miles away, while another family member took care of a younger sibling.
Brenda was making Thomas vomit – however this is not advised in the case of poisoning (see panel) as a caustic substance can burn on the way back up and there is also the risk it will go into the lungs and damage them. In hindsight, says Robert, it was probably lucky that Thomas had eaten two bowls of porridge with milk just half an hour earlier because this all came up as well.
“If it [the chemical] had gone down into an empty stomach it might have done more damage on the way back.”
The GP had called an ambulance to take the boy to Cork University Hospital but it was also essential to know what was in the resin-hardener that Thomas had consumed. Frantic phone calls were made to trace who had the original bottle and could tell medical staff what chemicals it contained.
Thomas was going downhill and he needed to be transferred to Temple Street children’s hospital in Dublin.
“For half a day there, we were almost expecting the worst,” says Robert, who works abroad and had to fly into Dublin to be at his son’s bedside. Thomas was put into a coma in the ICU in Temple Street, with a pipe down his nose into his lungs.
After 24 hours, the couple were told the initial panic was over. However, the prospect of long-term damage could not be assessed until Thomas was taken out of the coma.
“A consultant said that poisoning is a very inexact science – it depends on so many things, such as the amount swallowed, the strength of the child, how quickly action is taken. Some children come out of it blind; others with one lung, or kidney damage.”
But once Thomas was woken after two and a half days, he soon bounced back and was discharged after a week in hospital – just in time for Easter. The couple were told he had minor burning in the stomach and around the wind-pipe and oesophagus.
“It seems like the worst outcome is the very small amount of burning that was in the oesophagus – as it heals it can create scar tissue and the scar tissue is quite stiff and it can affect swallowing but they are going to test this in three or four weeks,” says Robert. “We are just incredibly thankful that it turned out the way it did.”
He pays tribute to the staff at Temple Street hospital. “They did not just look after Thomas but there was also attention on us as parents. We were blown away by it – it is a very, very special place.”
Naturally, after such a traumatic accident, the couple have been reflecting on what led up to it. Currently living abroad, they are having a house built in the southwest of Ireland and Brenda came back with the children for Easter, ahead of Robert, to stay in the house that is almost finished.
“When we were sitting at home about a month ago and talking about what was happening in the house we discussed how we really should not be having the kids in the house while work was going on,” says Robert. “We didn’t feel comfortable with that but we ignored our instincts and went with that anyway.”
Having grown up in Australia, Robert remembers it being drilled into him that you never take chemicals out of their original bottles. “So I was horrified that the chemical was actually in a child’s drinking bottle.”
The workmen were aware it was a potential hazard, he says, because one of them had phoned the evening before, after their first day of work in the house, to warn that there was a chemical liquid in a bottle and described where it was. The au pair, who answered the phone, put it out of reach until the men came back the next day to finish the job.
“And even after that,” says Robert, “it was carried into the kitchen and put on the kitchen bench. There was a chain of events there that very easily could have been prevented.”
The names of the family have been changed.
