Environmental hazards are among the top health concerns many parents have for their children. Pediatric residents receive little exposure to these topics, and busy practicing health care providers may have little exposure to them as well. It is with great pleasure that I have asked the authors cited in this issue to discuss these topics with specific reference to their area of expertise.
Dr. Powers highlights significant advances in the prevention and management of pediatric poisonings. Child-resistant packaging, ingestion safety education, organized poison control centers, and the emergence of medical toxicology as a discrete discipline have contributed to the decrease in child poisonings and mortalities annually. Many long-standing therapies have been questioned, and new antidotes and therapies are being developed. Despite this, there were more than 1.5 million pediatric poison exposures reported in 1998 to the Toxic Exposure Surveillance System. Dr. Powers also discusses some of the newer designer drugs, as well as the effects of herbal medicines and the impact they may have on pediatric patients.
The article by Dr. Etzel, who is also the editor of the American Academy of Pediatrics Handbook of Pediatric Environmental Health published in 1999, provides an overview of the toxic effects of cigarette smoking, carbon monoxide, mercury, and toxigenic molds. Although outdoor pollution has decreased, indoor pollution has increased as Americans responded to the energy crisis of the 1970s by building more airtight homes and opening fewer windows for ventilation. She points out the major changes medicine has undergone and, in particular, the importance of obtaining an environmental checklist, which is our current "house call."
The article by Drs. Schexnayder and Schexnayder provides an overview of the recognition and treatment of snake bites, envenomations, spider bites, and bee, wasp, and fire ant stings, to cite a few. Although most bites and stings require only local care, it is important to recognize those patients who may be at high risk for either slow or rapid deterioration.
Dr. Zuckerman and myself examine the pediatric epidemic of drowning and near drowning, a topic close to my heart as the director of a pediatric critical care unit dedicated to the care of patients with neurologic and neurosurgical problems. Patients who suffer a severe anoxic injury have a poor outcome and there are no novel therapies immediately available to prevent the damage done by the anoxic insult. The most important takerhome message of this article is that PREVENTION is currently the only key to success.
Dr. Smith provides an overview of the epidemiology of pediatric burns and their recognition and management. These injuries occur commonly. Dr. Smith discusses which patients can be treated at home and which need hospitalization versus transfer to a regional bum center. He also discusses chemical and electrical burns and Stevens-Johnson syndrome, which, in its worst form, may necessitate the transfer of a child to a burn center.
I hope that the reader will enjoy these articles as much as I did. This is a great group of authors and I hope that this issue of Pediatric Annals will be well received by all who care for children.