Medical Assessment of Drug Endangered Children JAMYE COFFMAN, MD COOK CHILDREN S MEDICAL CENTER JAMYE.COFFMAN@COOKCHILDRENS.ORG
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1 Medical Assessment of Drug Endangered Children JAMYE COFFMAN, MD COOK CHILDREN S MEDICAL CENTER JAMYE.COFFMAN@COOKCHILDRENS.ORG
2 Course Overview and Objectives Understand thegeneral abuse and neglect issues as relevant to medical professionals Learn the standard medical protocol for Drug Endangered Children
3 Children Are NOT Small Adults Different diet Growing & developing (brain, liver, kidney, lungs); still vulnerable to damage Higher metabolic rate: absorb & metabolize toxins at a higher rate Developing nervous system Unusual habits (i.e. hand to mouth mouthbehaviors; eating strange things; close to ground/floor; unknowingly imitating; etc.)
4 Even More About the Kids Children breathe faster than adults Children have a faster heart beat than adults Children are smaller and closer to the ground than adults They have a heavier exposure to the chemicals due to the above
5 Few Case Series Few cases reported in the literature 18 children under 7 years old accidentally ingested methamphatamine. Their parents had left drugs out in easy access Symptoms:Increased heart rate, agitation, irritability and vomiting, muscle breakdown, fever,ataxia, seizure»kolecki, 1998
6 Other Health Hazards in Drug Environments Smoke detectors disabled or non existent, though risk for house fire or explosion is very highh Filthy home environment, filthy children. Littered with rotten food, garbage, feces = risk for food poisoning and diarrheal illnesses Skin infestations and infections No utilities, condemned housing Booby traps
7 General Abuse and Neglect Issues Physical abuse Sexual abuse Neglect Increased risk for accidental injury Increased risk for infant mortality
8 Physical Abuse Standard evaluation for physical abuse Under 2 yo Head dto toe examination Skeletal survey Diagnostics as indicated Over 2 yo Head to toe examination Diagnostics as indicated
9 Physical Abuse 2 year old found din box meth lab, locked up in a back bedroom Parents high on meth Chemical burns on the face and mouth Patterned burns on the back from a hair dryer Tibia fracture
10 Physical Abuse Reviewed 39 cases of children under 2 seen for drug exposure in 2011 Skeletal obtained in 23 children (59%) 2 children with healing rib fractures (9%) One with positive hair strand One with negative urine, insufficient hair for toxicology testing
11 Case 8 month old brought in by CPS Mom admitted to using methamphetamine for the last 30 days. History of heroin use in the past. Head to toe exam normal Skeletal survey showed advanced healing of left 8 th and 9 th posterior ribs Hair toxicology positive for methamphetamine, amphetamine, amphetamine (methamphetamine metabolite) benzoylecgonine (cocaine metabolite), and 6 MAM (heroin metabolite)
12 Sexual Abuse Meth increases sexual arousal in adults Meth addict homes littered with pornography Children are unsupervised around multiple strangers (drug buyers and associates) in the home Children may be sexually abused by their own parents, prostituted for drugs, or forced to view sexual acts, pornography
13 Neglect Neglect: Lack of nurturing and emotional stimulation results in: Developmental delays Depression Attachment disorder Malnutrition/Failure to Thrive Psychosocial dwarfism Iron dfii deficiency anemia Pica Lead exposure
14 Neglect Poor hygiene and infectious skin conditions (scabies, impetigo) Medical neglect of chronic medical problems (asthma, epilepsy) Little well child care/ Immunization delay No insurance/ Inadequate Medical Care
15 Neglect 8 children found in home when drug raid for concerns of selling drugs Home covered with feces and urine. No working plumbing. Ages 2 to 14 None of the children could read or knew their colors Flat affects, developmental delays
16 Neglect 2-year-old boy found in filthy home with large quantity of meth, parent under the influence
17 Increased Risk for Injury Lack of supervision results in increased injury from falls, burns, lacerations, drowning DUIs increases serious risk for injury from MVA w/wo car seat/ seatbelt Increases risk of injury in house fire
18 Risk for Injury 10 month old female rescued from a house fire in a trailer. Drugs and paraphernalia found in easy access. This infant and 5 year old sibling urine tox meth+
19 Risk for Injury Contact burns from falling debris Singed Hair
20
21 Possible Increased Infant Morbidity/Mortality Associated risk of positional overlay Lack of prenatal care May lead to prematurity and/or complications
22 Texas Alliance for DEC Medical Protocol Decontamination/Cleansing Immediate Within 72 hours Follow up
23 Decontamination Maximum Undress and rinse/wash at scene, all new clothes Medium Undress and wipe off and put on new clothes Donothing and transport with a covering blanket or suit for off site decontamination Most medical facilities will require decontamination PRIOR to arrival Toys/Objects y/ left at scene
24 Immediate Evaluation Children may present differently than adults Recognition of symptoms can be difficult Different normal values for vital signs Pre verbal Familiarity with normal childhood behavior and signs of distress Immediate exam should be done by someone with pediatric expertise
25 Medical Exam Immediate Immediate Examination Vital Signs Lungs Skin Urine Tox Screen Most likely to get positive result if obtained within 2 9 hours Per local protocol Consider chain of custody Usually not MEDICALLY indicated (used for investigation) Hair strand testing NOT medically indicated Indicative of exposure in past 3 months No specific timeframe
26 Cook s Hair Tests 56% positive if under 2 29% positive if over 2 Many polydrug ld
27 Urine Tox Screens NIDA levels work place screening 500 ng/dl confirmatory level Exposure levelsl May be volume dependent Usually done by lab Reported out only if asked Level down to 50 to 100 ng/dl Collect first urine after leaving scene
28 Exam Within 72 hours Comprehensive Medical Exam Developmental Assessment Mental Health Assessment Dental Evaluation Blood testing if appropriate p Referrals as appropriate
29 Optional Blood Tests Complete blood count (CBC) anemia (solvents, nutrition) cancers (solvents) Liver function tests (LFT s) solvents Kidney function tests (BUN, Cr) solvents
30 Medical Evaluation Follow Up Repeat Exams in 30 days, 6 months and 1 year Specific medical follow up as indicated by exam findings Follow up developmental evaluations as indicated Follow up mental tlhealth evaluation and service
31 Children Removed from Meth labs Dr. Penny Grant, Tulsa, OK DEC project 85 children under 13 years with ihurine toxicology and blood analysis (chemistries and cell count) <10% hd had mild changes in blood chemistries, none that were clinically apparent When the urine was collected within an average of 2.45 hours of removal, 71% were positive
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