Electronic cigarettes have been marketed as a safer alternative to cigarettes, and their use is expanding exponentially. However, there is a severe lack of scientific data about the ingredients in the liquid used in the device and the health consequences of using electronic cigarettes. As technology has outpaced regulations, the production and sale of electronic cigarettes are, as yet, unregulated and do not fall under the purview of the Food and Drug Administration. This article will review the mechanism of action and what is currently known about the safety of electronic cigarettes. The risk of poisoning for children will also be identified, as well as the implications for home healthcare clinicians.
Electronic CIGARETTES A Safer Alternative or Potential Poison? Electronic cigarettes (e-cigarettes) are becoming increasingly popular, but what do you know about these new smoking devices? Do you think these nicotinedelivering devices are a safe alternative to conventional tobacco cigarettes? Do you know how e-cigarettes work? Do you know who regulates the sale of these nontraditional tobacco products? Do you know how vaping compares to cigarette smoking? What are the safety concerns related to children and e-cigarettes? This article will answer these questions and describe some of the current research on e-cigarettes.
Janet E. Smith, MBA, MSN, RN Lee Badrock/Alamy
532
Home Healthcare Nurse
www.homehealthcarenurseonline.com
Copyright © 2014 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
S
moking remains a public health problem in the United States. In spite of education on the health conseE-cigarettes are lithium batteryquences of smoking, as well as on the operated and use liquid that dangers of second-hand smoke to othcontains nicotine, water, flavorings, ers, both adults and youth continue to smoke. The Centers for Disease propylene glycol and glycerin. Control and Prevention (CDC) estimates that 18% of adults over age 18 smoke (CDC, 2014a). Surprisingly, 23% of high-school students and 6.7% of middle-school outpacing laws and regulation. In April of 2014, students also smoke cigarettes (CDC, 2014b). the FDA issued a proposed rule to extend its own E-cigarettes are lithium battery-operated and authority to novel tobacco products, including use liquid that contains nicotine, water, flavorings, e-cigarettes. However, the rule change is still in propylene glycol, and glycerin. Puffing on the ethe comment period and has not yet been enacted cigarette activates the heating element, turning (FDA, 2014). The FDA, however, has analyzed the liquid into an aerosol, which is then inhaled by some of the most popular liquid nicotine products the smoker. Vapers is the term for individuals who and found that one contained a chemical used in use e-cigarettes and vaping is the term for inhaling antifreeze and several others contained known the liquid tobacco vapor. E-cigarettes, also known carcinogens. As no data on e-cigarettes have as Electronic Nicotine Delivery Systems, are marbeen formally submitted to the FDA, the safety of keted as a safer alternative to traditional cigae-cigarettes is unknown. Moreover, without data, rettes. However, the accuracy of this claim at this the public health implications of e-cigarette use time is unknown. Initially they were available only are unknown. through Internet purchase, but as the demand has expanded, e-cigarettes are now available in many Research retail outlets selling traditional cigarettes. In some There is little available toxicology research on eparts of the country, vapor stores and vaping cigarettes. There are a number of issues related to lounges have opened to sell e-cigarette products, research on e-cigarette products. First, there are a reflecting their growing popularity. large number of brands available, each with differA difference between e-cigarettes and conent delivery devices, and unregulated manufacturventional cigarettes is that e-cigarette users are ing processes. Secondly, little is known regarding exposed to toxicants via inhalation of heated vathe source and potential contamination of ingredipors; whereas with conventional cigarettes, users ents used in the liquid that vaporizes during use. inhale smoke produced by burning tobacco (Orr, Third, there is the lack of a standardized approach 2014). The toxicity and public health implications to comparing toxicants in e-cigarettes versus conof this are as yet unknown because scientific data ventional cigarettes (Orr, 2014). Adults and teens are lacking. Because production is unregulated, that have completed smoking cessation programs many of the liquid products contain other unidenare increasingly turning to e-cigarettes, thinking tified chemicals. Most e-cigarettes are designed that these are a safe alternative to traditional toto look like conventional cigarettes, but some bacco cigarettes. look like everyday objects, such as ink pens. The Etter & Bullen (2014) posted a questionnaire e-cigarettes are refillable, with the liquid being regarding e-cigarette use on the Internet, with sold in many tobacco and convenience stores. plans for a longitudinal study. A total of 1,329 people completed the initial questionnaire. However, only 367 people completed all three surveys at Regulation of Sales baseline, 1 month, and 1 year. The group answerThe sale of e-cigarettes is currently unregulated in ing all three surveys was predominantly former the United States. The Food and Drug Administrasmokers, with a median of 10 weeks’ abstinence. tion (FDA) can only regulate products containing The majority (76%) used e-cigarettes daily. After cut tobacco. As e-cigarettes do not use cut to1 year, those using both e-cigarettes and conbacco, they do not as yet come under the purview ventional cigarettes decreased their daily use of of the FDA. This is an instance of technology
vol. 32 • no. 9 • October 2014
Home Healthcare Nurse
Copyright © 2014 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
533
or through the gastrointestinal tract if swallowed. Chemicals in the liquid nicotine are neurotoxins, and can lead Liquid nicotine can be absorbed to seizures and death (Richtel, 2014). As little as one teaspoon can kill a todthrough the skin or through the dler. The number of accidental poisongastrointestinal tract if swallowed. ings related to liquid nicotine/liquid tobacco has increased dramatically over the past 2 years. Nationwide, between the years 2012 and 2013, the number of accidental poisonings increased cigarettes by 10 cigarettes/day after beginning to by 300% and that number is expected to double use e-cigarettes. Among the daily vapers at baseagain in 2014 (Richtel, 2014). Although the issue line, 81% were still vaping daily after 1 year. Alis particularly serious for children, adults can also though this study does provide some longitudinal be poisoned if they absorb liquid nicotine through data, it is limited by self-reports of participants, the skin or GI tract. and a self-selected sample of predominantly former smokers. One analysis (Goniewicz et al., 2014) found that Home Healthcare Implications the level of nicotine listed on the label of 11 brands Nicotine in liquid form is a known poison, but of e-cigarettes available in Poland and 1 brand most of the public is unaware of this. Liquid nicofrom Great Britain varied from 4 mg/cartridge tine is not sold with childproof caps. Home healthto 18 mg/cartridge. However, the researchers’ care professionals are case-finders and health analysis found that several brands actually coneducators and can play a role in preventing tragtained much less nicotine than stated. The same edy. When assessing smoking, a question about research group analyzed the toxicity of e-cigarette smoking electronic cigarettes should be added vapor and found that although there were potento other assessment questions. Home visits are tially toxic compounds in the vapor, it was 9 to an opportunity to educate parents, grandparents, 450 times less than in conventional cigarettes. and other adults about the risks related to liquid In a very small study, funded by a manufacturer nicotine for both children and adults. Toxic sympof e-cigarettes, Nides et al. (2014) found that use toms range from rapid heartbeat, elevated blood of e-cigarettes might decrease cravings, prevent pressure, nausea, vomiting, and diarrhea to confurelapse to tobacco cigarettes in former smokers, sion and seizures (Glatter, 2014). and lead to smoking cessation in current smokers. It is imperative that home healthcare profesHowever, their testing period was only 1 week, sionals teach adults to keep their liquid e-cigarette so no conclusions can be made about the longerrefills locked and away from children. It is espeterm use of e-cigarettes for smoking reduction or cially important to educate adults when there are cessation. The researchers also noted that with no children living in the home, but children visit the brand of e-cigarette (NJOY King Bold) used in on occasion, as with grandparents. Would adults their study, the amount of nicotine supplied was leave another known poison within the reach of similar to currently available nicotine replacement children? Liquid nicotine should be treated just products approved by the FDA (gum, inhalers, like any other potentially poisonous product at nasal spray). home. Most adults are unaware that e-cigarettes are harmful, and therefore are very casual about where the products are stored or left in the home. Impact on Children The time to prevent a tragedy, through education Of utmost concern is the impact of liquid nicotine and regulation, is now. on small children. The taste of tobacco cigarettes would deter most children from eating them. However, the liquid nicotine products used to refill Conclusion e-cigarettes are flavored and may attract children. The popularity of e-cigarettes is increasing, and These products are often left casually around these products are becoming more widely availhomes and are easily retrieved by children. Liqable. Marketing campaigns tout safety and promote uid nicotine can be absorbed through the skin the popular belief that e-cigarettes are a safer
534
Home Healthcare Nurse
www.homehealthcarenurseonline.com
Copyright © 2014 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
option than tobacco cigarettes. However, with a dearth of research and lack of manufacturing and sales regulation, the safety of these products is unknown. One thing that is known is that liquid nicotine can be a danger to children and that accidental poisonings have increased. Home healthcare professionals are in a position to both assess use of ecigarettes and educate patients and families about potential dangers of liquid nicotine to children. Janet E. Smith, MBA, MSN, RN, is an Instructor, School of Nursing and Health Sciences, La Salle University, Philadelphia, Pennsylvania. The author declares no conflicts of interest. Address for correspondence: Janet E. Smith, MBA, MSN, RN, School of Nursing and Health Sciences, La Salle University, 1900 W. Olney Ave., Philadelphia, PA 19141 ([email protected]).
DOI:10.1097/NHH.0000000000000138 REFERENCES Centers for Disease Control and Prevention. (2014a). Adult cigarette smoking in the United States: Current estimates. Retrieved
from http://www.cdc.gov/tobacco/data_statistics/fact_sheets/ adult_data/cig_smoking Centers for Disease Control and Prevention. (2014b). Youth and tobacco use. Retrieved from http://www.cdc.gov/tobacco/data_ statistics/fact_sheets/youth_data/tobacco_use Etter, J. F., & Bullen, C. (2014). A longitudinal study of electronic cigarette users. Addictive Behaviors, 39(2), 491-494. Food and Drug Administration. (2014). Electronic Cigarettes. Retrieved from www.fda.gov/NewsEvents/PublicHealthFocus Glatter, R. (2014, March 24). The real dangers of liquid nicotine. Retrieved from www.forbes.com/sites/robertglatter/2014/03/24/ the-real-danger-of-liquid-nicotine Goniewicz, M. L., Knysak, J., Gawron, M., Kosmider, L., Sobczak, A., Kurek, J., ..., Benowitz, N. (2014). Levels of selected carcinogens and toxicants in vapour from electronic cigarettes. Tobacco Control, 23(2), 133-139. Nides, M. A., Leischow, S. J., Bhatter, M., & Simmons, M. (2014). Nicotine blood levels and short-term smoking reduction with an electronic nicotine delivery system. American Journal of Health Behavior, 38(2), 265-274. Orr, M. S. (2014). Electronic cigarettes in the USA: A summary of available toxicology data and suggestions for the future. Tobacco Control, 23(Suppl. 2), ii18-ii22. Richtel, M. (2014, March 23). Selling poison by the barrel: Liquid nicotine for e-cigarettes. New York Times. Retrieved from www.newyorktimes.com/business2014/03/23
Lidocaine Viscous: Drug Safety Communication—Boxed Warning Required— Should Not Be Used to Treat Teething Pain AUDIENCE: Consumer, pediatrics, family practice. ISSUE: The Food and Drug Administration (FDA) notified healthcare professionals, their provider organizations, and caregivers for infants that prescription oral viscous lidocaine 2% solution should not be used to treat infants and children with teething pain. The FDA is requiring a Boxed Warning to be added to the prescribing information (label) to highlight this information. Oral viscous lidocaine solution is not approved to treat teething pain, and use in infants and young children can cause serious harm, including death. Topical pain relievers and medications that are rubbed on the gums are not necessary or even useful because they wash out of the baby’s mouth within minutes. When too much viscous lidocaine is given to infants and young children or they accidentally swallow too much, it can result in seizures, severe brain injury, and problems with the heart. Cases of overdose due to wrong dosing or accidental ingestion have resulted in infants and children being hospitalized or dying. BACKGROUND: In 2014, the FDA reviewed 22 case reports of serious adverse reactions, including deaths, in infants and young children 5 months to 3.5 years of age who were given oral viscous lidocaine 2% solution for the treatment of mouth pain, including teething and stomatitis, or who had accidental ingestions. See further details in the FDA Drug Safety Communication. RECOMMENDATION: Healthcare professionals should not prescribe or recommend this product for teething pain. Parents and caregivers should follow the American Academy of Pediatrics’ recommendations for treating teething pain.
vol. 32 • no. 9 • October 2014
• Use a teething ring chilled in the refrigerator (not frozen). • Gently rub or massage the child’s gums with your finger to relieve the symptoms. The FDA is also encouraging parents and caregivers not to use topical medications for teething pain that are available over the counter because some of them can be harmful. The FDA recommends following the American Academy of Pediatrics’s recommendations to help lessen teething pain.
Home Healthcare Nurse
Copyright © 2014 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
535
Electronic CIGARETTES A Safer Alternative or Potential Poison? Electronic cigarettes (e-cigarettes) are becoming increasingly popular, but what do you know about these new smoking devices? Do you think these nicotinedelivering devices are a safe alternative to conventional tobacco cigarettes? Do you know how e-cigarettes work? Do you know who regulates the sale of these nontraditional tobacco products? Do you know how vaping compares to cigarette smoking? What are the safety concerns related to children and e-cigarettes? This article will answer these questions and describe some of the current research on e-cigarettes.
Janet E. Smith, MBA, MSN, RN Lee Badrock/Alamy
532
Home Healthcare Nurse
www.homehealthcarenurseonline.com
Copyright © 2014 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
S
moking remains a public health problem in the United States. In spite of education on the health conseE-cigarettes are lithium batteryquences of smoking, as well as on the operated and use liquid that dangers of second-hand smoke to othcontains nicotine, water, flavorings, ers, both adults and youth continue to smoke. The Centers for Disease propylene glycol and glycerin. Control and Prevention (CDC) estimates that 18% of adults over age 18 smoke (CDC, 2014a). Surprisingly, 23% of high-school students and 6.7% of middle-school outpacing laws and regulation. In April of 2014, students also smoke cigarettes (CDC, 2014b). the FDA issued a proposed rule to extend its own E-cigarettes are lithium battery-operated and authority to novel tobacco products, including use liquid that contains nicotine, water, flavorings, e-cigarettes. However, the rule change is still in propylene glycol, and glycerin. Puffing on the ethe comment period and has not yet been enacted cigarette activates the heating element, turning (FDA, 2014). The FDA, however, has analyzed the liquid into an aerosol, which is then inhaled by some of the most popular liquid nicotine products the smoker. Vapers is the term for individuals who and found that one contained a chemical used in use e-cigarettes and vaping is the term for inhaling antifreeze and several others contained known the liquid tobacco vapor. E-cigarettes, also known carcinogens. As no data on e-cigarettes have as Electronic Nicotine Delivery Systems, are marbeen formally submitted to the FDA, the safety of keted as a safer alternative to traditional cigae-cigarettes is unknown. Moreover, without data, rettes. However, the accuracy of this claim at this the public health implications of e-cigarette use time is unknown. Initially they were available only are unknown. through Internet purchase, but as the demand has expanded, e-cigarettes are now available in many Research retail outlets selling traditional cigarettes. In some There is little available toxicology research on eparts of the country, vapor stores and vaping cigarettes. There are a number of issues related to lounges have opened to sell e-cigarette products, research on e-cigarette products. First, there are a reflecting their growing popularity. large number of brands available, each with differA difference between e-cigarettes and conent delivery devices, and unregulated manufacturventional cigarettes is that e-cigarette users are ing processes. Secondly, little is known regarding exposed to toxicants via inhalation of heated vathe source and potential contamination of ingredipors; whereas with conventional cigarettes, users ents used in the liquid that vaporizes during use. inhale smoke produced by burning tobacco (Orr, Third, there is the lack of a standardized approach 2014). The toxicity and public health implications to comparing toxicants in e-cigarettes versus conof this are as yet unknown because scientific data ventional cigarettes (Orr, 2014). Adults and teens are lacking. Because production is unregulated, that have completed smoking cessation programs many of the liquid products contain other unidenare increasingly turning to e-cigarettes, thinking tified chemicals. Most e-cigarettes are designed that these are a safe alternative to traditional toto look like conventional cigarettes, but some bacco cigarettes. look like everyday objects, such as ink pens. The Etter & Bullen (2014) posted a questionnaire e-cigarettes are refillable, with the liquid being regarding e-cigarette use on the Internet, with sold in many tobacco and convenience stores. plans for a longitudinal study. A total of 1,329 people completed the initial questionnaire. However, only 367 people completed all three surveys at Regulation of Sales baseline, 1 month, and 1 year. The group answerThe sale of e-cigarettes is currently unregulated in ing all three surveys was predominantly former the United States. The Food and Drug Administrasmokers, with a median of 10 weeks’ abstinence. tion (FDA) can only regulate products containing The majority (76%) used e-cigarettes daily. After cut tobacco. As e-cigarettes do not use cut to1 year, those using both e-cigarettes and conbacco, they do not as yet come under the purview ventional cigarettes decreased their daily use of of the FDA. This is an instance of technology
vol. 32 • no. 9 • October 2014
Home Healthcare Nurse
Copyright © 2014 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
533
or through the gastrointestinal tract if swallowed. Chemicals in the liquid nicotine are neurotoxins, and can lead Liquid nicotine can be absorbed to seizures and death (Richtel, 2014). As little as one teaspoon can kill a todthrough the skin or through the dler. The number of accidental poisongastrointestinal tract if swallowed. ings related to liquid nicotine/liquid tobacco has increased dramatically over the past 2 years. Nationwide, between the years 2012 and 2013, the number of accidental poisonings increased cigarettes by 10 cigarettes/day after beginning to by 300% and that number is expected to double use e-cigarettes. Among the daily vapers at baseagain in 2014 (Richtel, 2014). Although the issue line, 81% were still vaping daily after 1 year. Alis particularly serious for children, adults can also though this study does provide some longitudinal be poisoned if they absorb liquid nicotine through data, it is limited by self-reports of participants, the skin or GI tract. and a self-selected sample of predominantly former smokers. One analysis (Goniewicz et al., 2014) found that Home Healthcare Implications the level of nicotine listed on the label of 11 brands Nicotine in liquid form is a known poison, but of e-cigarettes available in Poland and 1 brand most of the public is unaware of this. Liquid nicofrom Great Britain varied from 4 mg/cartridge tine is not sold with childproof caps. Home healthto 18 mg/cartridge. However, the researchers’ care professionals are case-finders and health analysis found that several brands actually coneducators and can play a role in preventing tragtained much less nicotine than stated. The same edy. When assessing smoking, a question about research group analyzed the toxicity of e-cigarette smoking electronic cigarettes should be added vapor and found that although there were potento other assessment questions. Home visits are tially toxic compounds in the vapor, it was 9 to an opportunity to educate parents, grandparents, 450 times less than in conventional cigarettes. and other adults about the risks related to liquid In a very small study, funded by a manufacturer nicotine for both children and adults. Toxic sympof e-cigarettes, Nides et al. (2014) found that use toms range from rapid heartbeat, elevated blood of e-cigarettes might decrease cravings, prevent pressure, nausea, vomiting, and diarrhea to confurelapse to tobacco cigarettes in former smokers, sion and seizures (Glatter, 2014). and lead to smoking cessation in current smokers. It is imperative that home healthcare profesHowever, their testing period was only 1 week, sionals teach adults to keep their liquid e-cigarette so no conclusions can be made about the longerrefills locked and away from children. It is espeterm use of e-cigarettes for smoking reduction or cially important to educate adults when there are cessation. The researchers also noted that with no children living in the home, but children visit the brand of e-cigarette (NJOY King Bold) used in on occasion, as with grandparents. Would adults their study, the amount of nicotine supplied was leave another known poison within the reach of similar to currently available nicotine replacement children? Liquid nicotine should be treated just products approved by the FDA (gum, inhalers, like any other potentially poisonous product at nasal spray). home. Most adults are unaware that e-cigarettes are harmful, and therefore are very casual about where the products are stored or left in the home. Impact on Children The time to prevent a tragedy, through education Of utmost concern is the impact of liquid nicotine and regulation, is now. on small children. The taste of tobacco cigarettes would deter most children from eating them. However, the liquid nicotine products used to refill Conclusion e-cigarettes are flavored and may attract children. The popularity of e-cigarettes is increasing, and These products are often left casually around these products are becoming more widely availhomes and are easily retrieved by children. Liqable. Marketing campaigns tout safety and promote uid nicotine can be absorbed through the skin the popular belief that e-cigarettes are a safer
534
Home Healthcare Nurse
www.homehealthcarenurseonline.com
Copyright © 2014 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
option than tobacco cigarettes. However, with a dearth of research and lack of manufacturing and sales regulation, the safety of these products is unknown. One thing that is known is that liquid nicotine can be a danger to children and that accidental poisonings have increased. Home healthcare professionals are in a position to both assess use of ecigarettes and educate patients and families about potential dangers of liquid nicotine to children. Janet E. Smith, MBA, MSN, RN, is an Instructor, School of Nursing and Health Sciences, La Salle University, Philadelphia, Pennsylvania. The author declares no conflicts of interest. Address for correspondence: Janet E. Smith, MBA, MSN, RN, School of Nursing and Health Sciences, La Salle University, 1900 W. Olney Ave., Philadelphia, PA 19141 ([email protected]).
DOI:10.1097/NHH.0000000000000138 REFERENCES Centers for Disease Control and Prevention. (2014a). Adult cigarette smoking in the United States: Current estimates. Retrieved
from http://www.cdc.gov/tobacco/data_statistics/fact_sheets/ adult_data/cig_smoking Centers for Disease Control and Prevention. (2014b). Youth and tobacco use. Retrieved from http://www.cdc.gov/tobacco/data_ statistics/fact_sheets/youth_data/tobacco_use Etter, J. F., & Bullen, C. (2014). A longitudinal study of electronic cigarette users. Addictive Behaviors, 39(2), 491-494. Food and Drug Administration. (2014). Electronic Cigarettes. Retrieved from www.fda.gov/NewsEvents/PublicHealthFocus Glatter, R. (2014, March 24). The real dangers of liquid nicotine. Retrieved from www.forbes.com/sites/robertglatter/2014/03/24/ the-real-danger-of-liquid-nicotine Goniewicz, M. L., Knysak, J., Gawron, M., Kosmider, L., Sobczak, A., Kurek, J., ..., Benowitz, N. (2014). Levels of selected carcinogens and toxicants in vapour from electronic cigarettes. Tobacco Control, 23(2), 133-139. Nides, M. A., Leischow, S. J., Bhatter, M., & Simmons, M. (2014). Nicotine blood levels and short-term smoking reduction with an electronic nicotine delivery system. American Journal of Health Behavior, 38(2), 265-274. Orr, M. S. (2014). Electronic cigarettes in the USA: A summary of available toxicology data and suggestions for the future. Tobacco Control, 23(Suppl. 2), ii18-ii22. Richtel, M. (2014, March 23). Selling poison by the barrel: Liquid nicotine for e-cigarettes. New York Times. Retrieved from www.newyorktimes.com/business2014/03/23
Lidocaine Viscous: Drug Safety Communication—Boxed Warning Required— Should Not Be Used to Treat Teething Pain AUDIENCE: Consumer, pediatrics, family practice. ISSUE: The Food and Drug Administration (FDA) notified healthcare professionals, their provider organizations, and caregivers for infants that prescription oral viscous lidocaine 2% solution should not be used to treat infants and children with teething pain. The FDA is requiring a Boxed Warning to be added to the prescribing information (label) to highlight this information. Oral viscous lidocaine solution is not approved to treat teething pain, and use in infants and young children can cause serious harm, including death. Topical pain relievers and medications that are rubbed on the gums are not necessary or even useful because they wash out of the baby’s mouth within minutes. When too much viscous lidocaine is given to infants and young children or they accidentally swallow too much, it can result in seizures, severe brain injury, and problems with the heart. Cases of overdose due to wrong dosing or accidental ingestion have resulted in infants and children being hospitalized or dying. BACKGROUND: In 2014, the FDA reviewed 22 case reports of serious adverse reactions, including deaths, in infants and young children 5 months to 3.5 years of age who were given oral viscous lidocaine 2% solution for the treatment of mouth pain, including teething and stomatitis, or who had accidental ingestions. See further details in the FDA Drug Safety Communication. RECOMMENDATION: Healthcare professionals should not prescribe or recommend this product for teething pain. Parents and caregivers should follow the American Academy of Pediatrics’ recommendations for treating teething pain.
vol. 32 • no. 9 • October 2014
• Use a teething ring chilled in the refrigerator (not frozen). • Gently rub or massage the child’s gums with your finger to relieve the symptoms. The FDA is also encouraging parents and caregivers not to use topical medications for teething pain that are available over the counter because some of them can be harmful. The FDA recommends following the American Academy of Pediatrics’s recommendations to help lessen teething pain.
Home Healthcare Nurse
Copyright © 2014 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
535
