LIQUID DETERGENTS PODS POSE RISK TO CHILDRENS EYE HEALTH

Liquid laundry and dishwasher detergent pods are an emerging source of chemical exposure in children. When squeezed or bitten into, these pods can burst and send detergent into the mouth, nose, and eyes. A new report published in the current issue of the Journal of the American Association for Pediatric Ophthalmology and Strabismus (AAPOS) cautions that these products should be kept away from children because the bursting detergent pods can cause significant corneal injury.

Detergent pods may offer a simpler way to do laundry, but they represent a source of potential danger when in the hands of a young child. Available in the European market for over a decade and first introduced to the American market in 2010, liquid detergent pods are brightly colored, which makes them attractive to young children who mistake them for toys.

Michael E. Gray, MD, and Constance E. West, MD, from the Abrahamson Pediatric Eye Institute at Cincinnati Children’s Hospital Medical Center, began tracking ocular injuries from detergent pods after noticing an increase in patients over the course of several months beginning in 2012. Ten children, all under 4 years of age, were treated for eye injuries stemming from burst detergent pods. Over the same time frame, 21 other children were seen in the emergency room for injuries caused by ingestion of the detergent contained in the pods.

For the children with eye injuries, two cases involved the child biting down on the pod, seven cases resulted from children squeezing the pod in their hands, and in the last case, the cause was unknown. All ten children with eye injuries presented with significantly bloodshot eyes, although no limbal ischemia or clinically significant conjunctival chemosis was found. Corneal abrasions were found in all of the cases, with defect sizes ranging from 3 mm in diameter to a nearly complete corneal epithelial defect. In addition, three children also had mild periorbital edema or erythema ipsilateral to the corneal abrasion.

During ophthalmologic examination, the ocular surface pH was measured and found to be neutral in all cases, but as study co-author Dr. Gray, Pediatric Ophthalmologist and Assistant Professor, Division of Pediatric Ophthalmology at Cincinnati Children’s and UC Department of Ophthalmology, points out, the pH levels among different brands can vary. “Alkaline injury should also be suspected in association with the ocular cases. However, reported pH from Material Safety Data Sheets (MSDS) of different brands of pods is variable. The pH of some brand name pods is close to neutral (6.8 – 7.6), whereas other brands are considerably alkaline (8.0 – 11.0).”

The report also explains that because these pods are designed to be concentrated, they often contain higher levels of surfactants than traditional detergent, making them more likely to cause injury when they are ingested or when the chemicals enter the eye.

In the study, all affected subjects were treated with irrigation and topical antibiotic ointment. The recovery period for the children averaged just under four days, and none of the patients experienced additional complications or relapse.

While makers of these detergent pods have made changes to packaging to try to keep children out, not all brands adhere to the same safety standards. “Manufacturers have taken steps to prevent such injuries, such as warning labels and container lid safety features,” states Dr. West, Pediatric Ophthalmologist and Associate Professor, Cincinnati Children’s and UC Department of Ophthalmology. “These safety features are not always present, however, particularly with off-brand or generic laundry pods that might be sold at discount stores.”

As convenient as detergent pods may be, families with young children need to take safety precautions. As Dr. Gray concludes, “This consecutive case series highlights the risk of ocular injuries from laundry detergent pods in the United States. Parents or caregivers must be aware of the potential for ocular injury from these pods and prevent access to these chemicals by young children.”

FIGHTING PARENTS HURT CHILDRENS ABILITY TO RECOGNIZE AND REGULATE EMOTIONS

Exposure to verbal and physical aggression between parents may hurt a child's ability to identify and control emotions, according to a longitudinal study led by NYU's Steinhardt School of Culture, Education, and Human Development

The findings, which appear in the journal Development and Psychopathology, also suggest that household chaos and prolonged periods of poverty during early childhood may take a substantial toll on the emotional adjustment of young children.

"Our study points to ways in which aggression between parents may powerfully shape children's emotional adjustment," says C. Cybele Raver, professor of applied psychology at NYU Steinhardt and the study's lead author. "Arguing and fighting is psychologically stressful for the adults caught in conflict; this study demonstrates the costs of that conflict for children in the household as well."

Research has demonstrated that exposure to conflict and violence in the home can shape children's neurobiological, cognitive, and behavioral responses. Increased hypervigilance may support children's safety in the short term, but can be detrimental for their long-term emotional adjustment. For instance, children who hear or witness their parents fighting may have trouble regulating their emotions in less risky situations, such as a classroom.

While earlier research established a link between parental conflict at a single point in time and children's adjustment later in life, Raver and her colleagues saw a need to explore how children may be adversely affected by prolonged exposure to this aggression.

"We also were interested in other forms of adversity in the children's environment, including poverty and household chaos, that could affect their emotional adjustment, since few studies have considered multiple factors," says study author Clancy Blair, professor of applied psychology at NYU Steinhardt.

In the study, the researchers measured children's exposure to several forms of adversity, and how they predicted their ability to recognize and regulate negative emotions, such as fear and sadness. The researchers followed 1,025 children and their families living in eastern North Carolina and central Pennsylvania, two geographical areas with high poverty rates.

The researchers evaluated the families in a series of home visits from the time a child was two months old through 58 months of age. They gathered data through parent questionnaires, administering tasks to the parents and children, and measuring the level of household chaos -- including the number of times children moved, changes in caregiver, noise levels, cleanliness, and the number of people compared to the number of rooms -- versus stability. At approximately 58 months of age, the researchers assessed the children's ability to correctly recognize and identify emotions.

Verbal and physical aggression between parents from infancy through early childhood significantly predicted children's ability to accurately identify emotions at 58 months of age. Higher exposure to physical aggression between parents was associated with children's lower performance on a simple emotions labeling task. Surprisingly, higher exposure to verbal aggression was associated with greater emotion knowledge among the children.

Prolonged exposure to aggression between parents was also linked to children's ability to regulate their own feelings of sadness, withdrawal, and fear, placing them at greater risk for symptoms of anxiety and depression later on.

Other forms of adversity also contributed to children's emotional adjustment. The higher the number of years spent in poverty, the lower a child's ability to accurately identify different emotions. Increased household chaos, especially disorganization, also lowered a child's ability to recognize emotions.

"This study shines a bright light on the importance of supporting parents as they navigate the ups and downs of partnership or marriage," says Raver. "Parents need help regulating their own feelings of anger, frustration, and worry when balancing the demands of work, family, and romantic partnership, especially when money is tight."