Issue Briefs

(1) Toys-R-Dangerous?

December 2007

Toys-R-Dangerous?

By Joan Dawson, MPH and Diana Zuckerman, PhD

An increasing number of toys and products have been pulled off the shelves this year because they were found to be harmful to children. According to Consumers Union, toy recall levels have reached a record high in 2007, with over 20 million toys recalled for having lead or other hazards. Some swings, cribs and bicycles were also found to be unsafe. The bottom line: parents need to be more careful when they buy or use these products, because they can’t count on government inspectors to ensure 100% safety.

Who Makes Sure That Toys and Children’s Products are Safe?

The Consumer Product Safety Commission (CPSC) is an independent federal regulatory agency whose job is to protect the public from products that could pose electrical, chemical or mechanical hazards. This includes toys, household items, furniture, bicycles and many other products used by children and families.

The CPSC develops and enforces standards, recalls products, conducts research and educates the public. This is an enormous responsibility, and their budget has not kept up with the work load. Fewer inspections means that too many products are being placed on retailers’ shelves without being adequately tested.

CPSC budget problems are not the only reason to be concerned about the safety of toys and other products. For example, the agency has been criticized for weakening safeguards for all-terrain vehicles in 1998, which resulted in thousands of people dying from ATV accidents since then.

Companies themselves are not required to test many of the products that are sold in stores and brought to our homes. As a result, about 33 million people are injured by consumer products each year. So in August, the CPSC made a list of the top five hidden home hazards to help the public identify potential dangers. Topping the list was magnets in toys and coming in second was recalled products (tip-overs, window coverings and pool drains also made the list).

Magnets and Toys

Magnets have been used in toys for a long time, but companies are now using smaller and more powerful magnets referred to as “rare-earth” magnets. These magnets are found not only in toys but also in some jewelry and refrigerator magnets. The problem arises when children swallow them. According to CPSC, if two or more are swallowed, these magnets “can attract in the body and twist or pinch the intestines, causing holes, blockages, infection, and death, if not treated properly and promptly.” Symptoms include stomach pains, nausea, vomiting and diarrhea. These magnets may be very small, most parents won’t even see them, and the children don’t realize what they are swallowing, so it can be difficult to diagnose.

Mattel’s Polly Pocket play sets were recalled in November 2006 for having tiny magnets in the dolls’ hands and feet, clothing, hair accessories and other accessories. Some of the magnets had fallen out of 170 sets. They were accidentally ingested by three children who, as a result, required surgery.

Lead and Toys

One of the most common reasons for recalls this year was the presence of lead in toys. Jewelry, bibs, lunch boxes and clothes were also been found to contain this metal. When lead enters the human body, whether inhaled or eaten, it can affect almost any organ or system. In young children, lead exposure can lead to developmental delays or learning disabilities.

You can have toys tested for lead yourself with home kits. Although the CPSC warns that such tests may be inaccurate, Consumer Reports believe they are useful and fairly easy to use – with a little practice. However, they agree with CPSC that the kit can detect lead only on the surface of a toy, not underneath it. If the test is negative, but you have reason to believe the toy contains lead, it can be tested by a professional (but it will not be returned). The home kit is unable to test metal jewelry, but Consumer Reports warns against buying any jewelry for children because children are likely to suck on or swallow it and cheap metal jewelry is likely to contain lead.

Some of the Toys Recalled for Lead ContaminationMattel’s Barbie Dolls and Accessories – In September 2007, Mattel Inc. recalled 800,000 Barbie dolls and 675,000 accessories because the toys contained lead paint and small magnets that could be swallowed by young children.

Fisher-Price’s Sesame Street and Dora the Explorer Dolls – In August 2007, Fisher-Price recalled nearly a million Sesame Street and Dora the Explorer dolls and play-figures because they contained lead paint.

RC2 Corp.’s Thomas the Tank EngineToys – In June 2007, RC2 Corp. recalled about 200,000 Thomas the Tank Engine wooden railway toys because the paint contained lead.

Other Dangers in Toys

Aside from magnets and lead, toys can be hazardous if they cause injuries such as choking, strangulation, burning or poisoning.

Aqua Dots craft kits (also known as Aqua Beads) were recalled after two young children ingested the small colored beads and became comatose. Researchers found that the coating on the beads contained a chemical that, when ingested, could break down into GHB, known as the date-rape drug, and cause coma, respiratory depression and seizures. Fortunately, the children have recuperated.

HealthyToys.org lists several chemicals, such as cadmium, chlorine, arsenic and mercury that consumers should know about. They tested products and found these chemicals in toys. In some cases, standards exist for safe levels but are not enforced.

Other Unsafe Products

The CPSC has jurisdiction over more than 15,000 types of consumer products used in and around the home, in sports, recreation, and schools. In addition to toys, these products include:

Household items, such as clothing, furniture, cookware and electrical devices
Outdoor products, such as sprinklers, lawn mowers, grills, and gardening equipment
Sports and recreation products, such as bicycles, tents, snowmobiles and golf carts
Child products, such as cribs, clothing, jewelry and strollers
Specialty products, such as vending machines and emergency lights

The CPSC has recalled two all-terrain vehicles (ATVs) this year. Some ATV companies are lobbying Congress to make the safety standards on ATVs mandatory rather than voluntary. Unfortunately, the voluntary standards have allowed cheaper and less safe vehicles to be marketed.

The CPSC is also supposed to regulate amusement park rides. Unfortunately, these rides are rarely inspected, and in the past ten years, for example, five deaths have occurred on the Sizzler ride. The CPSC, however, has yet to act.

The products that are not regulated by the CPSC include automobiles and other on-road vehicles, tires, boats, alcohol, tobacco, firearms, food, medicine, cosmetics, pesticides, and medical devices.

Unsafe Products for Your ChildBassettbaby Wendy Bellissimo Collection Convertible Crib – This crib was recalled in November 2007 after reports that the bolts that connect the corners of the crib can loosen, creating a gap and posing an entrapment and suffocation hazard.

Bumbo Baby Sitter Seats – This seat was recalled in October 2007 after reports that when it was placed on an elevated surface, the child could arch its back and flip out of the seat.

Huffy “Howler” and “Highland” Bicycles – These bicycles were recalled in October 2007 after reports that the crank could unexpectedly fall off, causing the rider to lose control, fall and sustain injuries.

Razor USA E300 Electric Scooters – This scooter was removed from the market in October 2007 after reports that the handlebar could detach, causing the rider to fall off.

Fisher-Price Rainforest Open Top Take-Along Swing – This swing was recalled in May 2007 after reports that babies could get stuck between the seat and the frame, causing cuts and bruises.

What Can You Do to Keep Your Kids Safe?

1. Check to see if any of your child’s toys or products have been recalled. You can do this by visiting the Consumer Product Safety Commission’s Web site at http://www.recalls.gov. If the toy or product has been recalled, check the guidelines for what to do next as procedures vary. And, if you find recalled products on the shelf the next time you go shopping, notify the retailer. If the toy has been recalled for lead, throw it out immediately but don’t panic. If you have purchased it recently, it may not have done any harm. If, however, your child has played with it for a while or parts of it have broken off, have a doctor test your child’s blood for lead.

2. Throw away toys that you believe may contain harmful chemicals. These would include toys with chipped paint, broken parts, or worn down plastic. If you have any doubts, throw it away. You can, and should, clean toys regularly in case any household dirt or dust (that might contain lead) has contaminated them.

3. Be careful which toys you buy. Just because they are for sale doesn’t mean they are safe. Most toys today are coming from China. This is also where most of the recalls have occurred. If you’d like, you can try to find toys made in the USA or even make them yourself. If you do, just be sure to use materials that state they are “non-toxic.” Also, avoid buying vintage toys that may have been painted with lead-based paint. If you have any at home, store them out of reach of young children.

For More Information

Coalition to End Childhood Lead Poisoning
www.leadsafe.org

Consumer Product Safety Commission
www.cpsc.gov
www.cpsc.gov/cpscpub/prerel/prerel.html

Department of Health and Human Services
www.atsdr.cdc.gov/tfacts13.html

HealthyToys.org
www.healthytoys.org

(2) CT Scans and Cancer Risks

Issue Brief for the National Research Center for Women & Families

CT Scans and Cancer Risks

By Joan Dawson, MPH

A growing number of medical reports warn that the dramatic increase in the use of CT scans may result in an increase in cancer. For patients, the question is: when do the benefits of CT scans outweigh the increased risk of cancer?

A CT scan, also called computed axial tomography (CAT) scan, uses x-rays to create three-dimensional images of an organ, region of the body, or the entire body. The patient lies down and goes into the scanner that then rotates around the body to take images. The whole procedure can be done in a few minutes. In fact, the latest models of scanners can scan the body from head to foot in less than thirty seconds, according to the National Institutes of Health.

CT scans have many benefits. They can be used to diagnose health problems in children or to screen for diseases in adults. They can provide images of the head, blood vessels, bones, abdomen, lungs, liver, and more recently, the heart. CT scans provide greater detail than x-rays, and they can sometimes be used instead of exploratory surgery.

Because of these advantages, the number of CT scans went from three million in the U.S. in 1980 to 67 million in 2006. Of these, approximately four million scans were done on children.

Experts warn, however, that a CT scan exposes patients to much more radiation than an x-ray. For example, a chest CT scan exposes a patient to 150 times as much radiation as a chest x-ray. This increase in exposure to radiation may increase the risk of cancer, especially for individuals who have several CT scans. While there have been no studies to demonstrate exactly how much CT scans increase the risk of cancer, experts have estimated the risks based on studies of the survivors of the atomic bombs dropped in Hiroshima and Nagasaki, Japan.

From those data, experts expect there will be one additional case of cancer in approximately every 1,000 to 2,000 scanned patients. A child’s developing body is much more sensitive to radiation than an adult’s, so children will be more vulnerable, perhaps experiencing one case per every 500 scanned. Younger people will be more at risk than older people. And young women will have the highest risk of all, according to Andrew Einstein of Columbia University, reporting his findings in the Journal of the American Medical Association in 2007; he estimates that 20-year old women will have one additional case of cancer for every 143 scanned. (1)

It is estimated that one-third of all CT scans in the U.S. are unnecessary. Sometimes doctors order them to be cautious or to meet a patient’s demand. A study by Lee et al (2004) cited in the New England Journal of Medicine found that, in fact, most (75%) radiologists and emergency-room physicians underestimate the radiation dose and many (53% radiologists and 91% emergency-room physicians) may not believe CT scans increase the lifetime risk of cancer. (2)

The benefits of CT scans will clearly outweigh the risks for many patients, so the goal is for patients and physicians to be aware of the risks and benefits and discuss them before a decision is made. When a physician recommends a CT scan, for instance, patients should ask if an ultrasound or MRI could be used instead. Let your doctor know that you are concerned about the risks from radiation, especially on children.

Recently, the American College of Radiology joined with the Alliance for Radiation Safety in Pediatric Imaging to launch the “Image Gently” campaign. The goal is to inform health professionals about ways to lower radiation doses in children. We want to share that message with parents, consumers, and patients, to help us all reduce any unnecessary risks from radiation exposure and help us all live healthier lives.

Notes:

Einstein AJ, Henzlova MJ, Rajagopalan S. Estimating risk of cancer associated with radiation exposure from 64-slice computed tomography coronary angiography. JAMA 2007;298(3):317-323.