Protecting Children from Carbon Monoxide Poisoning
See the Centers for Disease Control and Prevention (CDC) Health Advisory, "Hurricane Harvey – Clinical Guidance for Carbon Monoxide (CO) Poisoning".
The American Academy of Pediatrics (AAP) encourages pediatricians, families, and communities to work together to protect children against carbon monoxide poisoning, especially in times of a crisis or disaster. The risk of carbon monoxide poisoning increases after disasters when gasoline- or diesel-powered generators may be more frequently used to supply power. Although carbon monoxide poisoning can be fatal to anyone, children, pregnant women, and older adults as well as persons with chronic illness are particularly vulnerable to carbon monoxide poisoning. When home generators were used to supply electricity after Hurricane Ike, one child died and 15 other children were injured as a result of carbon monoxide poisoning. The CDC recognizes this hazard and offers Clinical Guidance for Carbon Monoxide Poisoning After a Disaster.
Carbon monoxide is a colorless, odorless, poisonous gas that can cause sudden illness and death if present in sufficient concentration in the ambient air. Unintentional carbon monoxide poisonings accounted for approximately 400 to 500 deaths (all ages) and more than 15,000 emergency department visits in the United States annually according to the AAP Council on Environmental Health manual "Pediatric Environmental Health, 3rd Edition".
Prevention of Exposure
Primary prevention of carbon monoxide poisoning requires limiting exposure to known sources. Proper installation, maintenance, and use of combustion appliances can help to reduce excessive carbon monoxide emissions. Carbon monoxide detectors that meet the UL standard 2034, when used properly, may provide early detection and warning and may prevent unintentional carbon monoxide related deaths. The US Consumer Product Safety Commission recommends installation of a carbon monoxide detector in the hallway near every separate sleeping area of the home.
Preventing Problems With Carbon Monoxide in the Home and Other Environments
Fireplaces and Woodstoves
- Forced-air furnaces should be checked by a professional once a year or as recommended by the manufacturer. Pilot lights can produce carbon monoxide and should be kept in good working order.
- All fuel-burning appliances (eg, gas water heaters, gas stoves, gas clothes dryers) should be checked professionally once a year or as recommended by the manufacturer.
- Gas cooking stove tops and ovens should not be used for supplemental heat.
- Fireplaces and woodstoves should be checked professionally once a year or as recommended by the manufacturer. Check to ensure the flue is open during operation. Proper use, inspection, and maintenance of vent-free fireplaces (and space heaters) are recommended.
- Fuel-burning space heaters should be checked professionally once a year or as recommended by the manufacturer.
- Space heaters should be properly vented during use, according to the manufacturer's specifications.
Automobiles/Other Motor Vehicles
- Barbecue grills and hibachis should never be used indoors.
- Barbecue grills and hibachis should never be used in poorly ventilated spaces such as garages, campers, and tents.
Generators/Other Fuel-Powered Equipment
- Regular inspection and maintenance of the vehicle exhaust system are recommended. Many states have vehicle inspection programs to ensure this practice.
- Never leave an automobile running in the garage or other enclosed space; Carbon monoxide can accumulate even when a garage door is open.
- Follow the manufacturer's recommendations when operating generators and other fuel-powered equipment.
- Never operate a generator indoors or near an open window when the generator is outdoors.
- Always set up a generator at least 20 feet from your house.
- For additional information, view the CDC fact sheet in English and Spanish.
- Be aware that carbon monoxide poisoning can mimic symptoms of sea sickness.
- Schedule regular engine and exhaust system maintenance.
- Consider installing a carbon monoxide detector in the accommodation space on the boat.
- Never swim under the back deck or swim platform as carbon monoxide builds up near exhaust vents.
The symptoms and signs of carbon monoxide poisoning are variable and nonspecific. The most common symptoms of carbon monoxide poisoning are headache, dizziness, weakness, nausea, vomiting, chest pain, and altered mental status. Symptoms of severe carbon monoxide poisoning include malaise, shortness of breath, headache, nausea, chest pain, irritability, ataxia, altered mental status, other neurologic symptoms, loss of consciousness, coma, and death.
In patients treated for carbon monoxide poisoning, lethargy and partial or complete loss of consciousness were reported more frequently in children than in adults. Fetuses, infants, and pregnant women may be particularly sensitive to carbon monoxide. Infants and children have an increased susceptibility to carbon monoxide toxicity because of their higher metabolic rates. Children with existing pulmonary or hematologic illness (eg, anemia) that compromise oxygen delivery are more susceptible to adverse effects at lower levels of carbon monoxide exposures than healthy individuals.
These situations can increase during times when extreme temperatures increase the use of the above-mentioned items or when natural disasters such as floods or hurricanes/storms lead to increased use of gas stoves or generators.Treatment
Patients who have been exposed to carbon monoxide should be removed from the source immediately. Treatment consists of supplemental oxygen, monitoring for cardiac dysrhythmias, and in severe cases, ventilator support. When the patient poisoned by carbon monoxide is cared for, consultation with a pediatric critical care specialist familiar with treatment options, including hyperbaric oxygen therapy, is suggested. Providers should also consult with the Poison Control Center 1-800-222-1222 or the Divers Alert Network as treatment with hyperbaric oxygen needs to be individualized.
To protect children in disaster situations, it is important for pediatricians to talk with families, especially those in disaster-prone areas about How to Prevent Carbon Monoxide Poisoning
and other Family Preparedness Planning