03-06-06 Children in Meth Labs

What is the Initial Evaluation of Children Living in Homes with Methamphetamine Labs?

Recently, there has been media attention regarding the medical community’s evaluation of children living in homes where there is a methamphetamine lab. The medical community is being asked to assess the child that has been found in such a house. Multiple protocols have been proposed, based on little research data.  Protocols range from “do nothing” to “do everything,” including CT scans, drug analysis, etc. 

A national committee from within the American College of Medical Toxicology (ACMT) is currently addressing this issue (supported by the Agency for Toxic Substance and Disease Registry (ATSDR)).  Hopefully, within a year, there will be some guidelines about many aspects of methamphetamine labs (including the initial evaluation of children).  Until these guidelines are announced, the Medical Toxicologists at Tennessee Poison Center make the following recommendations.

The most common poisons found in methamphetamine production sites include solvents, ephedrine, acids, iodine, lye, phosphorus, and salt.

The dangers from living in a home that houses a methamphetamine lab include:

1)  injury or death from fire or explosions from flammable materials used in the lab

2)  poisoning from accidental ingestion or absorption of accessible chemicals

3)  upper respiratory symptoms, headaches, rashes from exposure to chemicals in the environment (inhalation , skin contact)

4)  chemical burns

5)  long term health effects, such as asthma, neurologic problems

6)  nutrition

7)  emotional or physical neglect

Questions regarding a child found in the home producing methamphetamine are the need for decontamination and the need for an immediate evaluation by a health care provider.

Decontamination

If there is residue on the clothes of an asymptomatic child, clothing can be changed prior to transfer.  Alternatively, the children can be given something disposable to sit on (newspaper, diaper) and then change clothes later on if need be.  The children should take a shower at some time, but do not need to be decontaminated at the scene.  Take the least traumatic approach.  Do not take toys or any materials from the house.

Initial Evaluation

Need for immediate evaluation by a health care provider can be determined by assessing if the child is asymptomatic or symptomatic. 

  • Asymptomatic

Asymptomatic children do not need to be immediately evaluated by a physician. If the paramedic or policeman find a child that is completely asymptomatic, there is no need to take that child to the emergency department (ED). If there is a requirement for the child to be evaluated by a physician before the child can be placed in the appropriate social setting, then ED evaluation requires only a history and physical exam.

Children can subsequently be followed-up at their pediatrician’s office where issues such as neglect can be addressed. 

  • Symptomatic

For the symptomatic child, the workup should include a physical exam and history.  The laboratory testing should be based on PE findings or concerning symptoms.  A medical toxicologist is always available by calling Tennessee Poison Center. Either Dr. Williams or I will discuss specific aspects of the case.

Although there are concerns about the long-term effects of these exposures, there is not an initial evaluation or intervention that can identify or change the long-term outcome.

We will be developing more extensive recommendations and disseminating them to all Tennessee emergency departments and pediatricians in the near future.

I am interested in any questions you would like answered in the Question of the Week.  Please email me with any suggestion at Donna.Seger@Vanderbilt.edu.

Donna Seger, MD

Medical Director

Tennessee Poison Center