Most parents breathe a little easier while their children are at school, assuming that their kids are safely under the supervision of teachers and other qualified personnel.

This feeling of security might be misplaced, however according to recent studies that show an increasing number of children are at risk of exposure to poisons and pesticides, both inside the classroom and on the playground.

Pesticides, from disinfectants to herbicides and insecticides, are used on and around school property. Schools located in agricultural areas may also be exposed to toxic run-off and drift from neighboring farms.

Surprisingly, there are no current federal requirements on limiting pesticide exposures at schools. This fact may change, however, in light of new findings published in The Journal of the American Medical Association from the National Institute for Occupational Safety and Health and the U.S. Centers for Disease Control and Prevention (CDC), Cincinnati, regarding pesticide-related illnesses connected to exposure at school.

The researchers gathered the data by using three pesticide surveillance systems: the Toxic Exposure Surveillance System (TESS), the California Department of Pesticide Regulation (CDPR), and the National Institute for Occupational Safety and Health’s Sentinel Event Notification System for Occupational Risks.

The study tracked reports of pesticide-related illnesses in both children and full-time school employees from 1998 to 2002. During this time period, illnesses related to pesticide exposure at a school or from neighboring drift occurred in 2,593 cases.

The majority of the reported cases were mild and there were no reported fatalities. Most of the 2,500-plus cases were of “low severity,” meaning no medical intervention was needed. Symptoms usually included eye, skin, or upper respiratory tract irritation.

Roughly 275 cases were moderately severe. While they weren’t disabling or life-threatening, they did require medical treatment.

Fortunately, only three of the cases found were severe. These illnesses often require hospitalization, and may be life-threatening.

The researchers noted, however, that the actual incidence of pesticide-related illnesses may be considerably higher since certain symptoms of chemical exposure mirror those associated with other illnesses thereby leading to possible misdiagnoses.

A breakdown of the types of pesticides and the prevalence of illness linked to them was noted as follows:

• Insecticides: 35% of reported illnesses
• Disinfectants: 32% of reported illnesses
• Repellants: 13% of reported illnesses
• Herbicides: 11% of reported illnesses
• Fungicides, rodenticides and others: 9% of reported illnesses

Among those exposed to pesticides, nearly seven out of 10 cases were directly linked to pesticides used at schools. The rest were connected to pesticides from drift from neighboring farms.

Overall, researchers found that between 1998 and 2002, 27. 3-per-million full time school workers and 7.4-per-million children have acute pesticide-related illnesses.

Dr. Philip Landrigan, director of the Center for Children’s Health and the Environment, and the Department of Community and Preventative Medicine at Mt. Sinai School of Medicine in New York City says that a few factors contribute to children’s vulnerability to pesticide exposure.

According to Dr. Landrigan: “Children are more susceptible to pesticide exposure because they breathe more air pound for pound than adults, they play on the floor, and they live two feet off the floor, where pesticides linger, rather than five to six feet off the floor like adults.”

Children also spend much of their time playing on wooden playground structures and on decks. These surfaces, a Canadian Study revealed, may expose children to significant levels of arsenic.

Until 2003, the wood used to make such structures was treated with the preservative chromated copper arsenate (CCA). A study published in the October 2004 issue of Environmental Health Perspectives found that children who play on wooden structures treated with CCA were left with more arsenic on their hands than children playing on other wooden sets.

To collect data, researchers from University of Alberta examined the hands of 66 children playing in 8 CCA playgrounds and compared them to the hands of 64 kids playing in 8 CCA-free playgrounds. After play, children washed their hands in a bag containing water. The solution was then analyzed for the presence of arsenic.

On average, the researchers found that kids playing in CCA playgrounds had more arsenic on their hands (.5 mcg compared to .095 mcg) than the other children. The amount found from CCA playgrounds ranged as high as 3.5 mcg.

Further, long term studies are needed to determine the significance of the data. It is known that exposure to higher concentrations of arsenic (200 mcg/L) in drinking water have been tied to an increase cancerous tumor growth, and to the existence of skin and bladder cancer.  Below that level, meaningful research on the subject remains to be conducted.

Also unknown is how exposure to arsenic in drinking water compares to children’s exposure to small doses of arsenic on the playground.

Still, any level of exposure to a known carcinogenic toxin is unsettling, particularly if the exposure is occurring in a location where children spend a lot of time and are presumed to be safe.

But what are the possibilities for reducing the risk of illness and health problems to children due to exposure to the poisons and pesticides around them?

The researchers from University of Alberta urge parents to have their kids always wash their hands thoroughly after playing on structures that are coated with CCA.

Another possible solution is to coat the wood with an oil or water-based sealant so that the arsenic cannot get onto children’s’ hands.

The Environmental Protection Agency (EPA) revealed in May of 2004 that an ongoing study with the Consumer Safety Products Commission (CPSC) found that a yearly coating of such a sealant could cut down on arsenic exposure.

Such preventative steps are surely worth taking, given the potential hazards of arsenic exposure. According to Dr. James Roberts, M.D., M.P.H., an associate professor of pediatrics at the Medical University of South Carolina in Charleston; “Arsenic in children’s bodies is a long-term exposure and the outcomes are often caner at a much later age.”

Physicians, Roberts said, must be aware of the risks children’s exposure to the poison so that they can urge families to follow EPA recommendations on treating CCA-coated wood. At this point, it’s the only type of protection available.

In the case of pesticide exposure, study co-author Dr. Geoffrey Calvert, a medical officer with the National Institute for Occupational Safety and Health in Cincinnati, and colleagues suggest that better pest-management techniques, along with the creation of buffer zones between schools and neighboring farms could help reduce exposure and the risk of pesticide related illness, or at least manage it.

Better pest control techniques include more diligent attempts at pest prevention such as keeping kitchens and food areas clean and keeping food in airtight, sealed containers and fixing cracks and crevices where pests can access a building.

Toxic chemicals, therefore, should be a last resort rather than the first step taken to fend off pests. “Only after you’ve taken these measures do you then treat for specific pests, but only using pesticides with the lowest toxicity, and only by someone well-trained in using pesticides,” Calvert said.

The problem of drift should be addressed in cooperation between schools and farms in the area.  Pesticides should be applied when children and school employees are not on school grounds. Buffer zones between the farm and the school would also be helpful.

“These episodes are occurring far too often, and that’s really not acceptable,” said Landrigan of illness due to pesticide exposure.  “These episodes are preventable, and parents, educators, school boards, and community officials need to take aggressive steps to reduce pesticide exposure.”

Clearly, children deserve to be protected from exposure to toxic chemicals in those areas where there is an expectation of safety. Schools and playgrounds should be the last places where children are put at risk in the short-term from chemically-induced illnesses and in the long-term from life-threatening diseases.

Anything less than everyone’s best efforts in this area are simply unacceptable given the innocence of the victims and the enormity of the risks.

The nine children of Howard R. Hoehmann Sr., a man who died while being treated for pneumonia at Nyack Hospital, have been awarded $820,000 in a malpractice lawsuit against two of the doctors who treated him.
According to court records, Hoehmann, a semi-retired construction contractor and real estate agent, was admitted to Nyack Hospital on April 12, 2000, for a mild case of pneumonia.

The antibiotics he was prescribed by his primary care doctors treated the pneumonia but caused a bowel infection. Drs. James S. Vela, and Stephan Goodman, specialists in gastroenterology, were called in to treat the infection.
Hoehmann’s condition worsened and he developed toxic megacolon, in which his colon was enlarged and infected. He died April 21, 2000.

The doctors, who intend to appeal, maintain the death of the 69-year-old patient was not related to the care and treatment they provided to him. 

The family’s attorney, said the doctors failed to do tests that would have revealed Mr. Hoehmann had developed colitis from the antibiotics and “missed every opportunity to diagnose and treat him."
The doctors, the family’s attorney said, "were negligent and careless in failing to treat and care for (Hoehmann) in accordance with accepted standards of medical care."

The jury awarded Hoehmann’s estate $750,000 for his pain and suffering and $70,000 for related damages and expenses.

"He didn’t have to die," said his son George. "If he had gotten proper care, he wouldn’t have died. It’s a just verdict. My father died an awful, awful death."

According to environmental groups, U.S. consumers should start monitoring their swordfish intake, just as they are watching their intake of salmon, because of rising levels of mercury found in swordfish at many supermarket chains.

Tests done at the University of North Carolina laboratories found that swordfish being sold at Safeway, Albertsons and Whole Foods have, on average, 10% more mercury than federal regulations permit.

Out of 24 samples tested, the average was 1.1 parts per million. Federal limits are set at 1 part per million. 9% of the samples had twice the limit.

In response to these findings, environmental groups are seeking further government tests.
They are also asking that warning labels be put on the products in all stores, instead of just some stores.

Methylmercury, which is the form of mercury found in some fish, is dangerous to humans. If a human is exposed to excessive amounts of mercury, he or she might suffer: damage to the nervous system; kidney damage (changes in kidney function); damage to developing fetuses; tremors; loss of sensation; irritability; skin rashes; eye irritation; an memory problems.

Exposure to small amounts of mercury in its various forms and compounds is normal, and happens regularly. If you stay within the safety limit of 1 part per million (food and drink), you have nothing to worry about.

Mercury poisoning, however, is a more serious situation. It can occur through breathing mercury vapor or handling droplets from a spill. Extreme caution should be used in cleaning up such spills so as to avoid dispersing toxic mercury vapor.

Mercury is a heavy metal which is poisonous to humans and animals. Two studies in the November 2002 issue of the New England Journal of Medicine presented contradictory findings about possible heart-related dangers from eating mercury-laden fish.

Past research, however, has shown that mercury found in fish can have harmful effects on the developing brain of a child or fetus. Thus, pregnant women are strongly cautioned to avoid eating the type of large, deep-sea predatory fish which are most prone to contain high concentrations of mercury. These include swordfish, albacore tuna, shark, and bluefish.

Other recent studies dealt with the long term effects of mercury exposure on the hearts of middle-aged and elderly men. While one study found that men who had suffered a heart attack had higher levels of mercury, the other found no correlation between mercury level in the body and the risk of developing heart disease.

In April of 2002, researchers at the Glasgow Royal Infirmary in Scotland conducted a study of 180 dentists and concluded that dentists are more likely to suffer memory and kidney problems as a result of long term exposure to the mercury used in tooth fillings.

The test group had up to four times the normal level of mercury in their urine and nail samples. While fillings can emit vapors that are harmful to both dentists and their patients, the dentist is more likely to experience health-related complications such as Alzheimer’s disease since they are subjected to ongoing exposure to the mercury.
Dental associations, however, claim that the mercury in fillings is safe when it is mixed with other metals.

If you believe that you have been exposed to significant amounts of mercury, you should ask your doctor to perform either a heavy metal blood test or hair test to determine the level of mercury in your body.

Some symptoms of an elevated mercury level are hair loss, tiredness, and short-term memory loss. In most cases, the effects of an elevated mercury level are reversible within a few months after the source of the mercury is eliminated.

An elderly Massachusetts man entered Brockton Hospital in Boston with bipolar disorder. He was lucid and had no life-threatening illnesses. Unfortunately, four days later he was dead; killed by a massive dose of the wrong medication.

The patient was given 60 times the recommended dose of Librium when he was supposed to have received Lithium.

Even after a nurse discovered the initial mistake, the hospital continued to give the man other antidepressants and sedatives. He also received two doses of antibiotics over six hours late.

As to be expected, the hospital attempted to engage in damage control. When asked if the medication errors contributed to the death, a Hospital spokesman told The Patriot Ledger that autopsy results showed that the man had died of pneumonia.

According to the same spokesman: "When the error was found the doctor and the patient’s family were immediately notified. Brockton Hospital immediately launched an investigation and has taken several steps to ensure that this will not happen again."

The errors started when a pharmacist ordered Librium, a sedative taken for anxiety, for the patient instead of Lithium, which he was the drug actually prescribed for his bipolar disorder.

Amazingly, the pharmacist told investigators that even though he realized his mistake immediately, after failing to reach a nurse by telephone, he “forgot to follow through” on the matter. There was plenty of time in which to correct the mistake since the medication was not administered until the next morning.

While the two drugs have similar sounding names, the safe dosage for each is vastly different. A safe dose of Lithium runs up to 600 milligrams a day. The recommended dose of Librium for elderly people, however, is but 5 milligrams two to four times daily.

Thus, the patient received 300 milligrams of Librium, a full 60 times the safe dose of a drug he wasn’t even supposed to receive.

In the world of high stakes head-to-head Texas Hold’em Poker, the ultimate bluff or sign of confidence, as the case may be, is for a player to go “all in.”

Before doing so, however, a player will ponder the odds very carefully since the move is a decisive one after which the players simply stand up to watch the hand be dealt out face up. If the player who went “all in” wins, he doubles his money. If he loses, he leaves the table with nothing.

In the legal equivalent of going “all in,” Merck has presumably pondered the odds and decided to let billions of dollars in potential liability hinge on one jury trial that begins tomorrow in its home state of New Jersey. Make no mistake; the outcome of this case will either put Merck back in the game or threaten the pharmaceutical giant’s very existence.

As I have pointed out in previous articles and editorials, it should not have come as a surprise to Merck to find itself in the serious predicament it now faces.  Merck can take the position that it was always concerned with safety and that it only pulled Vioxx off the market after there was evidence that a cardiovascular risk existed, but the mountain of evidence is clearly to the contrary.

Thus, Merck has had to make a decision as to whether to put each case to the test at trial or to settle the bulk of the cases and try only the cases that are least likely to succeed.

Even a decision that the company is “in this for the long haul” doesn’t mean that at all. If Merck were to lose the next several trials, the war would be over.  Merck would have to fold its tents and settle the rest of the cases.

Here is what Merck now faces:

•Almost 5,000 U.S. personal injury cases split between a class-action and individual lawsuits;
•Cases from England;
•Cases from Australia;
•Cases from Israel;
•Cases from Canada;
•An action by the state of Texas charging Merck defrauded the state out of hundreds of millions of dollars in Medicaid payments by misrepresenting the safety of Vioxx for several years.

In addition to $168 million in damages, the state is seeking additional civil penalties. Texas Attorney General Greg Abbot believes the state can prove total damages in excess of $250 million including treble (triple) reimbursement of $56 million (or $168 million) for five years of filled Vioxx prescriptions. Other states are planning to follow Texas’ lead.

•A national class-action covering every private third-party payer that allowed members of its health benefits plan to buy Vioxx. Merck could face a judgment of billions of dollars if it loses the case brought by the International Union of Operating Engineers Local 68 Welfare Fund.

Most Vioxx purchases were made through health plans run by insurance companies and health maintenance organizations and the union’s case could therefore encompass millions of consumers who took the popular painkiller that’s been linked to increase risk of heart attack and stroke. Unlike the individual personal injury cases, Local 68 lawyers do not have to prove any physical injury.

Under state law, all that needs to be shown is that third-party payers were influenced by unconscionable Merck business practices, such as deceptive marketing and promotion of Vioxx (and is there plenty of that). If the union wins, all third-party payers nationwide can recoup payments to Merck as well as treble damages and attorney fees. These money damages could run as high as $10 billion or more.

•Congressional investigations; and
•Potential stockholder derivative lawsuits on behalf of investors who regard Merck’s actions with respect to Vioxx as having seriously diminished the value of their investments in the company  as well as the reputation and stability of the company itself.

There are additional factors that make this next trial a huge gamble for Merck.

The plaintiff is an ex-Marine, who received two Purple Hearts for battle injuries received in Vietnam, who was taking Vioxx for knee pain related to one of those wounds.

Moreover, unlike the Texas case that involved an arrhythmia, or irregular heartbeat and not a heart attack, this plaintiff suffered a myocardial infarction (heart attack) which is precisely the injury Vioxx use has been linked to.

Originally, Merck had taken the position that it intended to litigate every case to conclusion. Following the $253 million Texas verdict, the company’s lead attorney hinted at the possibility of settling some cases.

As numerous additional class-actions started to take shape in England, Australia, Canada, and Israel, however, settlements may no longer have seemed a viable way to approach the problem. The domino-effect would set billions of dollars in exposure in motion.

Between all of the actions outlined above, the price tag for buying out of the debacle could actually approach the astronomical figures speculated about by financial and legal experts for the past year. $20, $30, or even $50 billion would no longer be out of the realm of possibility.

Such amounts could easily exceed Merck’s insurance coverage and financially cripple the world’s third largest drug maker. They could hamper product development as well as Merck’s ability to partner with smaller companies in joint ventures.

Massive settlement payments could also enrage disgruntled shareholders who have already suffered significant losses since last October.

Thus, while the downside risks to Merck are great, the company’s decision to return to its hard-line position is not all that surprising.

If Merck is able to win this second trial in its home state, where a local jury might not want to bring one of the state’s largest private employers to its knees, the tide would change dramatically.

No longer would the first trial be looked upon as the beginning of the end. It could now be explained away as little more than an aberration wherein a working-class jury ignored science and medicine in favor of sympathy and suspicion.

That verdict might even be reversed on appeal since the injury was not among the ones attributed to Vioxx.
To help put the best possible team on the field; Merck (and its insurers) added Philip Beck to its legal team. Beck represented President Bush in the 2000 election fight.

A win would change everything. Plaintiffs and their attorneys would have to consider the potential of losing their cases. Moreover, smaller settlements would then be possible. Merck would regain leverage and stabilize the litigation mess it finds itself in around the country (and world).

Of course, a loss would raise the specter of an avalanche of unfavorable (and quite large) verdicts. Future trials might become little more than “rearranging deck chairs on the Titanic.” The possibility of small, or even reasonable, settlements would evaporate.

There would also be the potential that courts (especially in Texas and New Jersey) would start applying the doctrine of “collateral estoppel” to specific issues involving Merck’s liability thereby preventing the company from re-litigating them over and over again hoping to convince different juries to reach different results on the same evidence.

Fraud actions by medical insurers, unions, and state Medicare systems would zero in for the kill. Merck shareholders would be making battle plans. Indeed, for Merck a loss would be like having one foot in the grave and the other on a banana peel.

So, while the game will only be starting on Monday morning, Merck has already decided to go “all in.”

A placebo-controlled study conducted at UCSF reveals two popular weight loss supplements that are promoted as “ephedra-free” and safe for dieters could have harmful effects on some people.

The findings are published in this month’s issue of the American Journal of Medicine.

Both of the weight loss products tested contain Citrus aurantium, or bitter orange extract, a substance that is rapidly replacing ephedra in dietary supplements since its ban by the FDA last year due to concerns about severe health effects of the herbal supplement.

(Although a federal judge lifted the ban, ephedra has gradually been phased out by many supplement manufacturers concerned with potential civil liability for injuries and deaths blamed on the supplement.)

In the first clinical study of the effects of these newly formulated dietary supplements, researchers monitored blood pressure, heart rate, moods, and emotions of 10 healthy adults.

Single doses of both Xenadrine EFX and Advantra Z caused increased heart rate among those tested. Xenadrine EFX also increased blood pressure and alertness. Neither product showed a serious effect on mood.

Researchers found that while Advantra Z contains only bitter orange, one dose of Xenadrine EFX has many other ingredients, including as much caffeine as found in 3 cups of coffee.

They concluded that the increased blood pressure Xenadrine EFX caused did not come from the caffeine alone, but was probably due to the combination of other ingredients of the supplement.

According to Christine Haller, MD, UCSF assistant professor of medicine and lead author of the paper: "These findings indicate that ephedra-free dietary supplements could have some of the same adverse health effects associated with previously available ephedra products, such as Metabolife 356 and Ripped Fuel."

Until longer-term studies of these weight loss supplements are conducted, doctors should alert patients to the potential dangers of ephedra-free dietary supplements and should monitor blood pressure in people who choose to use them.

A new study finds that the procedures used to obtain and examine tissue for a cancer diagnosis may lead to a misdiagnosis in up to 12% of patients. 

The study is published in the November 15, 2005 issue of CANCER, a peer-reviewed journal of the American Cancer Society.

The frequency and cause of errors in cancer diagnosis has not been well studied due to the lack of national standards for error detection.  Dr. Stephen S. Raab, M.D. of the University of Pittsburgh School of Medicine and his colleagues decided to look at the frequency, cause, and impact of errors in cancer diagnosis.  They reviewed tissue specimens, pathologist’s findings, and medical records from four medical institutions in the mid-Atlantic and Midwestern regions of the country.

Patients often have multiple tests in order to diagnose cancer, and the researchers reviewed patient material when the diagnoses differed on multiple tests from the same patient.

The majority of errors were a result of poor specimen collection, while the proportion of errors caused my pathologist’s misinterpretation ranged from 5 to 50 %.  When pathologists reviewed specimens from other institutions they frequently disagreed with the assignment of error cause or the type of patient harm that the error was determined to have provoked.

According to HealthDay, the study’s author, Dr. Stephen Raab, issued a note of caution about patient harm.  “I want to make clear that the major consequence is not that patients unnecessarily have organs removed or have a false diagnosis of cancer.  Fortunately, patient symptoms almost always lead clinicians to do the right thing and retest, and this will lead to finding the cancer and a proper diagnosis.”

Based on their research, Dr. Raab and his colleagues found that the potential number of Americans who encounter diagnostic errors is large, in the range of 300,000 cancer patients annually.

The researchers say that the variation in clinical environments impairs the ability to truly understand the error causes.  To that end, “the standardization and uniform reporting of errors in cancer diagnosis is a first step in improving safety,” conclude the authors.

In a physician’s advisory dated October 6, 2005, St. Jude Medical Inc. announced that it has discovered that background levels of atmospheric ionizing cosmic radiation, more commonly known as cosmic rays, can affect a limited number of its older generation implantable cardioverter defibrillator (ICD) products.

The ICD products are within the Photon and Photon Micro device families and in certain Atlas devices.

They identified a particular vendor-supplied memory chip that can be affected at a low frequency rate by background cosmic radiation.  Background cosmic radiation bombards the earth constantly.  While the earth’s atmosphere acts as a shield and absorbs much of the cosmic radiation, some amount of high energy particles do arrive at the earth’s surface. 

When the chip is exposed to background levels of cosmic radiation, it can trigger a high current drain condition, which will deplete the battery voltage rapidly.  This can result in loss of output for a period of up to approximately 48 hours.  During this period, a patient would be without pacing or defibrillation therapy.  

The following St. Jude Medical ICDs are involved:

•    Photon DR (Model V-230HV) (certain serial numbers)
•    Photon Micro VR/DR (Models V-194/V-232)
•    Atlas VR/DR (Models V-199/V-240)

Approximately 26,000 of these devices are in service. To date, the incidence rate is low and there have been no serious patient injuries or deaths reported to St. Jude Medical attributable to this anomaly.

St. Jude Medical began using a different vendor, who utilized a different memory chip design, in 2002.  According to St. Jude Medical, laboratory testing and clinical experience indicate that the newer generation memory chip does not share the cosmic radiation problem.

St. Jude Medical notified the U.S. Food and Drug Administration (FDA) of the physician’s advisory, and the FDA may choose to recall the impacted devices.

The American Academy of Pediatrics (AAP) issued new guidelines today concerning Sudden Infant Death Syndrome (SIDS). SIDS is the sudden death of an infant under 1 year of age which remains unexplained after a thorough investigation.  

According to the Academy, Sudden Infant Death Syndrome continues to be responsible for more infant deaths in the United States than any other cause of death during infancy.  The occurrence of SIDS is rare during the first months of life, increases to a peak between 2 and 3 months of age, and then decreases.  The primary risk factors for SIDS are:

•    Prone sleep position
•    Sleeping on a soft surface
•    Maternal smoking during pregnancy
•    Overheating
•    Late or no prenatal care
•    Young maternal age
•    Preterm birth and/or low birth weight
•    Male gender

Consistently higher rates are found in black and American Indian/Alaska Native children – 2 to 3 times the national average.

In 1992, the American Academy of Pediatrics released a recommendation that infants be placed down for sleep in a non-prone position.  Both side sleeping and back sleeping were recommended. Campaigns to encourage parents to put babies to sleep on their sides or back resulted in a consistent decrease in the SIDS rate.

After further study, AAP no longer recognizes side sleeping as a reasonable alternative to back sleeping.  Studies have found that the side sleep position is unstable and increases the chances of the infant rolling onto his or her stomach.  The Academy now recommends that parents use the back sleep position during every sleep period.

Research into SIDS has shown an interesting relationship between pacifiers and SIDS, with several studies reporting a protective effect of pacifiers.  The Academy now recommends the use of pacifiers at nap time and bedtime throughout the first year of life.

The new guidelines issued by the American Academy of Pediatrics include the following:

•    Infants should be placed on their back for every sleep.
•    A firm crib mattress, covered by a sheet, is the recommended sleeping surface.
•    Keep soft objects and loose bedding out of the crib.
•    Do not smoke during pregnancy and avoid exposing infants to second hand smoke.
•    Bed sharing during sleep is not recommended.  A separate but close sleeping environment is recommended such as a separate crib in the parent’s bedroom.
•    Consider offering a pacifier at nap time and bedtime.  The pacifier should be used when placing the infant down for sleep and should not be reinserted once the infant falls asleep.
•    The infant should be lightly clothed for sleep, and the bedroom temperature should be kept comfortable.
•    Assure that everyone caring for the infant is aware of the recommendations.

The CPSC and Pottery Barn Kids of San Francisco have announced a recall of approximately 7,600 spinal cribs because the spindles on the crib’s front rail can loosen and detach from the rail, allowing the child to fall from the crib and posing a risk of entrapment.

The spinal cribs were manufactured in Taiwan and sold nationwide at Pottery Barn Kids retail stores, through the Pottery Barn Kids catalog and on PotteryBarnKids.com from January 2004 through July 2005 for between $300 and $500.

Pottery Barn Kids has received six reports of incidents involving spindles detaching from the crib. No injuries have been reported to date.

Consumers should stop using these cribs immediately and contact Pottery Barn Kids to receive a free replacement front rail or a full refund (including shipping).

This recall involves the Spindle Crib, model number 4825402. The product name and model number are printed on a label affixed to the base of the crib. Sold in white, pink and blue, the cribs are made of hardwood and measure 30.5 x 54.5 x 45” high.

For more information, consumers should contact Pottery Barn Kids at (800) 330-6905 between 7 a.m. and 12 a.m. ET daily or visit the firm’s Web site at www.potterybarnkids.com

Consumers may also contact the Potter Barn Kids Media Contact, Abigail Jacobs, at (415) 616-8432. The CPSC hotline is 800-638-2772.