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Tag: older children

  • Beware Noodle Soup

    Beware Noodle Soup

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    When the weather turns frigid, there is only one thing to do: make a pot of chicken-noodle soup. On the first cold afternoon in early December, I simmered a whole rotisserie chicken with fennel, dill, and orzo, then ladled it into bowls for a cozy family meal. Just as I thought we’d reached peak hygge, my five-month-old son suddenly grabbed my steaming bowl and tipped the soup all over himself. Piercing screams and a frenzied taxi ride to the pediatric emergency room ensued.

    My husband and I waited in the ER with our pantsless, crying child, racked with guilt. But when we told doctors and nurses what had happened, they seemed unperturbed. As they bandaged my son’s blistering skin, they explained that children get burned by soup—especially noodle soup—all the time. “Welcome to parenthood,” a nurse said, as we boarded an ambulance that transferred us to a nearby burn unit.

    That children are frequently scalded by hot liquids makes perfect sense. But soup? Indeed, soup burns “are very common,” James Gallagher, the director of the Burn Center at Weill Cornell Medicine and NewYork–Presbyterian, where I’d brought my son, told me. After hot tap water, soup is a leading cause of burn-related visits to the hospital among young children in the United States. An estimated 100,000 American children are scalded by spilled food and beverages each year—and in many cases, soup is the culprit. Pediatric soup injuries happen so frequently that an astonishing amount of scientific literature is dedicated to it, generating terms such as meal-time morbidity, starch scalds,  and the cooling curve of broth.

    Anyone can get burned by soup, yet kids can’t help but knock things over. Infants have minimal control over their grabby little hands, and older children still lack balance and coordination. Give them a bowl of soup, or even put one near them, and you have a recipe for disaster. Consider instant noodle soup—the kind prepared by pouring boiling water into a Styrofoam container with dried noodles, or filling it with water and microwaving it. In one small study from 2020, 21 children ages 4 to 12 carried foam cups of blue paint—meant to mimic containers of instant noodles—from a microwave toward a table. Blue splashes on their white shirts revealed that nearly one in five children spilled the “soup,” most commonly on their arms.

    Part of the danger is the nature of soup itself. Boiling water is hot enough to scald skin. But salt, oil, and other ingredients raise water’s boiling point, meaning that soup can reach a much higher temperature and cause greater injury, Gallagher said. Soup also stays hotter for longer, prolonging the potential for harm: A 2007 study found that certain soups took more time to cool than tap water after being boiled. Even when slightly cooled, to about 150 degrees Fahrenheit, it can cause “a significant scald burn,” one commentary noted.

    Not all soups are created equal. As the authors of the 2007 study found, noodles “may adhere to the skin” and cause a deep burn, calling to mind the stinging tentacles of a jellyfish. They may also stay hot longer than expected. “Noodles do seem to be particularly problematic,” Wendalyn Little, a professor of pediatrics and emergency medicine at Emory University School of Medicine who studies soup burns, told me. Hearty soups are generally more hazardous than brothy ones: Engineers who studied two kinds of canned soup—chunky (chicken noodle) versus runny (tomato)—concluded that the former can lead to more severe burns because its solid constituents prevent it from flowing off the skin. “A runny soup seems a lot like water, but what if it’s a New England clam chowder? That’s real thick and stays in place,” Gallagher said. The chicken soup I’d made for my family was on the brothy side, but the orzo made it particularly viscous. (Thank goodness I hadn’t made gloopy congee that day.)

    For these reasons, perhaps the most dangerous soup of all is instant noodle soup. Nearly 2,000 American kids get burned by it annually, according to one estimate; in an analysis published earlier this year, this kind of soup caused 31 percent of pediatric scalds in a Chicago hospital over a decade. These products are dangerous for reasons beyond their contents. They tend to be packaged in tall, flimsy containers that are perilously easy to topple. Microwaveable versions can be dangerous for kids who haven’t yet fully grasped that a room-temperature product, heated for several minutes in a microwave, can come out piping hot. “Fluids like that can be superheated such that when you touch them, there’s almost like a mini explosion,” splashing boiling liquid onto skin, Gallagher explained.

    Soup burns can be quite serious. In a few cases, the burns can be so severe that they require tube feeding or intravenous narcotics. The 2007 study of children scalded by instant noodle soup noted that all of them had “at least second-degree burns,” which damage the first two layers of skin and usually erupt into blisters. The children who were burned on their upper body—mostly young kids, who tend to reach toward objects on elevated surfaces—stayed in the hospital for an average of 11 days.

    In most cases, however, burns from soup are painful but not life-threatening. Scarring, if it occurs at all, is worst in childhood, then fades away, Gallagher said. If burns do happen, he told me, immediately remove any clothes or diapers soaked with hot liquid, then run cool water over the injury for 20 minutes and call your doctor. Avoid applying ice to the injured area, he added, because doing so can damage tissue.

    Kids move on quickly. It’s the parents who deal with long-term consequences. “There’s a special kind of guilt when your baby is burned,” Gallagher said. A week after the incident, my family returned to the burn unit for a follow-up visit. Parents with small children filled the waiting room; we exchanged knowing glances. A nurse removed a thick bandage from my son’s thigh. Fortunately, unlike his parents, he emerged without a scar.

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    Yasmin Tayag

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  • Will Flu and RSV Always Be This Bad?

    Will Flu and RSV Always Be This Bad?

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    In the Northern Hemisphere, this year’s winter hasn’t yet begun. But Melissa J. Sacco, a pediatric-intensive-care specialist at UVA Health, is already dreading the arrival of the one that could follow.

    For months, the ICU where Sacco works has been overflowing with children amid an early-arriving surge of respiratory infections. Across the country, viruses such as RSV and flu, once brought to near-record lows by pandemic mitigations, have now returned in force, all while COVID-19 continues to churn and the health-care workforce remains threadbare. Most nights since September, Sacco told me, her ICU has been so packed that she’s had to turn kids away “or come up with creative ways to manage patients in emergency rooms or emergency departments,” where her colleagues are already overwhelmed and children more easily slip through the cracks. The team has no choice: There’s nowhere else for critically ill kids to go.

    Similar stories have been pouring in from around the nation for weeks. I recently spoke with a physician in Connecticut who called this “by far the worst spike in illness I’ve seen in 20 years”; another in Maryland told me, “There have been days when there is not an ICU bed to be found anywhere in the mid-Atlantic.” About three-quarters of the country’s pediatric hospital beds are full; to accommodate overflow, some hospitals have set up tents outside their emergency department or contemplated calling in the National Guard. Last week, the Children’s Hospital Association and the American Academy of Pediatrics asked the Biden administration to declare a national emergency. And experts say there’s no end to the crisis in sight. When Sacco imagines a similar wave slamming her team again next fall, “I get that burning tear feeling in the back of my eyes,” she told me. “This is not sustainable.”

    Read: The worst pediatric-care crisis in decades

    The experts I spoke with are mostly optimistic that these cataclysmic infection rates won’t become an autumn norm. But they also don’t yet fully understand the factors that have been driving this year’s surge, making it tough to know with certainty whether we’re due for an encore.

    One way or another, COVID has certainly thrown the typical end-of-year schedule out of whack. Respiratory viruses typically pick up speed in late fall, peak in mid-to-late winter, and then bow out by the spring; they often run in relay, with one microbe surging a bit before another. This year, though, nearly every pathogen arrived early, cresting in overlapping waves. “Everything is happening at once,” says Kathryn Edwards, a pediatrician and vaccinologist at Vanderbilt University. November isn’t yet through, and RSV has already sent infant hospitalizations soaring past pre-pandemic norms. Flu-hospitalization rates are also at their worst in more than a decade; about 30 states, plus D.C. and Puerto Rico, are reporting high or very high levels of the virus weeks before it usually begins its countrywide climb. And the country’s late-summer surge in rhinovirus and enterovirus has yet to fully abate. “We just haven’t had a break,” says Asuncion Mejias, a pediatrician at Nationwide Children’s Hospital.

    Previous pandemics have had similar knock-on effects. The H1N1-flu pandemic of 2009, for example, seems to have pushed back the start of the two RSV seasons that followed; seasonal flu also took a couple of years to settle back into its usual rhythms, Mejias told me. But that wonky timetable wasn’t permanent. If the viral calendar is even a little more regular next year, Mejias said, “that will make our lives easier.”

    This year, flu and RSV have also exploited Americans’ higher-than-average vulnerability. Initial encounters with RSV in particular can be rough, especially in infants, whose airways are still tiny; the sickness tempers with age as the body develops and immunity builds, leaving most children well protected by toddlerhood. But this fall, the pool of undefended kids is larger than usual. Children born just before the pandemic, or during the phases of the crisis when mitigations aplenty were still in place, may be meeting influenza or RSV for the first time. And many of them were born to mothers who had themselves experienced fewer infections and thus passed fewer antibodies to their baby while pregnant or breastfeeding. Some of the consequences may already have unfurled elsewhere in the world: Australia’s most recent flu season hit kids hard and early, and Nicaragua’s wave at the start of 2022 infected children at rates “higher than what we saw during the 2009 pandemic,” says Aubree Gordon, an epidemiologist at the University of Michigan.

    Read: What a ‘tripledemic’ means for your body

    In the U.S., many hospitals are now admitting far more toddlers and older children for respiratory illnesses than they normally do, says Mari Nakamura, a pediatric-infectious-disease specialist at Boston Children’s Hospital. The problem is worsened by the fact that many adults and school-age kids avoided their usual brushes with flu and RSV while those viruses were in exile, making it easier for the pathogens to spread once crowds flocked back together. “I wouldn’t be surprised,” Gordon told me, “if we see 50 to 60 percent of kids get infected with flu this year”—double the estimated typical rate of 20 to 30 percent. Caregivers too are falling sick; when I called Edwards, I could hear her husband and grandson coughing in the background.

    By next year, more people’s bodies should be clued back in to the season’s circulating strains, says Helen Chu, a physician and an epidemiologist at the University of Washington. Experts are also hopeful that the toolkit for fighting RSV will soon be much improved. Right now, there are no vaccines for the virus, and only one preventive drug is available in the U.S.: a tough-to-administer monoclonal antibody that’s available only to high-risk kids. But at least one RSV vaccine and another, less cumbersome antibody therapy (already being used in Europe) are expected to have the FDA’s green light by next fall.

    Even with the addition of better tech, though, falls and winters may be grueling for many years to come. SARS-CoV-2 is here to stay, and it will likely compound the respiratory burden by infecting people on its own or raising the risk of co-infections that can worsen and prolong disease. Even nonoverlapping illnesses might cause issues if they manifest in rapid sequence: Very serious bouts of COVID, for instance, can batter the respiratory tract, making it easier for other microbes to colonize.

    A few experts have begun to wonder if even milder tussles with SARS-CoV-2 might leave people more susceptible to other infections in the short or long term. Given the coronavirus’s widespread effects on the body, “we can’t be cavalier” about that possibility, says Flor Muñoz Rivas, a pediatrician at Baylor College of Medicine. Mejias and Octavio Ramilo, also at Nationwide, recently found that among a small group of infants, those with recent SARS-CoV-2 infections seemed to have a rougher go with a subsequent bout of RSV. The trend needs more study, though; it’s not clear which kids might be at higher risk, and Mejias doubts that the effect would last more than a few months.

    Gordon points out that some people may actually benefit from the opposite scenario: A recent brush with SARS-CoV-2 could bolster the body’s immune defenses against a second respiratory invader for a few days or weeks. This phenomenon, called viral interference, wouldn’t halt an outbreak by itself, but it’s thought to be part of the reason waves of respiratory disease don’t usually spike simultaneously: The presence of one microbe can sometimes crowd others out. Some experts think last year’s record-breaking Omicron spike helped punt a would-be winter flu epidemic to the spring.

    Even if all of these variables were better understood, the vagaries of viral evolution could introduce a plot twist. A new variant of SARS-CoV-2 may yet emerge; a novel strain of flu could cause a pandemic of its own. RSV, for its part, is not thought to be as quick to shape-shift, but the virus’s genetics are not well studied. Mejias and Ramilo’s data suggest that the arrival of a gnarly RSV strain in 2019 may have pushed local hospitalizations past their usual highs.

    Read: Will we get Omicron’d again?

    Behavioral and infrastructural factors could cloud the forecast as well. Health-care workers vacated their posts in droves during the pandemic, and many hospitals’ pediatric-bed capacity has shrunk, leaving supply grossly inadequate to address current demand. COVID-vaccination rates in little kids also remain abysmal, and many pediatricians are worried that anti-vaccine sentiment could stymie the delivery of other routine immunizations, including those against flu. Even temporary delays in vaccination can have an effect: Muñoz Rivas points out that the flu’s early arrival this year, ahead of when many people signed up for their shot, may now be aiding the virus’s spread. The new treatments and vaccines for RSV “could really, really help,” Nakamura told me, but “only if we use them.”

    Next fall comes with few guarantees: The seasonal schedule may not rectify itself; viruses may not give us an evolutionary pass. Our immune system will likely be better-prepared to fend off flu, RSV, rhinovirus, enterovirus, and more—but that may not be enough on its own. What we can control, though, is how we choose to arm ourselves. The past few years proved that the world does know how to drive down rates of respiratory disease. “We had so little contagion during the time we were trying to keep COVID at bay,” Edwards told me. “Is there something to be learned?”

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    Katherine J. Wu

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