Below is a news release on a policy statement to be published in the June issue of Pediatrics, the peer-reviewed, scientific journal of the American Academy of Pediatrics (AAP). This policy statement is being made available online in advance of publication in Pediatrics in order to disseminate this important information in the most timely manner possible.
For release April 3, 2003
CHICAGO – The American Academy of Pediatrics (AAP) recommends that households within 10 miles of a nuclear power plant keep potassium iodide (KI) on hand to protect the thyroid in the event of an accidental or intentional release of radioactive iodines («radioiodines») into the environment. Schools and child care facilities within the same radius also should have immediate access to KI. It may be prudent to consider stockpiling KI within a larger radius because of more distant windborne fallout. These are among the recommendations the AAP is releasing to help prevent and minimize damage from harmful levels of radiation in its new policy statement, «Radiation Disasters and Children.»
Children are much more vulnerable to the harmful effects of radiation disasters than the general population because their bodies absorb and metabolize substances differently, and because they are more likely to develop certain cancers from such an exposure. They also are closer to the ground, where radioactive fallout settles. In addition to physical harm, children may suffer from loss of parents, separation from their homes, and post-traumatic stress.
Radiation incidents may be unintentional, as in nuclear power plant mishaps, or intentional, as in terrorist attacks with «dirty bombs,» or detonation of a nuclear weapon. Appropriate response to any radiation emergency would depend on the source of the radiation, the level of exposure, the population density of the affected area, and other factors. Citizens should seek the advice of public health and safety officials about the best response in the event of a disaster.
In situations involving release of radioiodines into the environment, KI is an effective preventive treatment. This compound works to block the thyroid’s absorption of harmful radiation, preventing thyroid cancer, which is one of the most common harmful effects of radiation disasters. Nuclear power plant accidents or sabotage, and explosion of nuclear weapons, are the most likely situations in which radioiodines would be released.
If administered right before exposure to radioiodines, KI can be 100 percent effective in preventing radiation-induced thyroid effects, including thyroid cancer. The need to administer KI right before or immediately after a radioiodine release is the reason that it should be kept in homes, schools and day care centers. The efficacy of KI diminishes if administered later, but it is somewhat effective if ingested soon after exposure. KI is not effective in preventing other long-term radiation effects, such as leukemia and breast cancer. KI will not prevent acute radiation effects such as nausea, vomiting, diarrhea, bleeding and hair loss.
The new AAP policy statement includes information on where to purchase KI (see accompanying chart) and advice on administering it to children. There are special considerations for giving KI to newborns, pregnant and breastfeeding mothers, and older adults. The AAP calls on the FDA to facilitate development of a pediatric preparation of KI. Parents should know the risks and benefits of this medication, and should not use it before consulting with health authorities.
Radioiodines are secreted in breast milk, and pose particular risks to infants. Breastfeeding mothers should be cautioned to temporarily suspend breastfeeding after exposure to radiation, unless no other alternative exists. This is a short-term measure until public health authorities declare that it is safe to go back to breastfeeding.
Certain radiation disasters, such as explosion of «dirty bombs» containing radioactive materials, or an accident in transporting such materials, could spread radioactive fallout over several blocks and would dissipate quickly. In these instances, radioiodines are not as likely to be involved, and so there would be no role for KI.
Evacuation to escape contamination would be the best response in many situations, time permitting. Sheltering in a home or other building is an important alternative to evacuation. Masonry structures provide more protection than wood, and basements are preferable to upper floors.
In the event of a radiation disaster, it is important for the public to stay alert to the local emergency broadcast system and instructions from local, state and federal public health officials. In addition to advice about evacuation, sheltering, and KI, these authorities will advise families about consumption of food and drink after the emergency. It is important to have a battery-operated radio readily available should electricity be cut off.
Other recommendations in the new policy statement include:
1. Pediatricians should become familiar with local preparedness and evacuation protocols and work with public health agencies on their development;
2. Pediatricians should assist local schools and child care facilities in developing protocols to reunite children with their parents in the event of a disaster;
3. Pediatricians and government planners should recognize and prioritize the need to respond to the psychosocial consequences of disasters on children, as past radiation disasters have resulted in significantly higher-than-normal rates of psychiatric and behavioral problems, particularly in children and mothers of young children; and
4. Future sites for nuclear power facility construction should be selected so as to minimize the risk to the population
Because radiation from diagnostic X-ray exposures are cumulative, pediatricians should limit exposures (especially to CT scans) insofar as possible, and thus preserve the child’s tolerance for unavoidable exposures.