An updated AAP policy statement and a new technical report summarize guidelines for management of children and families in the event of a radiologic disaster.
The material was developed by radiation scientists with expertise in acute and long-term health effects in children and adolescents exposed to radiological and nuclear emergencies in conjunction with the AAP Council on Environmental Health. The technical report provides a detailed, updated review of scientific studies on the health effects and supports the revised AAP recommendations, which were updated from 2003.
The reports, Pediatric Considerations Before, During, and After Radiological/Nuclear Emergencies, are available at and http://pediatrics.aappublications.org/content/early/2018/11/21/peds.2018-3000 and http://pediatrics.aappublications.org/content/early/2018/11/21/peds.2018-3001and will be published in the December issue of Pediatrics.
Pediatricians, hospital emergency department staff and officials working in public health can benefit from this latest review of the science; the detailed guidance will be useful to mitigate health risks in the event of a broad range of radiological and nuclear emergencies.
The technical report also provides a comprehensive review of long-term and more recent studies of health effects in radiation-exposed pediatric populations, including the Japanese atomic bomb survivors, individuals exposed to nuclear accidents (e.g., Chernobyl and Fukushima Daiichi nuclear plants), those coming into contact with improperly disposed X-ray and radiotherapy equipment, and individuals living near nuclear plants.
The authors review the evidence base for measures to reduce radiation exposure in the immediate aftermath of a radiological or nuclear disaster, including diagnosis and management of external and internal contamination, use of potassium iodide (KI) and actions related to breastfeeding. They describe public health and clinical implications and emphasize the importance of awareness of and management of acute radiation syndrome, acute and long-term psychologic effects, and cancer risks and other late tissue reactions following low to high levels of radiation exposure.
Recommendations for pediatricians
- Download information on how and when to use KI, and ensure the information is accessible in an emergency (http://bit.ly/2qej2Gn).
- When the risk of exposure to radioactive iodine is temporary, mothers can continue to breastfeed their infants if appropriate doses of KI are given to them within four hours of contamination; if not, they should be prioritized to receive other protective measures like evacuation.
- Monitoring children for contamination and decontamination should be done at a center equipped to perform these functions. Pediatric providers should ask local and state health departments about the location of community facilities that may be designated in real time (see http://bit.ly/2Rhnpfl).
- Pediatric medical centers should ensure their facilities are equipped to receive and manage contaminated children (and accompanying adults). Inpatient centers should download the Internal Contamination Clinical Reference Application at https://emergency.cdc.gov/radiation/iccr.asp.
- Pediatricians should provide ongoing assessment, treatment and specialist referrals for the mental health needs of patients/parents affected by radiation emergencies.
- Training of health professionals in managing mental health issues related to emergency events should be expanded. Accrediting agencies should include requirements for office training and preparedness, including KI administration to exposed children.
Consult the policy statement for recommendations for government and families. Table 3 in the technical report summarizes guidance for parents.
Dr. Linet is the lead author of the technical report.