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## Complete Summary

#### GUIDELINE TITLE

Radiation disasters and children.

#### BIBLIOGRAPHIC SOURCE(S)

Radiation disasters and children. Pediatrics 2003 Jun;111(6 Pt
1):1455-66. \[70 references\]
[PubMed](http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=12777572)

#### GUIDELINE STATUS

This is the current release of the guideline.

AAP Policies are reviewed every 3 years by the authoring body, at which
time a recommendation is made that the policy be retired, revised, or
reaffirmed without change. Until the Board of Directors approves a
revision or reaffirmation, or retires a statement, the current policy
remains in effect.

### COMPLETE SUMMARY CONTENT

 SCOPE\
 METHODOLOGY - including Rating Scheme and Cost Analysis\
 RECOMMENDATIONS\
 EVIDENCE SUPPORTING THE RECOMMENDATIONS\
 BENEFITS/HARMS OF IMPLEMENTING THE GUIDELINE RECOMMENDATIONS\
 CONTRAINDICATIONS\
 QUALIFYING STATEMENTS\
 IMPLEMENTATION OF THE GUIDELINE\
 INSTITUTE OF MEDICINE (IOM) NATIONAL HEALTHCARE QUALITY REPORT
CATEGORIES\
 IDENTIFYING INFORMATION AND AVAILABILITY\
 DISCLAIMER

### SCOPE

#### DISEASE/CONDITION(S)

-   Radiation exposure

-   Short-term effects of radiation such as nausea and vomiting, anemia,
    infection, generalized bleeding, thermal injuries

-   Long-term effects of radiation such as thyroid cancer, thyroid
    adenoma, leukemia, chronic fear and anxiety

#### GUIDELINE CATEGORY

Counseling\
Management\
Prevention\
Screening

#### CLINICAL SPECIALTY

Emergency Medicine\
Endocrinology\
Family Practice\
Oncology\
Pediatrics

#### INTENDED USERS

Health Care Providers\
Hospitals\
Physicians\
Psychologists/Non-physician Behavioral Health Clinicians\
Public Health Departments

#### GUIDELINE OBJECTIVE(S)

To present guidelines for pediatricians and government organizations on
how to prepare for radiation disasters and how to manage children
exposed to radiation

#### TARGET POPULATION

Children exposed to radiation

#### INTERVENTIONS AND PRACTICES CONSIDERED

**Preparation for a Radiation Disaster**

1.  Local planning for a possible radiation disaster including creation
    of disaster management protocols, education of first responders and
    health care professionals, and acquisition of appropriate equipment
    and supplies

2.  Providing potassium iodide (KI) to all citizens living within 10
    miles of a nuclear power plant, developing evacuation and sheltering
    plans, establishing nuclear disaster response teams

3.  Establishing the threshold radiation concentration that would
    require evacuation, and providing education for the public

**Management/Treatment**

1.  Initiation of the emergency broadcast system

2.  Implementation of evacuation and sheltering plans

3.  Diagnostic measures such as nasal and skin swabs, urine and stool
    analysis, complete blood cell and platelet counts, absolute
    lymphocyte count, HLA antigen subtyping, and lymphocyte cytogenetics

4.  Topical decontamination of children, establishing a site for the
    placement of contaminated clothing, preventing hypothermia,
    management of skin burns

5.  Pharmacotherapy with KI

> **Note**: Other drugs have been suggested but have not been proven
> effective or without serious adverse effects.

6.  Thyroid function monitoring

7.  Management of psychological harm to children, including screening
    children for the presence of anxiety and stress, providing advice to
    parents and supportive counseling to children, and referring
    children for mental health services as needed

#### MAJOR OUTCOMES CONSIDERED

Not stated

### METHODOLOGY

#### METHODS USED TO COLLECT/SELECT EVIDENCE

Hand-searches of Published Literature (Secondary Sources)\
Searches of Electronic Databases

#### DESCRIPTION OF METHODS USED TO COLLECT/SELECT THE EVIDENCE

Systematic searches of electronic databases for original research papers
and evidence reviews were performed. In addition, all major textbooks
and monographs were obtained.

#### NUMBER OF SOURCE DOCUMENTS

Not stated

#### METHODS USED TO ASSESS THE QUALITY AND STRENGTH OF THE EVIDENCE

Not stated

#### RATING SCHEME FOR THE STRENGTH OF THE EVIDENCE

Not applicable

#### METHODS USED TO ANALYZE THE EVIDENCE

Review

#### DESCRIPTION OF THE METHODS USED TO ANALYZE THE EVIDENCE

Not applicable

#### METHODS USED TO FORMULATE THE RECOMMENDATIONS

Not stated

#### RATING SCHEME FOR THE STRENGTH OF THE RECOMMENDATIONS

Not applicable

#### COST ANALYSIS

A formal cost analysis was not performed and published cost analyses
were not reviewed.

#### METHOD OF GUIDELINE VALIDATION

External Peer Review

#### DESCRIPTION OF METHOD OF GUIDELINE VALIDATION

Not stated

### RECOMMENDATIONS

#### MAJOR RECOMMENDATIONS

**Recommendations for Pediatricians**

1.  Pediatricians should increase their knowledge about emergency
    medical aspects of radiation exposure.

2.  Pediatricians should become familiar with local preparedness and
    evacuation protocols and work with public health agencies on their
    development.

3.  Pediatricians should assist local schools and child care facilities
    in developing protocols to reunite children with their parents in
    the event of a disaster.

4.  All children at risk should receive potassium iodide (KI) before
    exposure, if possible, or immediately afterward. This will require
    that KI be available in homes located within 10 miles of a nuclear
    power plant. Child care facilities and schools within 10 miles of a
    nuclear power plant should plan to stockpile the agent. It may be
    prudent to consider stockpiling KI within a larger radius because of
    more distant windborne fallout, as occurred after Chernobyl; this
    will be determined by local and national public health authorities.
    For KI dosage and administration information refer to table 2 in the
    original guideline document.

5.  The risks and benefits of using KI should be discussed with parents.
    KI is available without a prescription, and families should be
    cautioned against using the medication before consulting with
    authorities.

6.  Because radioiodines pass into breast milk, pediatricians should
    caution lactating mothers not to breastfeed their infants after the
    release of radioiodines, unless no alternative is available. The
    restriction is temporary, until public health authorities declare it
    safe to go back to breastfeeding. Public health authorities will
    also advise about the safe consumption of produce and milk after a
    radiation disaster.

7.  The pediatrician should recognize and respond to the psychosocial
    consequences of disasters in children (National Council on Radiation
    Protection and Measurements, 2001; American Academy of pediatrics,
    1999; American Academy of Pediatrics, 2000).

**Recommendations for Government**

1.  Pediatricians should be included in all aspects of planning for a
    radiation disaster. Disaster planning exercises should include
    pediatric casualties and victims with mock psychologic injuries.

2.  Future sites for nuclear power facility construction should be
    selected to minimize the risk to populations. For existing power
    plants in populated regions, an accelerated timeline for
    decommissioning should be considered.

3.  Guidelines for the population radius within which to recommend KI
    stockpiling should be developed; distribution plans should also be
    created.

4.  The Food and Drug Administration (FDA) should facilitate the
    development of a pediatric preparation of KI.

5.  Plans should be developed for rapid communication with the public
    about evacuation versus sheltering, the safety of breast milk, and
    local food consumption.

6.  Government planners should make mental health a high priority in the
    response plan for a radiation incident.

#### CLINICAL ALGORITHM(S)

None provided

### EVIDENCE SUPPORTING THE RECOMMENDATIONS

#### REFERENCES SUPPORTING THE RECOMMENDATIONS

[References open in a new
window](http://www.guideline.gov/summary/select_ref.aspx?doc_id=3842)

#### TYPE OF EVIDENCE SUPPORTING THE RECOMMENDATIONS

The type of supporting evidence is not specifically stated for each
recommendation.

### BENEFITS/HARMS OF IMPLEMENTING THE GUIDELINE RECOMMENDATIONS

#### POTENTIAL BENEFITS

-   Appropriate management of children exposed to radiation

-   When taken promptly after a radioiodine release and at proper dose,
    potassium iodide (KI) is effective in preventing radiation-induced
    thyroid effects.

#### POTENTIAL HARMS

Side effects of potassium iodide (KI)

### CONTRAINDICATIONS

#### CONTRAINDICATIONS

Potassium iodide (KI) should not be given to individuals with known
iodine sensitivity or to those with dermatitis herpetiformis or
hypocomplementemic vasculitis. KI should be used with caution in
individuals with thyroid disease (such as multinodular goiter, Graves
disease, and autoimmune thyroiditis), especially if dosing extends
beyond a few days. Such individuals should have monitoring of thyroid
function.

### QUALIFYING STATEMENTS

#### QUALIFYING STATEMENTS

The guidance in this report does not indicate an exclusive course of
treatment or serve as a standard of medical care. Variations, taking
into account individual circumstances, may be appropriate.

### IMPLEMENTATION OF THE GUIDELINE

#### DESCRIPTION OF IMPLEMENTATION STRATEGY

An implementation strategy was not provided.

### INSTITUTE OF MEDICINE (IOM) NATIONAL HEALTHCARE QUALITY REPORT CATEGORIES

#### IOM CARE NEED

Getting Better\
Staying Healthy

#### IOM DOMAIN

Effectiveness\
Safety\
Timeliness

### IDENTIFYING INFORMATION AND AVAILABILITY

#### BIBLIOGRAPHIC SOURCE(S)

Radiation disasters and children. Pediatrics 2003 Jun;111(6 Pt
1):1455-66. \[70 references\]
[PubMed](http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=12777572)

#### ADAPTATION

Not applicable: Guideline was not adapted from another source.

#### DATE RELEASED

2003 Jun

#### GUIDELINE DEVELOPER(S)

American Academy of Pediatrics - Medical Specialty Society

#### SOURCE(S) OF FUNDING

American Academy of Pediatrics

#### GUIDELINE COMMITTEE

Committee on Environmental Health

#### COMPOSITION OF GROUP THAT AUTHORED THE GUIDELINE

*Members of the Committee on Environmental Health, 2002-2003*: \*Sophie
J. Balk, MD (Chairperson); Dana Best, MD, MPH; Christine L. Johnson, MD;
Janice J. Kim, MD, PhD, MPH; Lynnette J. Mazur, MD, MPH; David W.
Reynolds, MD; James R. Roberts, MD, MPH; \*Michael W. Shannon, MD, MPH;
William B. Weil, Jr, MD

*Liaisons*: Robert W. Amler, MD (Centers for Disease Control and
Prevention/Agency for Toxic Substances and Disease Registry); Elizabeth
Blackburn, RN (US Environmental Protection Agency); Martha Linet, MD
(National Cancer Institute); \*Robert W. Miller, MD, DrPH (National
Cancer Institute); Walter Rogan, MD (National Institute of Environmental
Health Sciences)

*Staff*: Paul Spire

\**Lead authors*

#### FINANCIAL DISCLOSURES/CONFLICTS OF INTEREST

Not stated

#### GUIDELINE STATUS

This is the current release of the guideline.

AAP Policies are reviewed every 3 years by the authoring body, at which
time a recommendation is made that the policy be retired, revised, or
reaffirmed without change. Until the Board of Directors approves a
revision or reaffirmation, or retires a statement, the current policy
remains in effect.

#### GUIDELINE AVAILABILITY

Electronic copies: Available from the [American Academy of Pediatrics
(AAP) Policy Web
site](http://aappolicy.aappublications.org/cgi/content/full/pediatrics;111/6/1455).

Print copies: Available from American Academy of Pediatrics, 141
Northwest Point Blvd., P.O. Box 927, Elk Grove Village, IL 60009-0927.

#### AVAILABILITY OF COMPANION DOCUMENTS

None available

#### PATIENT RESOURCES

None available

#### NGC STATUS

This summary was completed by ECRI on December 11, 2003. The information
was verified by the guideline developer on February 2, 2004.

#### COPYRIGHT STATEMENT

This NGC summary is based on the original guideline, which is subject to
the guideline developer\'s copyright restrictions. Please contact the
Permissions Editor, American Academy of Pediatrics (AAP), 141 Northwest
Point Blvd, Elk Grove Village, IL 60007.

### DISCLAIMER

#### NGC DISCLAIMER

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© 1998-2008 National Guideline Clearinghouse

Date Modified: 11/3/2008