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Health News 11 - Children
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Pediatricians Say Parents Should Store Antiradiation Pills

This alert will be published in the June, 2003 issue of Pediatrics, the peer-reviewed, scientific journal of the American Academy of Pediatrics (AAP). This Potassium Iodide (KI) 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.

Potassium Iodide Recommendation

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 potassium iodide 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."

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Children’s Vulnerability

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 Release

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, Potassium Iodide (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.

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Effectiveness of Potassium Iodide

If administered right before exposure to radioiodines, Potassium Iodide (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 Potassium Iodide 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. Potassium Iodide will not prevent acute radiation effects such as nausea, vomiting, diarrhea, bleeding and hair loss.

The new AAP policy statement includes advice on administering Potassium Iodide 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 Potassium Iodide. 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.

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Protection From Radiation

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.

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.

The American Academy of Pediatrics is an organization of 57,000 primary care pediatricians, pediatric medical subspecialists and pediatric surgical specialists dedicated to the health, safety and well-being of infants, children, adolescents and young adults.

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Recommended Doses of KI for Different Risk Groups 1

                                            Predicted                                        Number of
Group
                          Thyroid exposure     KI Dosage     32.5 mg tablets

Adults over 40 years                 >500 cGy           130 mg                   4
Adults 18-40 years                    >10                    130 mg                   4
Pregnant or lactating women     >5                     130 mg                  4
Adolescents* 12-18 years           >5                      65 mg                   2
Children 3-12 years                   >5                       65 mg                   2
Children 1 mo – 3 years             >5                      32 mg                   1
Birth through 1 month                >5                     16 mg                  1/2

*Adolescents approaching adult size (> 70 kg) should receive the full adult dose (130 mg).

The protective effect of KI lasts approximately 24 hours. For optimal prophylaxis, KI should therefore be dosed daily, until a risk of significant exposure to radioiodines by either inhalation or ingestion no longer exists. Individuals intolerant of KI at protective doses, and neonates, pregnant and lactating women (in whom repeat administration of KI raises particular safety issues, see below) should be given priority with regard to other protective measures (i.e., sheltering, evacuation, and control of the food supply).

Note that adults over 40 need take KI only in the case of a projected large internal radiation dose to the thyroid (>500 cGy) to prevent hypothyroidism.

1. Guidance: Potassium Iodide as a Thyroid Blocking Agent in Radiation Emergencies  U.S. Department of Health and Human Services, Food and Drug Administration, Center for Drug, Evaluation and Research (CDER), November 2001, Procedural  
http://www.fda.gov/cder/guidance/4825fnl.htm

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