CHILDREN EXPOSED TO METHAMPHETAMINE LAB SITES: 

ASSESSMENT AND TREATMENT

Children are occasionally discovered to be residing in or otherwise exposed to methamphetamine lab sites (“meth labs” or “meth houses”).  These children face acute health and safety risks, including abuse and neglect.  Firearms are often present.  Health care providers can be instrumental in determining whether these exposures have had any harmful effects and whether a child might need acute medical intervention.

The manufacture of methamphetamine includes an increased risk of hazards like explosions and fires.  Normal age-related behaviors of young children (such as frequent hand-to-mouth contact with their environment) increase their chances of inhaling, ingesting, or absorbing toxic chemicals, drugs, or contaminated foods.  They inhale the second-hand smoke of adults using meth; they can absorb meth and its constituent toxins from spills on household surfaces; they can receive an accidental skin prick or injection from discarded drug paraphernalia; they can become ill after directly ingesting chemicals.  Their physiological characteristics (such as higher respiratory and metabolic rates, increased skin surface to body mass ratio, and a developing central nervous system) leave them more vulnerable to the effects of toxic exposures.  A developing fetus is at particular risk.

Children should be medically assessed within 2 hours of being discovered at a methamphetamine production site. 

 On-Site Response

1. Any child in obvious critical condition should be immediately transferred to a medical facility equipped to provide pediatric critical care.
2. For those not in obvious critical condition, assess:
   1. ABC’s (airway, breathing, circulation)
   2. Vital signs (respirations, pulse, blood pressure, temperature)
   3.  For life-threatening findings immediately transfer child as in 1.
3. In cases of blatant chemical/drug contamination, the child’s clothing should be removed and clean attire provided before leaving the scene.  Soiled clothing should remain at the scene and be bagged as evidence.
4. The child’s personal belongings should be left at the scene to avoid the possibility of contaminating another setting.
5. If upon assessment there are no pressing clinical findings, child welfare personnel should arrange for short-term shelter or secure placement.
6. Children requiring immediate care (those that cannot wait 24 hours) should received treatment within 2 hours if possible, but not later than 4 hours after discovery.

Subsequent Assessment(may be conducted within 24 hours of lab seizure in cases not requiring immediate treatment)

1. Call Poison Control if clinically indicated (national toll-free number for poison centers is 1-800-222-1222).
2. A urine specimen should be collected from each child within 12 hours of identification because some chemicals/drugs are eliminated from the body within a short time.  Use appropriate chain of evidence procedures and request that urine screen and confirmatory test results be reported at any detectable level.
3. Obtain child’s medical history directly from parent/s or, if impossible, seek information from social workers who have taken the medical history.
4. Perform a complete physical exam, as close to EPSDT guidelines as possible.  Pay particular attention to the temperature, respiratory rate, skin condition, and neurologic screen.  Take photographs as appropriate.  Maintain comprehensive documentation.
5. Perform tests and procedures as indicated by clinical findings.

Required laboratory tests(if any are being run for forensic purposes use appropriate chain of evidence procedures):

1. Urine drug screen if not already obtained.  Handle as described in #2
2. Liver function tests (AST, ALT, total bilirubin, and alkaline phosphatase)

3. Kidney function tests (BUN and creatinine)
4. Electrolytes (sodium, potassium, chloride and bicarbonate)
5. CBC

Optional tests:

1. Complete metabolic panel (chem 20 or equivalent)
2. Oxygen saturation
3. Pulmonary function tests
4. Heavy metals screen

Ancillary assessment:

1. Consult a Child Protection Team or call the local child abuse and neglect hotline, if this has not already been done by law enforcement officials.
2. Conduct an age-appropriate developmental screen.  A specialist assessment may be helpful.
3. Conduct a mental health screen and provide crisis intervention services as clinically indicated.  These services may require a visit to a separate specialist or facility.  The child will likely benefit from follow with a psychologist.
4. Secure the release of the child’s medical records to the child welfare worker to ensure ongoing continuity of care.  Child welfare personnel may not have immediate legal access to certain health care records.

For general information, send mail to mapehsu@kumc.edu.  For questions or comments about this web site, send mail to mwalker3@kumc.edu.

© 2005.  Mid-America Pediatric Environmental Health Specialty Unit. The University of Kansas Medical Center.