By guest blogger Michael R. Cohen: President of the Institute for Safe Medication Practices
Exactly three years ago today, the New York City Department of Health and Mental Hygiene issued an alert about use of camphor products around children. The alert mentioned children who were hospitalized with seizures after ingestion and contact with over-the-counter (OTC) camphor products. I checked with New York City Poison Control, as well as the Poison Control Center at Children’s Hospital of Philadelphia, and exposures to camphor continue to occur. So here’s another warning for parents to keep camphor products away from kids.
Camphor is rapidly absorbed into the body from the skin, gastrointestinal tract, and respiratory tract. It comes as pure camphor for use as an insect or moth repellent but in other forms, it’s applied for itching and inhalation for upper respiratory congestion. It is an ingredient of anti-itch products applied to the skin like Benadryl Itch Stopping Gel, balms for muscle pain like Tiger Balm and cold medicines like Vicks VapoRub. Its strong aromatic odor can repel insects and moths, for which camphor is used as a repellent.
Camphor is never supposed to be swallowed, but that doesn’t stop curious little children or babies from trying to eat it. Also, according to Allison Muller, PharmD, who heads The Poison Control Center at The Children’s Hospital of Philadelphia, some well-meaning parents might miss the “external use only” warnings on product labels and give kids a teaspoonful or so of a camphor product to swallow for their ailment, not realizing that it can be harmful.
One New York case involved a 15-month-old child who presented to the emergency department (ED) with intractable vomiting followed by a generalized seizure approximately 40 minutes after licking a cube of camphor. The parents purchased the camphor (called “alcanfor” in Spanish) at a local botanica to treat the child’s cold. The camphor had been placed in a bowl of water on the floor of the child’s room and added to the humidifier water.
In another case, a 22-month-old boy presented to a hospital emergency department with seizures just an hour after his parents found him with a piece of camphor in his mouth. The family had been using the product to control roaches by placing it along the wall and in the corners of rooms.
In still another case, a 15- month-old girl presented to the ED with a second seizure after her mother applied a camphor chest rub too often to the child’s chest, back, and head - every hour for 10 hours - to treat cold symptoms. Still others have pulled Vicks out of the jar and stuck it in their mouth or ingested camphor in other products in other ways, and wound up in the hospital.
Some camphor is sold in blocks like these.
Surprisingly, Dr. Muller mentioned that while moth balls were thought to no longer be available commercially, they do still get calls now and then about ingestions of camphor from moth balls. Other poisonings are associated with camphor sold as small white cubes packaged in clear plastic (see photo). Such straight camphor is still available in bodegas, botanicas, discount stores, as well as from some pharmacies or on-line.
The latest national data are from American Association of Poison Control Centers National Poison Data System, published in the December 2009 Clinical Toxicology. Nationally, 10,808 exposures to camphor were reported to U.S. Poison Control Centers in 2008. Of these, 8,686 were in children under age 6 years and the vast majority were judged to be unintentional. Treatment in a health care facility was necessary in 1,013. Fortunately, none died, but at least 86 were harmed. Seizures or pulmonary aspiration are the major hazards.