title: Home Use of a Pyrethroid-Containing Pesticide and Facial Paresthesia in a Toddler: A Case Report.
abstract: Paresthesias have previously been reported among adults in occupational and non-occupational settings after dermal contact with pyrethroid insecticides. In this report, we describe a preverbal 13-month-old who presented to his primary care pediatrician with approximately 1 week of odd facial movements consistent with facial paresthesias. The symptoms coincided with a period of repeat indoor spraying at his home with a commercially available insecticide containing two active ingredients in the pyrethroid class. Consultation by the Northwest Pediatric Environmental Health Specialty Unit and follow-up by the Washington State Department of Health included urinary pyrethroid metabolite measurements during and after the symptomatic period, counseling on home clean up and use of safer pest control methods. The child's symptoms resolved soon after home cleanup. A diagnosis of pesticide-related illness due to pyrethroid exposure was made based on the opportunity for significant exposure (multiple applications in areas where the child spent time), supportive biomonitoring data, and the consistency and temporality of symptom findings (paresthesias). This case underscores the vulnerability of children to uptake pesticides, the role of the primary care provider in ascertaining an exposure history to recognize symptomatic illness, and the need for collaborative medical and public health efforts to reduce significant exposures in children.
authors.affiliation: Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, WA 98105, USA. aperk11@uw.edu.|Northwest Pediatric Environmental Health Specialty Unit, Seattle, WA 98105, USA. aperk11@uw.edu.
authors.forename: Alexandra
authors.initials: A
authors.lastname: Perkins
authors.affiliation: Bainbridge Pediatrics, Bainbridge Island, WA 98110, USA. fwalters@bainbridgepediatrics.com.
authors.forename: Frederick
authors.initials: F
authors.lastname: Walters
authors.affiliation: Washington State Department of Health, P.O. Box 47825, Olympia, WA 98504, USA. Jennifer.Sievert@doh.wa.gov.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Sievert
authors.affiliation: Washington State Department of Health, P.O. Box 47825, Olympia, WA 98504, USA. Blaine.Rhodes@doh.wa.gov.
authors.forename: Blaine
authors.initials: B
authors.lastname: Rhodes
authors.affiliation: Washington State Department of Health, P.O. Box 47825, Olympia, WA 98504, USA. Barbara.Morrissey@doh.wa.gov.
authors.forename: Barbara
authors.initials: B
authors.lastname: Morrissey
authors.affiliation: Northwest Pediatric Environmental Health Specialty Unit, Seattle, WA 98105, USA. ckarr@uw.edu.|Department of Pediatrics, University of Washington, Seattle, WA 98105, USA. ckarr@uw.edu.
authors.forename: Catherine J
authors.initials: CJ
authors.lastname: Karr
mesh_terms: D004781:Environmental Exposure / Q000032:analysis; D004782:Environmental Health; D004784:Environmental Monitoring; D005158:Facial Paralysis / Q000139:chemically induced* / Q000503:physiopathology; D006801:Humans; D007223:Infant; D007306:Insecticides / Q000506:poisoning* / Q000652:urine; D008297:Male; D010571:Pest Control; D011722:Pyrethrins / Q000506:poisoning* / Q000652:urine; D014861:Washington
chemical_list: D007306:Insecticides; D011722:Pyrethrins
keywords: biomonitoring; child; insecticide; paresthesia; pediatric; pesticide; pyrethroid