All preparations have been made for the new baby. Wall socket covers are in place and gates secure the staircase.
But what about the landscape? Will thorns mar baby's first exploration outside? Will poisonous mushrooms land Junior in the emergency room? Does that flowering ground cover beckon to both toddlers and honeybees?
Corrine Ray, a community educator for 24 years with the Los Angeles Regional Drug and Poison Information Center before retiring last October, said she stresses this cardinal rule with homeowners: "Know your plants."
Parents of a baby, whether they are landscaping a new house or renovating an existing landscape, should be familiar with all of the plants that could possibly come in contact with their child (including trees that might drop berries or leaves). Ray suggests that parents also be familiar with plants in the neighbor's yard.
With 100,000 reported plant exposures involving children every year, this knowledge is vital in an emergency. If a child eats a toxic plant, critical time could be lost in diagnosis and treatment if the parent cannot readily identify it.
Ray said her agency receives thousands of calls related to plant ingestion a year, but her center does not track statistics by age group. In 1993, the center received about 3,000 calls involving human exposure (either skin contact or ingestion) of a questionable plant.
Plants that prompted the largest number of calls to the center were mushrooms, oleander, philodendron, pyracantha, poinsettia, pothos, poison oak and dieffenbachia, she said.
The San Diego Regional Poison Center, which does keep statistics by age, reports that philodendron is the most commonly ingested plant by children under 6--both locally and nationally.
The plants can cause a burning irritation in the mouth and tongue for about 24 hours. "It's uncomfortable," said center spokesperson Anthony Manoguerra, "but it's not life threatening."
In 1993, the San Diego center received 1,234 calls involving children under 6 eating plants and an additional 111 calls involving small children eating mushrooms.
No other plant type was reported as often as the philodendron family. Other problem plants included some jasmine, lantana and oleander.
Oleander, a plant of concern at both poison centers, is so toxic that some adults have eaten it to commit suicide. However, Manoguerra said, the leaves taste so bitter that most children stop with the first one. "You'd have to eat a dozen leaves before it got serious," he said. In most cases, the quantity that children ingest is enough to cause stomach aches and maybe vomiting, but not death.
Some other potentially fatal plants are rare in Southern California gardens, he said. These include the castor bean, which usually grows in the wild, and tobacco plants.
On mushrooms, Manoguerra's advice for parents is to scout the back yard each morning before letting the youngsters out to play, and to remove and discard any mushrooms. "There are fungicides available," he said, "but I'm not sure they're effective."
He said 2- to 3-year-olds are the most likely to ingest mushrooms accidentally.
While most mushrooms cause vomiting and diarrhea, one native species can be fatal. Amanita ocreata, a pure-white mushroom that generally grows in the vicinity of oak trees, can kill children even in small doses.
But, in other cases, the reputation of a plant may be worse than the plant itself. Periodically, some parent's magazine will publish holiday warnings against poinsettias, but, Manoguerra said, the plant got a bad rap in the 1930s when a medical journal reported the death of a child in Hawaii after eating an unknown plant--presumed to be a poinsettia. Later research with laboratory mice proved the plant not as deadly as its reputation. There were no reported cases of poinsettia poisoning in San Diego for 1993, he added.
The San Diego Center publishes a list of dangerous plants, but Ray cautioned that lists may not always be definitive because often poisons are not uniformly distributed throughout a given plant.
Also, different varieties of the same plant may have different characteristics. For example, she said, the potted poinsettia sold during the holiday season is a nontoxic hybrid, but old varieties grown outdoors may be toxic.
The other factor that makes list-keeping difficult is that people vary in their reactions to the same plant. Some may be more sensitive to certain toxins--such as poison oak--than others.
Dr. Steven Krug, director of the Emergency Department at Children's Hospital in San Diego, estimates that his emergency room sees one plant ingestion case a week. Most cases are identified and treated at home, he said.
Like Krug, Dr. Marshall Morgan, director of emergency medicine at UCLA Medical Center, said he has seen few cases of plant poisoning in children--two or three children with oral burns from dieffenbachia and an occasional child brought in for eating plants.
Dr. Donald Barceloux, associate clinical professor of medicine at UCLA, who specializes in toxicology, said the most serious exposures to poisonous plants are not the toddler who casually picks up and eats a leaf, but the older child or adult who experiments with cooking and eating toxic plants.
Barceloux, who has co-authored a 1,500-page reference work titled "Medical Toxicology: Diagnosis and Treatment of Human Poisoning," said that while a majority of the 100,000 annual reported plant exposures nationwide involve small children and indoor plants, such as dieffenbachia and philodendron, there are few serious injuries in this age group.
"The problem is when children or adults boil plants and eat them," he said. He cites cases such as the elderly woman who died after brewing a tea of oleander leaves or the Boy Scouts who got severe gastroenteritis after cooking and eating castor beans. Castor beans, he added, grow wild near roads in the mountainous areas of the Los Angeles basin, such as the Santa Monica and San Gabriel mountains.
While Barceloux said there have been no reported cases of Amanita (mushroom) poisonings in Los Angeles, he said the mushroom grows wild in other parts of the state.
He also cautions that children seeking back yard culinary adventures could seriously poison themselves by cooking apricot or peach pits, which release cyanide, or by using sticks from toxic plants, such as oleander, as barbecue skewers.
The methods of ingestion and types of toxic plants are many, but Krug advises parents who suspect that their child has eaten a harmful plant to call the local poison control center before taking any other action.
When calling a poison center, parents should try to identify the plant material or at least have a specimen they can describe over the phone. They should also record any symptoms the child may have developed.
"Some people might immediately administer syrup of ipecac to induce vomiting," Krug added, "but that might disguise symptoms created by the plant--some induce vomiting all by themselves. Call first." Drinking water or juice, which may dilute the poison, is recommended.
Ray cautions that while some reactions will begin right away, other plant-related symptoms--such as digestive problems--may take up to half a day to develop.
Parents should also be familiar with procedures to take if the child has a contact exposure, such as poison ivy or poison oak, Krug said. In these cases, he recommends "rapid irrigation" of the exposure site with water, but not with soap. Soap may break down the body's natural oils, which provide a limited defensive barrier, he said.
Other contact exposures, such as thorns, burrs, cactus and spines, are best prevented by keeping these plants away from areas where children are likely to play. Children should also be kept out of the yard for several days after pesticide application.
Professional landscapers also encourage prevention--and toxic plants are only one hazard they address.
San Diego-based landscape architect Nick Martin, says the No. 1 safety concern for parents of babies and toddlers should be keeping them away from bodies of water--pools, spas, even decorative fountains. (See accompanying story.)
The next concern is securing the yard from the street--gates to prevent the child from leaving the yard or unwelcome visitors (such as strangers or stray dogs) from coming inside.
While Martin says he steers parents away from such toxic plants as oleander and calla lilies, he's more concerned with the potential dangers of plants that can stab a child or poke out an eye.
Plants that attract large quantities of bees should not be placed in or near the child's play area, especially if there is a history of bee-sting allergies in the family. Martin cautioned against bottle brush, pepper trees, honeysuckle, rosemary and red apple ice plant as especially attractive to bees.
"As a general rule, plants with a single large flower are less attractive to bees than plants with hundreds of flowers on each stalk," Martin said.
Pamela Homfelt, a landscape designer with Evergreen Nursery in San Diego, said she tells clients with children to avoid oleander, "but even more than poison, I'd avoid things with thorns such as bougainvillea, carissa, roses and chorisia speciosa (floss silk tree)."
Both Martin and Homfelt advise using Sunset's "The Western Garden Book" as a definitive resource for choosing and identifying plants.
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Plants to Beware
The following plants can produce severe poisoning in humans:
Abrus precatorius --Rosary pea Brugmansia sanguines --Red Angel's Trumpet B . arborea --Angel's Trumpet Cicuta douglasii --Western Water hemlock Conium maculatum --Poison hemlock Datura stramonium --Jimson weed Digitialis purpurea --Foxglove Nicotiana glauca --Tree tobacco Phytolacca americana --Pokeweed Ricinus communis --Castor Bean Taxus baccata --English Yew T . brevifolia --Western Yew Zigadenus venenosus --Death Camas
The following plants are capable of producing a wide range of ill effects from skin rashes to painful swelling of the mouth to severe vomiting and diarrhea. If eaten in large quantities, some of them may cause more serious poisoning. This is not a complete list.
Arrowhead Azaleas Boston Ivy Caladium Calla Lily China Berry Daffodil Delphinium Devil's Ivy Dieffenbachia Elephant Ear English Ivy Euphorbia Four O'Clock Holly Berries Hyacinth Hydranga Iris Jack-in-the-pulpit Jerusalem Cherry Jonquil Lantana camara Larkspur Lily of the valley Lobelia Mistletoe Morning glory Narcissus Nephthytis Night Blooming Jasmine Nightshade Oleander Pencil tree Periwinkle Philodendron Potato sprouts and leaves Privet Rhododendron Rhubarb leaf Tobacco Tomato vines Wisteria Yellow Jasmine
Source: San Diego Regional Poison Center at the UCSD Medical Center. (619) 543-6000