When teachers at DeRuyter Elementary told Amata Rounsaville that her kindergarten daughter was one of 15 pupils accidentally given Ritalin instead of a routine fluoride tablet Thursday morning, she hurried to the school to find out how such a mix-up could occur.
Both pills are small, but the fluoride was dark purple, smelled like grape candy and had a chunkier appearance than the gray, thin Ritalin pill.
“I’m definitely upset,” said the mother of four, who has two children enrolled in the district. “I’m not really sure how this happened.” According to elementary school principal Janice Ahlsen, the mix-up occurred after the DeRuyter school nurse confused two containers, giving kindergarten teacher Marcia Ludwig a bottle of the Ritalin pills prescribed for one student instead of fluoride tablets the district offers through a state dental health program.
The children, who take chewable fluoride supplements each day, complained of a bitter taste and were told by a substitute teaching assistant with a nursing background to spit the Ritalin out immediately, Ahlsen said.
“Kids are quick to let you know something doesn’t taste good,” she said, describing how staff quickly led the students to a classroom sink to spit and rinse.
Ahlsen said the school nurse, whom she would not name, had been looking for a substitute fluoride tablet for the class, because one kindergartner has a red-dye allergy and cannot take the pills the state sends. When different-looking pills showed up Thursday, the classroom teacher assumed a new tablet had been found, Ahlsen said.
Parents of all the kindergartners were notified about the accident, and the classroom was monitored by a nurse throughout the day to make sure students did not have adverse reactions, Ahlsen said.
“All of us are watching very closely,” she said. “We’re happy it turned out as well as it did, given the circumstances.”
But Rounsaville on Thursday removed both of her daughters from the district’s voluntary fluoride program because of the way the incident was handled.
“I felt the school downplayed it a little bit,” she said. “It bothers me that the children are the ones who noticed.”
Ritalin, a stimulant stronger than caffeine but weaker than amphetamines, is commonly prescribed for children who have Attention Deficit Hyperactivity Disorder, according to the National Institute on Drug Abuse. The drug is intended to have a calming and “focusing” effect on children.
Dr. Tom Welch, chairman of the pediatrics department at University Hospital, said it is unlikely a single dose of Ritalin would harm the students. He said the reaction would be similar to a 5-year-old being given a strong dose of caffeine.
“There really isn’t any acute thing to worry about with the kids,” he said. “That’s a medicine where even an allergy to it is pretty unusual.” Rounsaville said her pediatrician had her take her daughter’s temperature as soon as the girl arrived home from school. She was told to watch for symptoms such as nausea, a rash, an elevated fever, restlessness or drowsiness. The girl was fine Thursday evening, her mother said.
Morrisville pharmacist Jennifer Caloia, who owns Dougherty’s Pharmacy, agreed the effects would be minimal.
“If it was just in the mouth for a couple seconds, I don’t see that it would cause any harm,” she said.
Fluoride supplements are common in rural areas of Madison County, where municipal water in villages doesn’t have fluoride added, and families in outlying areas rely on wells for water, said Geoff Snyder, the county’s director of environmental health.
The towns of Canastota, Chittenango, Sullivan and Lenox have had fluoridated water since 1976, but the city of Oneida and other municipalities south of the Route 5 corridor are without.
Caloia said fluoride supplements prevent cavities, help teeth grow during developmental stages and help bones grow strong.
As part of a state-subsidized program aimed at improving dental health, families in the DeRuyter schools can have the school administer fluoride supplements to their children every morning, Ahlsen said.
The state’s Self-Applied Fluoride and Education Rinsing Program has operated in New York more than 20 years, and now has more than 300 participating schools, according to Claudia Hutton, director of public affairs for the state health department.
Children 6 and older use a sodium fluoride solution to gargle and rinse for one minute each morning. But kindergartners, considered too young to rinse, instead chew a daily tablet with 0.5 mg of fluoride, which is delivered to districts in cases of 120-tablet bottles, Hutton said.
Hutton said the doses are supposed to be administered by a school nurse. Teachers could be allowed to do it if the district has a special protocol. “Kids are supposed to be watched chewing the tablet and told when to swallow,” she said. “You want to make sure they get it chewed up well enough so it won’t upset their stomachs.”
Ahlsen said she wasn’t aware of all the state regulations about administering fluoride tablets. She said the district is taking immediate steps — such as using a different color and size of bottle for the fluoride tablets, and storing them in a different location, “to make sure that nothing akin to this ever happens again.”
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