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By Adriane Fugh-Berman, MD
"A spoonful of sugar helps the medicine go down."
In the original book, the magical nanny Mary Poppins broke off her fingers, which were made of different flavors of candy, as treats for the kids (I guess that wasn't a wholesome enough image to use in the movie). Candy has long been used as a delivery system for medicine; sweetened syrups and tablets have been used to encourage children to ingest antibiotics, antitussives, vitamins, etc., and in recent years, fentanyl lollipops have been used to administer opiates to children. Medicinal candy isn't just for children: Oral capsaicin, a topical analgesic agent from chili peppers, has been incorporated into taffy and used to treat oral mucositis pain secondary to chemotherapy or radiation.1
Everyone agrees that candy is bad for the teeth, and can pose an aspiration risk in young children, but here are some more unusual risks of candy: Lead poisoning has been associated with several types of imported candy. The culprit appears to be lead in the wrappers, which leaches into the candy. After elevated lead levels in a child was traced to tamarind candy, two types of tamarind candy were tested by the Oklahoma County Health Department; the investigation found that more than half of the tamarind suckers tested exceeded the Food and Drug Administration level of concern for lead in this type of product.2 Printed cellophane candy wrappers imported from Mexico also may present a significant risk for lead exposure.3
Essential oils used in candymaking can pose risks; an accidental ingestion of oil of wintergreen caused salicylate poisoning in an infant;4 cinnamon oil contains cinnamaldehyde, which can cause dermal and mucosal irritation; a second-degree burn was reported in an 11-year-old who broke a cinnamon oil vial in his rear pants pocket and left the area unwashed for 48 hours.5
Several confections can cause bezoars. Three cases of intestinal tract and esophageal obstruction have been reported in children who ingested chewing gum.6 Seven cases of bezoars associated with candied ginger root have been reported in children and edentulous elders.7
1. Berger A, et al. Oral capsaicin provides temporary relief for oral mucositis pain secondary to chemotherapy/radiation therapy. J Pain Symptom Manage 1995;10:243-248.
2. Lynch RA, et al. Lead-contaminated imported tamarind candy and children's blood lead levels. Public Health Rep 2000 ;115:537-543.
3. Fuortes L, Bauer E. Lead contamination of imported candy wrappers. Vet Hum Toxicol 2000;42: 41-42.
4. Howrie DL, et al. Candy flavoring as a source of salicylate poisoning. Pediatrics 1985;75:869-871.
5. Sparks T. Cinnamon oil burn. West J Med 1985;142:835.
6. Milov DE, et al. Chewing gum bezoars of the gastrointestinal tract. Pediatrics 1998;102:e22.
7. Corrigan D. Zingiber officinale. In: De Smet PAGM, et al, eds. Adverse Effects of Herbal Drugs. Vol 3. Berlin: Springer-Verlag; 1997.