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Out of children’s hands: The impact of pediatric medication poisonings
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Unintentional poisonings significantly impact the pediatric population, as the highest risk peaks at about age 2 years. Published data have demonstrated that medication products — OTC and prescription — as causes of unintentional poisonings have increased in recent years.
The impact of unintentional poisonings on infants and children is significant, although, fortunately, deaths are uncommon. Yet, any death of an infant or child from what can be a preventable occurrence, is concerning. Each year, greater than 500,000 children aged 5 years and younger experience a poisoning exposure from a medication product. Many of these children are treated in an emergency department (ED).
Nearly 50 years ago, the Poison Prevention Act mandated improvements in medication product safety by requiring child-resistant packaging. Although these improvements have significantly reduced pediatric poisonings, they have not been completely eliminated, and the impact of prescription products as a cause of poisoning have been increasing — child-resistant packaging does not equate to ‘child proof.” Child-resistant packaging is defined as a product package that is difficult for a child aged less than 5 years to open. More specifically, 85% of children must not be able to open a child-resistant package within 5 minutes, and 90% of adults should be able to open the product within the same time period.
Edward A. Bell
On the front lines of poison management
According to recently published data from the American Association of Poison Control Centers’ National Poison Data System, approximately 95% of ED visits related to medication poisoning in children aged younger than 5 years (n = 453,559) were related to unintentional self-exposure.
Based on data from nearly 500,000 ED visits from 2001-2008, medication products available by prescription only were responsible for 55% of ED visits, 76% of hospital admissions, and 71% of exposures assessed as a significant injury. This represents a 43% increase in injury and a 30% increase in ED visits over this 8-year period, as compared with an 8% increase in the U.S. population for this age group overall.
Medication classes that were mainly responsible for prescription product exposures were analgesics (predominantly opioids), central nervous system-acting agents (anticonvulsants, antidepressants, neuroleptics, sedative-hypnotics, stimulants), cardiovascular agents, and hypoglycemics. Hypoglycemic agents accounted for the highest hospital admission and injury rate. Ninety deaths were reported, with opioid and cardiovascular agents primarily responsible.
Similar data for children aged 5 years and younger have been reported for an 11-year period, 2000-2010, from poison centers representing 5 U.S. states, with a total population of nearly 55,000,000. Over this time period, poison exposures increased 12.4%, with a 33% increase in exposures related to a medication product. Exposures related to a non-medication product decreased by 2.8%. Exposures resulting in a serious medical outcome (defined as a moderate or major outcome, or death) increased by 53%, including 119 deaths. Substance categories with the greatest increase in serious medical outcomes included sedative/hypnotic/antipsychotic, cardiovascular and analgesic agents. The substance category evaluated with the largest percentage increase in poisonings over this 11-year period was “dietary supplements/herbals,” with a 274% increase from 2000 to 2010. Poisonings due to the substance category of “antimicrobials” increased by 16% during this period.
Curbing an escalating trend
While significant improvements have been made in reducing poisonings and deaths in the pediatric population over the past 50 years, recent data demonstrate that pediatric poisonings from medication products have been increasing. In recent years, medications have become the predominant cause of pediatric poisonings, and have surpassed household products as the major cause of poisonings among infants and children.
Researchers of these data suggest that as use of pharmacotherapies have increased in past years to treat increasingly diagnosed medical problems such as obesity/metabolic syndromes and cardiovascular disorders, more medications are available in homes with young children. As the availability and use of dietary supplements and herbal products have also increased in recent years, so have poisonings in young children from these products.
These ominous changes have been recognized, and some strategies for improvement have been implemented. For example, the PROTECT (Protecting Overdoses and Treatment Exposures Task Force) Initiative — an effort of various federal governmental, private, academic, professional, and consumer organizations — has helped lead to significant changes in medication product safety. Tylenol pediatric liquid products, for example, now have flow-restrictor and dosing device improvements to limit pediatric poisonings.
References:
Bar-Oz B, et al. Pediatr Drugs. 2004;6:123-126.
Bond GR, et al. J Pediatr. doi:10.1016/j.jpeds.2011.07.042.
Budnitz DS, et al. Journal Pediatr. doi:10.1016/j.jpeds.2011.09.02.
Budnitz DS, et al. Pediatrics. doi:10.1542/peds.2011-0926.
Canares TL, et al. Pediatr Rev. doi:10.1542/pir.36-2-82.
Spiller HA, et al. 2000-2010. Pediatr Emerg Care. doi:10.1097/PEC.0b013e31828e9d00.
For more information:
Edward A. Bell, PharmD, BCPS, is professor of pharmacy practice at Drake University College of Pharmacy and Health Sciences and Blank Children’s Hospital and Clinics, Des Moines, Iowa. He also is a member of the Infectious Diseases in Children Editorial Board. Bell can be reached at ed.bell@drake.edu.
Disclosure: Bell reports no relevant financial disclosures.