Opioids implicated in most fatal poisonings of US toddlers, study finds

ANAHEIM, Calif. — Opioids were implicated in nearly half of fatal poisonings of U.S. toddlers during a recent 14-year period, with most deaths occurring at home while the children were being supervised, a study found.

The proportion of opioid-related deaths more than doubled over the course of the study period, from around 24% in 2005 to around 52% in 2018 — likely a consequence of the opioid epidemic, said Christopher E. Gaw, MD, MBE, a pediatric emergency medicine fellow at The Children’s Hospital of Philadelphia, who presented findings from the study at the AAP National Conference & Exhibition.

“The belief is that new opioid sources that have appeared in communities over the past decade or so — such as illicit fentanyl and opioids used in medication-assisted treatment, for example methadone [and] buprenorphine — are increasing opportunities for children to be poisoned, sometimes fatally,” Gaw told Healio in an email.

Gaw and colleagues studied data reported by 40 states on fatal poisonings of U.S. children aged younger than 5 years. After opioids, over-the-counter pain, cold and allergy medications were the next most commonly named substances in the 731 fatal poisonings reported by the states to the NIH-funded National Fatality Review-Case Reporting System during those years.

The database was not set up to differentiate whether opioids were illicit or prescription medications. “They were all lumped into one category,” Gaw said.

“That being said,” he continued, “both prescription and illicit opioids are dangerous to infants and young children. With respect to illicit opioids, there is important work being done to reduce unnecessary opioid prescribing and drug diversion, and to treat substance use disorders. These efforts — though not directly related to children — also help protect them, since they can reduce the chance of exposure to opioids in the home.”

Opioids contributed to 47.3% of the fatal poisonings, according to the data. OTC pain, cold and allergy medications were listed as a contributing factor in 14.7% of deaths.

Other named substances included carbon monoxide (6.4%), amphetamines (4.4%), antidepressants (3.4%), cocaine (3.4%) and alcohol (1.8%).

Infants aged younger than 1 year accounted for 42.1% of all deaths but were less likely to be involved in an opioid-related death than children aged 1 year and children aged 2 to 4 years (34.1% vs. 61.4% vs. 54%).

Overall, 60.7% deaths occurred at the child’s home. In 70.6% of deaths, the child was being supervised — most often by a biological parent (58.5%), grandparent (10.9%) or other relative (5.5%). In more than a quarter of deaths (28.5%), the children were within sight of the supervisor.

“Poisonings can happen in a split second. It is not reasonable for us to expect a caregiver to watch a child 24/7 and be within arm's reach of them to keep them out of harm's way. Instead of supervision, families should focus on preparedness and prevention,” Gaw said.

He recommended that families save the number for Poison Control (1-800-222-1222) in their phones — two-thirds of the deaths in the study did not have a documented call to a poison control center — and store any medications or other dangerous substances "up, away, and out of sight and preferably in a locked cabinet or closet.”

Gaw referenced a study published last year in Pediatrics that found most fatalities among young children that were associated with cold and cough medications happened after the medications were given to them by a caregiver for nontherapeutic reasons.

“There has been a lot of work over the years among health care providers to counsel families on the proper dosing and use of medications such as Tylenol, Motrin and Benadryl,” Gaw said. “There has also been a push to educate families that using antihistamines, such as Benadryl, to sedate their children can be dangerous — and depending on the dose, potentially deadly.”

Returning to the topic of opioids, Gaw noted the effectiveness of naloxone as an antidote to opioid poisoning and said educating people on the signs and symptoms of opioid poisoning and “helping them feel empowered to use naloxone is something the public health world is working on.”

“We often think of using it in adults, but this is also a lifesaving medication for children poisoned by opioids,” Gaw said.

References:

Children’s Hospital of Philadelphia. Poison prevention: Keeping your family safe. https://www.chop.edu/health-resources/poison-prevention-keeping-your-family-safe. Accessed Oct. 10, 2022.

Gaw CE, et al. Characteristics of fatal poisonings among infants and young children in the United States. Presented at: AAP National Conference & Exhibition; Oct. 7-11, 2022; Anaheim, Calif.

Halmo LS, et al. Pediatrics. 2021;doi:10.1542/peds.2020-049536.