CHILDHOOD POISONINGS RESULT IN 71,224 EMERGENCY DEPARTMENT VISITS NATIONWIDE EVERY YEAR

Children are twice as likely to be poisoned by the medicine cabinet than by cleaning products or other household substances, researchers found.

Emergency department visits for unintentional poisoning involved prescription or over-the-counter medication in 68.9% of pediatric cases, according to Daniel S. Budnitz, MD, of the Centers for Disease Control in Atlanta, and colleagues.

Children taking medications without supervision caused 10 times as many poisonings as overdose errors by a parent or other caregiver in the national study of emergency department surveillance, the authors reported online ahead of print in the AMERICAN JOURNAL OF PREVENTIVE MEDICINE.

The findings held few surprises but emphasize the need for prevention, particularly with toddlers, commented Carl Baum, MD, of the Center for Children's Environmental Toxicology at Yale-New Haven Children's Hospital, who was not involved in the study.

Children 5 and under accounted for 81.3% of pediatric accidental poisonings in the study, which Baum chalked up to their inventiveness in bypassing adult measures to prevent access. "You have to be careful because toddlers are often one step ahead of adults," he asserted.

Budnitz' group analyzed data from the U.S. Consumer Product Safety Commission's National Electronic Injury Surveillance System (NEISS), which receives reports from a random sample of adult and pediatric hospitals across the country.

The database included 3,034 emergency department visits or hospital admissions of patients under 19 during 2004-2005 for a condition the treating physician attributed to a medication overdose (more than the intended dose or inadvertent exposure), or to poisoning from a nonpharmaceutical consumer product.

Cases included ingestion and skin or eye exposures but excluded illicit substances, alcohol, tobacco, bee stings, and lead.
The population rate of emergency care for medication overdoses was significantly higher than those for nonpharmaceutical products at 9.2 visits per 10,000 individuals per year (95% CI 7.3 to 11.0) compared with 4.2 (95% CI 3.3 to 5.0).
Commonly available over-the-counter medications accounted for 33.9% of cases overall. The most commonly implicated drugs were:
• Acetaminophen (9.3%).
• Cough and cold medications (7.3%).
• Antidepressants (6.1%).
• Nonsteroidal anti-inflammatory drugs (NSAIDs, 5.3%).

Inclusion of cough and cold medicines on this list highlights the risks emphasized recently by both the FDA and trade groups representing the manufacturers.

(See Pediatric OTC Cough and Cold Remedies Should be Shunned in Toddlers and FDA Repeats Warning on Cough and Cold Medicines and Hopes That Parents Get the Message )
Cough and cold medicines "do a very poor job of treating symptoms that are usually self-limiting" and are potentially dangerous for children, Baum noted.

Medication overdose rates peaked at age 2 years (54.7 per 10,000 individuals per year) and fell with age until adolescence, when rates again rose (1.8 per 10,000 per year at ages 12 to 14 versus 3.3 at ages 15 to 18).

"The fact that, annually, one of every 180 children age 2 years is treated in an emergency department for a medication overdose, despite current prevention efforts, underscores the size of this public health issue," Budnitz's group concluded.
If anything, the results probably underestimate the scope of childhood poisonings, since poison control centers receive many more calls about pediatric poisonings, they noted. However, only a quarter of those result in direct treatment by a healthcare professional, they noted.Since unsupervised ingestion of medications by children 5 and under accounted for more than 75% of childhood poisonings, prevention efforts should concentrate on this problem, the investigators recommended.

Child-resistant bottles, blister packs, and other packaging have been effective against childhood medication overdoses, Baum noted, though these can be defeated by failure to use them properly, such as cross-threading a lid. Further efforts are recommended to focus on improving packaging for the drugs most commonly implicated in poisonings, such as bottles that release only a single dose at a time or restrict the amount that can be ingested by an unsupervised child, the researchers said.

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