Pediatric Drug Poisonings on the Rise

More children are being exposed to medicines in toxic doses as prescription drug use by Americans increases.

The number of young children hospitalized from accidental poisonings has risen dramatically in recent years, researchers reported in the September 16 online issue of the Journal of Pediatrics. Prescription and OTC drugs left unsecured—not therapeutic errors—are to blame for the dangerous trend, according to lead author and emergency medicine physician Randall Bond, MD.

"Prevention efforts at home have been insufficient," said Dr. Bond, who is also directer of the Drug and Poison Information Center at the Cincinnati Children's Hospital Medical Center. Although educating parents about safe medication storage is part of the solution, better packaging is also key, the physician said. "We need to improve storage devices and child-resistant closures and perhaps require mechanical barriers, such as blister packs.”

He and colleagues examined patient records of 544,133 children aged 5 years and younger who visited emergency departments between 2001 and 2008 due to possible poisoning by a prescription or OTC medicine. The investigators observed a 22% increase in accidental drug exposures, even though the US population of children younger than 5 increased just 8% during the study period. Opioid analgesics, sedative hypnotics, and cardiovascular medications had the biggest impact, the authors noted.

WEIGH IN When it comes to poison prevention, which approach is better? Educating parents or improving child-resistant drug packaging? Share your thoughts in the comments.

More prescriptions, more exposure

In 2008, roughly half of the US population reported using at least one prescription drug, and 11% took 5 or more. As Americans age and drug therapy evolves, childrens' access to medicines at home is only likely to increase. National efforts to prevent poisoning should focus on designing safer pharmaceutical packaging, according to the study’s authors.

Containers that restrict the flow of liquid medications or dispense a single tablet at a time would "reduce the quantity a child could quickly and easily access in a self-ingestion episode," limiting the potential for accidental poisoning, authors explained. They added that changes to packaging should be considered for both prescription and OTC drugs.

Rethinking package and label design is one objective of the PROTECT initiative for medication safety. Launched in 2008 by the CDC, the project brings together stakeholders in government, industry, and academia to achieve a common goal: reduce the 70,000 emergency department visits that occur each year as a result of unintentional medication overdoses in children.

Early outcomes of the PROTECT initiative include the addition of flow restrictors to bottles of Children's and Infant's Tylenol and the creation of standards for the dosing of OTC liquid medications, including changes to the concentration of pediatric liquid acetaminophen.

To protect children, educate parents

Frequent and ongoing patient education should continue to supplement any changes to packaging, according to the authors of the Journal of Pediatrics study. To that end, a PROTECT workgroup is also working to identify key messages that will be communicated in a national educational campaign about the safe use of OTC medicines.

When dispensing medications, pharmacists can bolster these efforts by recommending steps parents can take to "poison proof" their homes. According to Dr. Bond, "Prevention efforts of parents and caregivers to store medicines in locked cabinets or up and away from children continue to be crucial."

For other articles in this issue, see:

• Expert Blasts FDA Labeling of Cancer Drugs
• Engaging Patients With Rx Packaging