Pediatric Drug Poisoning on the Rise

Jim Kling

September 16, 2011

September 16, 2011 — Pharmaceutical poisoning of children is on the rise, and the most serious consequences result from self-ingestion of opioids, sedative-hypnotics, and cardiovascular drugs, according to a study published online September 16 in the Journal of Pediatrics.

Annually, more than 500,000 children younger than 5 years accidentally ingest pharmaceuticals, and more than 50,000 come to an emergency department (ED). The annual number of calls to poison centers about children ingesting drugs dropped between 1990 and 2000, but rose between 2001 and 2008.

G.Randall Bond, MD, from the Division of Emergency Medicine, Department of Pediatrics, and the Drug and Poison Information Center, Cincinnati Children’s Hospital Medical Center, University of Cincinnati, Ohio, and colleagues, set out to determine which medications and circumstances cause the most serious consequences, as measured by ED visits, hospitalization, and harm. They reviewed records from the National Poison Data System of the American Association of Poison Control Centers between 2001 and 2008, focusing on records for children aged 5 years and younger who were seen in a healthcare facility for potential pharmaceutical poisoning.

They classified the pharmaceuticals involved as over-the-counter or prescription, and by the drug's therapeutic category. Each event was tallied as self-ingestion or the result of a therapeutic error. For each category, the researchers totaled emergency visits, admissions, and significant injuries.

During the 8-year length of the study, 544,133 children aged 5 years or younger received care at an ED for documented overexposure to a pharmaceutical. Of these children, the researchers focused on 453,559 who were known to have been exposed to a single agent. Of these patients, 95% were classified as being examined for self-ingestion, 55% of the visits involved prescription drugs, and self-exposure to prescription drugs was responsible for 76% of hospital admissions and 71% of significant injuries.

The highest admission rate was seen for oral hypoglycemic agents (49%), as well as the highest injury rate (20%). High rates of total visits and significant increases in admission rate or injury rate were seen with prescription opioid analgesics (self-ingestion, 7% of visits overall; 86% increase in admission rate between 2001 and 2008 [P < .05]; 92% increase in injury rate [P < .05]), sedative-hypnotics (self-ingestion, 8% of total visits; no significant change in admission rate between 2001 and 2008; 14% increase in injury rate [P < .05]), and cardiovascular drugs (self-ingestion, 9% of visits overall; also no significant change in admission rate; 33% increase in injury rate between 2001 and 2008 [P < .05]).

A trend analysis showed increases during the study period for injury (43%), admission (36%), ED use (28% for single agents and 30% overall), and exposures (22%). All of these increases were significantly greater than the population increase in children aged 5 years or younger in the United States during the same time (8%; P < .05 for all).

The findings suggest that safety measures for children are not adequate, the authors conclude. "It's not so much the drugs as bad habits and the packaging the drugs come in," agrees Dennis Bryan, RPh, a pharmacist who has worked in institutional and community settings for 30 years, and is past president of the Illinois Pharmacist Association. Mr. Bryan told Medscape Medical News, when asked for independent comment, "We haven't changed the safety bottles since they first came out 20 years ago. Children have gotten smarter since then. If they can work an iPad or an iPhone, you wonder how much a safety bottle [will discourage them]."

Parents also need to do a better job of keeping drugs out of the hands of children. "I just call it location, location, location. Find a spot where you can store medications and keep them there. Maybe physicians can try to educate a patient who they know has kids at home. They can say, 'there are a lot of problems with this medication. Be a little astute about what you do with it,' " said Mr. Bryan.

The authors and Mr. Bryan have disclosed no relevant financial relationships.

J Pediatrics. Published online September 16, 2011. Full text


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