Ingesting Liquid Laundry Packets Is a New Hazard for Children

April 08, 2013

By Lorraine L. Janeczko

NEW YORK (Reuters Health) Apr 08 - Laundry packet ingestions are an important new pediatric hazard that can have gastrointestinal, respiratory, ocular and metabolic effects, according to a new study.

Liquid laundry detergent packets were introduced in U.S. stories in late 2011 and early 2012. The American Association of Poison Control Centers (AAPCC) began to collect data on exposures to these products when it became clear that children who accidentally mouthed or ingested the contents were suffering severe outcomes, said study author Dr. Rais Vohra, associate medical director of the California Poison Control System's Fresno-Madera Division, in an email to Reuters Health.

Dr. Vohra and his colleagues used the California Poison Control System electronic database to study the toxic effects of exposure to liquid laundry packets, as well as the demographics, clinical aspects and hospital course for trends and patterns related to SUDS toxicity.

"Our findings detail the first nine months of calls made to the California Poison Control System (CPCS) and reveal that these products or 'SUDS' (Single-Use Detergent Sacs) can cause a variety of adverse effects in children," he said.

The researchers presented their findings in a poster March 17 at the American College of Medical Toxicology Annual Scientific Meeting in San Juan, Puerto Rico.

They identified a total of 589 laundry detergent packet exposure cases from March through December 2012. (To put that in perspective, data from the U.S. Census Bureau indicates there were roughly 2.5 million children under age five living in California in 2011. As Dr. Vohra told Reuters Health, "The incidence of poisonings is probably very low.")

Most cases involved ingestions at home, and the median patient age was two years old.

Children who ingested SUDS (n=523) had gastrointestinal, respiratory, metabolic and CNS effects. Most emergency room-treated cases were discharged (81%). For those who were hospitalized, the length of stay ranged from one to six days. Effects were minor in 56% of cases, moderate in 5%, and severe in 4%.

Overall, the top three problems in children who ingested SUDS were any gastrointestinal effects (vomiting, diarrhea, sore throat, abdominal pain, drooling, laryngeal edema) in 370 patients (70.7%) and vomiting (induced in eight cases) in 328 patients (62.7%). A fifth of patients (113, or 21.6%), had no symptoms. Seven children had corneal damage from ocular exposure.

Four children required endotracheal intubation and 11 children were admitted to pediatric intensive care units, but no deaths were reported.

The three major SUDS brands - Tide Pods, Purex UltraPacks, and All Mighty Packs -- varied in the severity of their effects. Two brands were disproportionately responsible for the moderate and severe effects: the Purex UltraPacks and All's Mighty Packs.

"Bright and colorful packaging is attractive to children, and the soft and easily graspable SUDS may be part of the reason why children are more likely to be exposed to SUDS as opposed to more traditional liquid or powdered detergent," Dr. Vohra said.

Why some children exposed to SUDS become severely ill while others have no symptoms is unknown, and the authors say more studies are needed to explain the toxic mechanisms of SUDS and to identify strategies to treat exposure complications.

"We have yet to elucidate which specific chemical components or aspects of product formulation and delivery cause severe effects," Dr. Vohra said in his email.

"From a public health perspective, prevention and effective treatment of household injuries is a cycle in which challenges are renewed after each innovation in the retail marketplace. Parents and care providers must constantly recheck the child-protective mechanisms that protect the children in their lives, and ensure that new products don't turn into new hazards," he added.

Dr. Paul M. Wax, executive director of the American College of Medical Toxicology and a surgeon at the University of Texas Southwestern Medical School in Dallas, said in an email to Reuters Health, "Liquid laundry packet poisoning is newly described phenomenon and this study is one of the first to report on this new public health issue."

"Given that young children may be attracted to these liquid laundry packets, would industry consider changing their packaging of these packets to make them less attractive to naturally inquiring children?" he asked. Dr. Wax was not involved in the study.

Kathryn Corbelly, Director of Corporate Affairs for The Sun Products Corp in Wilmington, Connecticut, parent company of the All brand of detergents, told Reuters Health that in 2012, when cases of accidental ingestion by children began to appear in the media, "we began to look at our product and make the changes, including education, reminding consumers to close the laundry detergent package and place it on a high shelf out of reach of children and pets.

Since then, she said, "All the packaging has changed and has new safety icons and warnings. Our website has changed. We have made a lot of changes across our website and packaging to help remind our consumers to safely store everything out of reach of children.

"It's a transition in stages," Corbelly added. "In 2013 we did a stickering program first. We had people in the stores put the safety icons on the packages that were manufactured prior to our getting the revised packaging on the shelf."

Also, Corbelly said, "We have placed warnings on our coupons, on our television advertisements, and in our print advertising. We have enhanced our warnings on our packaging, our digital advertising, and all our social media sites."

Anne Candido, Tide Communications Manager for Proctor & Gamble in Cincinnati, Ohio, told Reuters Health her company has made several changes to its packages. "The first has been on the lid," she said. "Now the lid has a dual latch that makes it more difficult for kids to get to the product, and a safety sticker across the top. We're also changing the exterior package, which is going to be a solid orange color. It will have pictures of the product, but it won't be as appealing to children because they won't see the actual packets."

Corbelly said Sun Products' new packaging also makes it impossible to see the packets from the outside.

Tide's Candido added, "We take these things very seriously. We have gone through a big effort to make sure that we are providing the best we can for consumers, especially in light of what's happened to the littlest members of our consumer base.

Dr. Vohra pointed out that if the individual packets themselves are not wrapped in a child resistant packaging, "once the larger container is breached a child has pretty easy access to one or multiple single use detergent sac (SUDS) packets, which is concerning."

He added that reporting all cases to the local Poison Control System will help manage exposures and support SUDS exposure surveillance efforts.

For a poison emergency in the U.S., call 1-800-222-1222.