Pediatric Prescription Drug Poisonings Parallel Adult Use

Ricki Lewis, PhD

June 03, 2013

Prescription drug classes that contribute the most to childhood exposures and poisonings parallel the most frequently prescribed drugs to adults, according to results from a study published online June 3 in Pediatrics.

Lindsey C. Burghardt, MD, from Boston Children's Hospital in Massachusetts, and colleagues identified a strong association between increasing use of certain prescription medications in adults and increasing incidence of childhood poisonings with those drugs.

Pediatric prescription drug exposures and poisonings have been increasing during the last 4 decades, despite public health efforts such as child-resistant drug containers and educational campaigns. The researchers considered children's ages and drugs by category, including hypoglycemics, beta-blockers, antihyperlipidemics, and opioids.

The researchers consulted the American Association of Poison Control Centers' National Poison Data System and the National Ambulatory Medical Care Surveys for 2000 through 2009. They used multiple time-series analysis to consider children aged from newborn to 5 years, from 6 to 12 years, and from 13 to 19 years. Evidence for pediatric exposures and poisonings was serious injuries, emergency department visits, and hospital admissions.

During the 10-year period covered in the study, 38,485 exposures were to hypoglycemics, 39,693 to antihyperlipidemics, 49,075 to beta-blockers, and 62,416 to opioids.

The strongest association was for opioids. The greatest risk for all 4 drug classes was seen among children younger than 5 years, followed by those in the oldest cohort. The higher rate of ingestion among the youngest children likely reflects exploratory behavior of young children. However, in the oldest group, in whom opioids were by far the most-used drug class, ingestion is more likely a result of drug abuse or intent to harm self.

Serious injuries were most likely after ingestion of opioids (26.8%) or hypoglycemics (19.5%). Emergency department visits were most likely after ingestion of hypoglycemics (60.1%) and beta-blockers (59.7%). Hospitalizations were most likely to follow use of opioids (35.2%) and hypoglycemics (49.4%).

"Increasing rates of adult drug prescriptions are strongly associated with increases in drug exposures and poisonings among children and appear to be a direct cause of exposures and poisonings," the researchers conclude. Preventive measures must account for the increase in adult use of prescription medications, they add.

The researchers single out obesity for contributing greatly to the problem, as obese individuals constitute much of the markets for antihyperlipidemics, oral hypoglycemics, and beta-blockers.

Limitations of the study include patient reporting of drug use and dose. The findings may be underestimates because the analysis excluded combination medications. In addition, reports to the poison control centers surveyed are voluntary. To combat the problem in the future, it might be helpful to identify the relationships between the individuals for whom drugs are prescribed and the exposed or poisoned children, the researchers add.

One author was supported by a grant from the National Institute of Child Health and Human Development. The authors have disclosed no relevant financial relationships.

Pediatrics. Published online June 3, 2013. Full text

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