Anyone who takes care of children knows that they have to make their home safe. Whether it's putting up a gate to keep an adventurous child from falling, or covering electrical outlets to keep a curious child away from danger, a safe home is job one. The risk of child poisonings with medicines in the home, however, may not be considered and addressed.1
Every minute of every day, a poison control center answers a call about a young child that has accidentally ingested a medicine.2 The American Association of Poison Control Centers (AAPCC) receives more than half a million reports of medicine poisonings in children less than 6 years of age every year.1 On top of that, one child is treated in an emergency department for accidental medicine poisoning every 8 minutes. That's more than 60,000 children rushed to the hospital each year for evaluation.1 In almost all cases, the children have taken the medicines themselves, unwitnessed by an adult. Only 5% of child medicine poisonings are due to dosing errors made by parents or caregivers.3
A recent study provides parents with insights regarding accidental child poisonings with medicines.1 The purpose of the study was to identify the deep-rooted causes of accidental poisonings with medicines. To do this, the researchers conducted interviews with caregivers who reported child poisonings, asking questions that may have been overlooked in prior studies, such as:
• When did the poisoning occur in relation to the last proper dose?
• In what room did the poisoning occur?
• Was the medicine in its usual storage location when the poisoning occurred?
The most remarkable finding from this study was that most child poisonings occurred when the medicine was not in its normal storage location when the child got into it. Instead, the medicine had been removed from its storage location so it could be taken by an adult or given to a child. Then, the medicine was not immediately returned to its usual storage location. During this time, children were able to access the medicine. Thus, no matter how securely medicines are secured between uses, this study suggests that there is a period of great risk for child poisonings shortly after removing or taking medicines, before they are put away properly and securely. Children are at greatest risk when medicines in the home are in use.
The study looked at 220 cases of child poisonings involving over-the-counter (OTC) medicines reported during a 4-month period to McNeil Consumer Healthcare. McNeil is a company that markets a wide range of OTC products, including Tylenol (acetaminophen), Benadryl (diphenhydramine), Zyrtec (cetirizine), Imodium (loperamide), Motrin (ibuprofen), and Sudafed (phenylephrine and/or pseudoephedrine, may contain dextromethorphan).
All of the children involved in the poisonings were less than 7 years old. The children were the intended recipient of the medicine in about half of the cases. Children's medicines were involved more often than adult medicines, and liquid medicines were ingested more often than chewable tablets and regular tablets. At the time of the poisonings, about two-thirds of the medicines were not in their normal storage locations. Most of the medicines were in the kitchen or bedroom. More than half of the children climbed on a chair, toy, or other device to reach the medicine when an adult was not observing.
At the time of the poisonings, all the medicines were in their original containers. About half of the medicines contained a child-resistant closure, and the closure was intact on more than half of these containers. When the child-resistant closure was not on the medicine, it was most often due to removal of a recent dose. In a few cases, the closure was on but not secured properly. One in ten poisonings happened within 1 minute of the last correct dose of the medicine, and another one in ten poisonings happened within 15 minutes. Most of the remaining poisonings occurred within 24 hours of the last proper dose. One in 10 children was taken to an emergency room for evaluation. One child had his stomach pumped. However, most children experienced mild, self-limiting symptoms that resolved.
For more than 60 years, significant efforts in the US have been taken to prevent child medicine poisonings. One of the most recent efforts includes the Up and Away and Out of Sight educational program that reminds families of the importance of safe medicine storage.4 The campaign was developed through the PROTECT Initiative by the Centers for Disease Control and Prevention (CDC) and the Consumer Healthcare Products Association (CHPA). Another organization, Safe Kids Worldwide, has been working with more than 600 coalitions in the US to increase education, awareness, and planning to prevent child injuries from poisonings and other serious risks. This agency just issued an extensive report on Keeping Families Safe Around Medicine.1
Despite extensive public education, child medicine poisonings remain a significant public health concern. See the recommendations for steps parents and caregivers can take to prevent child medicine poisonings.
√ Keep all medicines in a secure cabinet, locked if possible, up and away from the reach or view of children. This includes medicines you take every day, as well as products you might not think about as medicines such as diaper rash remedies, eye drops, and vitamins.
√ Keep medicines currently in use in a secure location and under close observation during the entire administration period to prevent a child from accessing the medicine while taking a dose or while giving a dose to another child.
√ Return medicines to a secure location, high and out of sight, immediately after use. Don't leave them out as a reminder to take a medicine. If you need a reminder to take doses of medicine, set an alarm on your watch or cell phone, or write a note.
√ Never leave medicines on counters, nightstands, or tables (including children's vitamins or iron supplements), even if they have child-resistant caps.
√ With oral liquid medicines, never leave a syringe bottle adaptor (a device that makes it easy to withdraw liquids using an oral syringe) in place if it prevents you from replacing the child-resistant cap.
√ Keep any refrigerated medication out of the view and reach of children. Store the medicine on a high shelf (not the refrigerator door), behind but away from food. Do not let children see you return the medicine to the refrigerator.
√ Avoid keeping medicines in purses, backpacks, or suitcases where children may explore, or in pockets where the medicine can fall out.
√ Be alert to visitors' medicine, as guests in your home may not be thinking about medicine safety. When you have guests, offer to put purses, bags, and coats out of reach of children to guard against a curious child.
√ Don't take medicines in front of children, because children tend to mimic adults.
√ Don't put medicines away in front of children.
√ Never refer to medicine as candy.
√ Use child-resistant caps on containers and be sure they are closed properly after use. Remember that "child resistant" does not mean "child proof." Children can sometimes defeat safety caps, so keep medicines up and away, and out of reach.
√ Always replace child-resistant caps on prescription containers, including liquids. Make sure you hear the click so proper closing is assured.
√ When children visit other homes, or when family or friends visit, look out for potential poisoning dangers and intervene before an accident happens. Don't hesitate to ask hosts or guests specifically about medicine access.
√ Educate children early that, although medicines may taste good, they are not candy; children should only take medicine or eat candy when an adult has given them permission.
√ Get rid of unused or expired medicines. Call your pharmacy to see if your community has a medicine take-back program. To dispose of medicines yourself, pour the medicine into a sealable plastic bag or other sealable container, add water to dissolve it if they are tablets, mix it with an inedible substance (e.g., kitty litter, sawdust, coffee grounds), and seal the bag or container before throwing it away in the household trash.
√ If a child is exhibiting any symptoms or acting strangely for any reason, don't wait. Keep the possibility of a poisoning in mind and seek help immediately.
√ Contact the Poison Help number (1-800-222-1222) immediately if you think an accidental poisoning occurred. This is what you need to know when you call the poison center:
• The child's age and weight
• Condition of the child (e.g., trouble breathing, staying awake)
• The child's health history, including allergies
• Information from the medicine container, including the exact product name, the quantity of medicine in the container, the strength, and the active ingredients
• How much was taken, and how long ago.1,5
But, don't hesitate to call, even if you don't have all this information. The quicker you call, the better a child's chance of survival.
References
1) Ferguson RW, Samuel E. Keeping families safe around medicine. Washington, DC: Safe Kids Worldwide; March 2014. www.safekids.org/med_report_2014
2) Mowry JB, Spyker DA, Cantilena LR Jr, et al. 2012 Annual report of the American Association of Poison Control Centers' National Poison Data System (NPDS): 30th annual report. Clinical Toxicology. 2013;51:949-1229.
3) Schoenewald S, Ross S, Bloom L, et al. New insights into root causes of pediatric accidental unsupervised ingestions of over the counter medications. Clinical Toxicology. 2013;51:930-6.
4) PROTECT, Centers for Disease Control and Prevention. Up and Away. www.upandaway.org/
5) National Capital Poison Center. Questions about calling the poison center. www.poison.org/actFast/calling.asp
