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Prevention of poisoning in children

Author
Nancy R Kelly, MD, MPH
Section Editor
Jan E Drutz, MD
Deputy Editor
Mary M Torchia, MD

EPIDEMIOLOGY

Exposure to poisons is a common problem. The Institute of Medicine estimates that the incidence of poisoning in the United States is approximately 4 million cases per year, with 300,000 cases leading to hospitalization, and approximately 30,000 deaths [1]. In 2003-2004, poisoning accounted for 18 percent of all injury deaths and 10 percent of hospital discharges for injuries [2].

Poisoning is a significant public health issue for children. Each year in the United States, more than 1 million poison exposures among children younger than six years of age are reported to the American Association of Poison Control Centers (AAPCC) [3-7]. In addition, approximately 130,000 to 140,000 exposures are reported for children 6 to 12 years and 150,000 to 160,000 exposures for teenagers 13 to 19 years [7]. Because not all poisoning exposures are reported to poison control centers, these numbers are most likely an underestimate.

Over 90 percent of poisoning exposures occur in homes [3-7]. The pattern of poisonings varies by age and sex. For preadolescents, poisoning occurs slightly more often in males than females, but this trend reverses in teenagers, with slightly more than one-half of all poisonings in the 13- to 19-year age group occurring in females (60 percent in 2014) [7]. The majority of poisonings involving young children are classified as unintentional (eg, exploratory ingestions, therapeutic errors) [7,8]. In contrast, more than one-half of poisoning exposures involving teenagers are intentional (58 percent in 2014) [7].

Fatalities — Poisoning exposure typically causes minor symptoms in young children; death is a relatively rare occurrence. In 2014, the AAPCC reported 16 exposure-related fatalities in children <6 years old [7]. In addition, there were 10 reported deaths in the 6- to 12-year age group and 61 in the 13- to 19-year age group [7].

Among the 16 fatalities in children younger than six years, 10 were reported as unintentional. One death was reported as resulting from "malicious intent," and four as unknown intention [7].

                   

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Literature review current through: Nov 2016. | This topic last updated: Tue Feb 02 00:00:00 GMT+00:00 2016.
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References
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  1. Committee on Poison Prevention and Control, Board on Health Promotion and Disease Prevention, Institute of Medicine of the National Academies. Magnitude of the problem. In: Forging a Poison Prevention and Control System, National Academies Press, Washington, DC 2004. p.43.
  2. Bergen G, Chen LH, Warner M, Fingerhut LA. Injury in the United States: 2007 Chartbook, National Center for Health Statistics, Hyattsville, MD 2008.
  3. Bronstein AC, Spyker DA, Cantilena LR Jr, et al. 2010 Annual Report of the American Association of Poison Control Centers' National Poison Data System (NPDS): 28th Annual Report. Clin Toxicol (Phila) 2011; 49:910.
  4. Bronstein AC, Spyker DA, Cantilena LR Jr, et al. 2011 Annual report of the American Association of Poison Control Centers' National Poison Data System (NPDS): 29th Annual Report. Clin Toxicol (Phila) 2012; 50:911.
  5. 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. Clin Toxicol (Phila) 2013; 51:949.
  6. Mowry JB, Spyker DA, Cantilena LR Jr, et al. 2013 Annual Report of the American Association of Poison Control Centers' National Poison Data System (NPDS): 31st Annual Report. Clin Toxicol (Phila) 2014; 52:1032.
  7. Mowry JB, Spyker DA, Brooks DE, et al. 2014 Annual Report of the American Association of Poison Control Centers' National Poison Data System (NPDS): 32nd Annual Report. Clin Toxicol (Phila) 2015; 53:962.
  8. Kang AM, Brooks DE. US Poison Control Center Calls for Infants 6 Months of Age and Younger. Pediatrics 2016; 137:e20151865.
  9. Hampton LM, Nguyen DB, Edwards JR, Budnitz DS. Cough and cold medication adverse events after market withdrawal and labeling revision. Pediatrics 2013; 132:1047.
  10. Mazer-Amirshahi M, Reid N, van den Anker J, Litovitz T. Effect of cough and cold medication restriction and label changes on pediatric ingestions reported to United States poison centers. J Pediatr 2013; 163:1372.
  11. Bond GR, Woodward RW, Ho M. The growing impact of pediatric pharmaceutical poisoning. J Pediatr 2012; 160:265.
  12. Burghardt LC, Ayers JW, Brownstein JS, et al. Adult prescription drug use and pediatric medication exposures and poisonings. Pediatrics 2013; 132:18.
  13. Lovegrove MC, Weidle NJ, Budnitz DS. Trends in Emergency Department Visits for Unsupervised Pediatric Medication Exposures, 2004-2013. Pediatrics 2015; 136:e821.
  14. Lovegrove MC, Mathew J, Hampp C, et al. Emergency hospitalizations for unsupervised prescription medication ingestions by young children. Pediatrics 2014; 134:e1009.
  15. Litovitz T, Manoguerra A. Comparison of pediatric poisoning hazards: an analysis of 3.8 million exposure incidents. A report from the American Association of Poison Control Centers. Pediatrics 1992; 89:999.
  16. Henry K, Harris CR. Deadly ingestions. Pediatr Clin North Am 2006; 53:293.
  17. Michael JB, Sztajnkrycer MD. Deadly pediatric poisons: nine common agents that kill at low doses. Emerg Med Clin North Am 2004; 22:1019.
  18. Miller TR, Lestina DC. Costs of poisoning in the United States and savings from poison control centers: a benefit-cost analysis. Ann Emerg Med 1997; 29:239.
  19. King WD, Palmisano PA. Poison control centers: can their value be measured? South Med J 1991; 84:722.
  20. Chafee-Bahamon C, Lovejoy FH Jr. Effectiveness of a regional poison center in reducing excess emergency room visits for children's poisonings. Pediatrics 1983; 72:164.
  21. Litovitz T, Kearney TE, Holm K, et al. Poison Control Centers: is there an antidote for budget cuts? Am J Emerg Med 1994; 12:585.
  22. Blizzard JC, Michels JE, Richardson WH, et al. Cost-benefit analysis of a regional poison center. Clin Toxicol (Phila) 2008; 46:450.
  23. Zaloshnja E, Miller T, Jones P, et al. The potential impact of poison control centers on rural hospitalization rates for poisoning. Pediatrics 2006; 118:2094.
  24. Zaloshnja E, Miller T, Jones P, et al. The impact of poison control centers on poisoning-related visits to EDs--United States, 2003. Am J Emerg Med 2008; 26:310.
  25. Vassilev ZP, Marcus SM. The impact of a poison control center on the length of hospital stay for patients with poisoning. J Toxicol Environ Health A 2007; 70:107.
  26. Committee on Injury and Poison Prevention, American Academy of Pediatrics. Injury prevention in and around the home. In: Injury Prevention and Control for Children and Youth, American Academy of Pediatrics, Elk Grove Village, IL 1997. p.47.
  27. Grant-Alfieri A, Schaechter J, Lipshultz SE. Ingesting and aspirating dry cinnamon by children and adolescents: the "cinnamon challenge". Pediatrics 2013; 131:833.
  28. Committee on Injury and Poison Prevention, American Academy of Pediatrics. The science of injury prevention. In: Injury Prevention and Control for Children and Youth, American Academy of Pediatrics, Elk Grove Village, IL 1997. p.1.
  29. Dershewitz RA, Posner MK, Paichel W. The effectiveness of health education on home use of ipecac. Clin Pediatr (Phila) 1983; 22:268.
  30. Woolf A, Lewander W, Filippone G, Lovejoy F. Prevention of childhood poisoning: efficacy of an educational program carried out in an emergency clinic. Pediatrics 1987; 80:359.
  31. Watson M, Kendrick D, Coupland C, et al. Providing child safety equipment to prevent injuries: randomised controlled trial. BMJ 2005; 330:178.
  32. Kelly NR, Huffman LC, Mendoza FS, Robinson TN. Effects of a videotape to increase use of poison control centers by low-income and Spanish-speaking families: a randomized, controlled trial. Pediatrics 2003; 111:21.
  33. Polivka BJ, Casavant MJ, Malis E, Baker D. Evaluation of the Be Poison Smart! poison prevention intervention. Clin Toxicol (Phila) 2006; 44:109.
  34. Kendrick D, Smith S, Sutton A, et al. Effect of education and safety equipment on poisoning-prevention practices and poisoning: systematic review, meta-analysis and meta-regression. Arch Dis Child 2008; 93:599.
  35. DiGuiseppi C. Preventing household and recreational injuries. In: U.S. Preventive Services Task Force. Guide to Clinical Preventive Services, 2nd ed, Williams & Wilkins, Baltimore 1996. p.659.
  36. Centers for Disease Control (CDC). Unintentional poisoning among young children--United States. MMWR Morb Mortal Wkly Rep 1983; 32:117.
  37. Palmisano PA. Targeted intervention in the control of accidental drug overdoses by children. Public Health Rep 1981; 96:150.
  38. Clarke A, Walton WW. Effect of safety packaging on aspirin ingestion by children. Pediatrics 1979; 63:687.
  39. Walton WW. An evaluation of the Poison Prevention Packaging Act. Pediatrics 1982; 69:363.
  40. Committee on Poison Prevention and Control, Board on Health Promotion and Disease Prevention, Institute of Medicine of the National Academies. Historical context of poison control. In: Forging a Poison Prevention and Control System, The National Academies Press, Washington, DC 2004. p.20.
  41. Liegey M. Accidental poisonings drop in the U.S. Prevention efforts cited. Chemical Times and Trends 1991; 14:14.
  42. Baker S, O'Neill B, Karpf R. Poisonings. In: The Injury Fact Book, Lexington Books, Lexington, MA 1984. p.191.
  43. Consumer Product Safety Commission. Poison Prevention Packaging Act of 1970. www.cpsc.gov/businfo/pppa.html (Accessed on April 20, 2006).
  44. Woolf AD, Lovejoy FH Jr. Prevention of childhood poisonings. In: Clinical Management of Poisoning and Drug Overdose, Haddad LM, Shanon MW, Windchester JF III (Eds), WB Saunders, Philadelphia 1998. p.300.
  45. Centers for Disease Control (CDC). Update: childhood poisonings--United States. MMWR Morb Mortal Wkly Rep 1985; 34:117.
  46. Rodgers GB. The effectiveness of child-resistant packaging for aspirin. Arch Pediatr Adolesc Med 2002; 156:929.
  47. Tenenbein M. Unit-dose packaging of iron supplements and reduction of iron poisoning in young children. Arch Pediatr Adolesc Med 2005; 159:557.
  48. Bronstein AC, Spyker DA, Cantilena LR Jr, et al. 2007 Annual Report of the American Association of Poison Control Centers' National Poison Data System (NPDS): 25th Annual Report. Clin Toxicol (Phila) 2008; 46:927.
  49. Food and Drug Administration, HHS. Iron-containing supplements and drugs; label warning statements and unit-dose packaging requirements; removal of regulations for unit-dose packaging requirements for dietary supplements and drugs. Final rule; removal of regulatory provisions in response to court order. Fed Regist 2003; 68:59714.
  50. US Food and Drug Administration. Using over-the-counter cough and cold products in children. www.fda.gov/ForConsumers/ConsumerUpdates/ucm048515.htm (Accessed on March 11, 2014).
  51. US FDA Center for Drug Evaluation and Research. Guidance for industry. Dosage delivery devices for orally ingested OTC liquid drug products. May 2011. www.fda.gov/downloads/Drugs/GuidanceComplianceRegulatoryInformation/Guidances/UCM188992.pdf (Accessed on May 18, 2011).
  52. Lovegrove MC, Hon S, Geller RJ, et al. Efficacy of flow restrictors in limiting access of liquid medications by young children. J Pediatr 2013; 163:1134.
  53. Sibert JR, Frude N. Bittering agents in the prevention of accidental poisoning: children's reactions to denatonium benzoate (Bitrex). Arch Emerg Med 1991; 8:1.
  54. Berning CK, Griffith JF, Wild JE. Research on the effectiveness of denatonium benzoate as a deterrent to liquid detergent ingestion by children. Fundam Appl Toxicol 1982; 2:44.
  55. Rodgers GC Jr, Tenenbein M. The role of aversive bittering agents in the prevention of pediatric poisonings. Pediatrics 1994; 93:68.
  56. White NC, Litovitz T, Benson BE, et al. The impact of bittering agents on pediatric ingestions of antifreeze. Clin Pediatr (Phila) 2009; 48:913.
  57. Vernberg K, Culver-Dickinson P, Spyker DA. The deterrent effect of poison-warning stickers. Am J Dis Child 1984; 138:1018.
  58. Fergusson DM, Horwood LJ, Beautrais AL, Shannon FT. A controlled field trial of a poisoning prevention method. Pediatrics 1982; 69:515.
  59. Litovitz T, Whitaker N, Clark L. Preventing battery ingestions: an analysis of 8648 cases. Pediatrics 2010; 125:1178.
  60. Demorest RA, Posner JC, Osterhoudt KC, Henretig FM. Poisoning prevention education during emergency department visits for childhood poisoning. Pediatr Emerg Care 2004; 20:281.
  61. COMMITTEE ON DRUGS. Metric units and the preferred dosing of orally administered liquid medications. Pediatrics 2015; 135:784.
  62. American Academy of Pediatrics Committee on Injury, Violence, and Poison Prevention. Poison treatment in the home. American Academy of Pediatrics Committee on Injury, Violence, and Poison Prevention. Pediatrics 2003; 112:1182.
  63. American Academy of Pediatrics. Keep your home safe from poisons. Available at: www.healthychildren.org/English/safety-prevention/all-around/pages/Keep-Your-Home-Safe-From-Poisons.aspx (Accessed on December 01, 2016).
  64. American Association of Poison Control Centers. Available at: www.aapcc.org/dnn/AAPCC/AboutAAPCC.aspx (Accessed on October 13, 2011).
  65. Kelly NR, Kirkland RT, Holmes SE, et al. Assessing parental utilization of the poison center: an emergency center-based survey. Clin Pediatr (Phila) 1997; 36:467.
  66. Vassilev ZP, Marcus S, Jennis T, et al. Rapid communication: sociodemographic differences between counties with high and low utilization of a regional poison control center. J Toxicol Environ Health A 2003; 66:1905.
  67. Kelly NR, Groff JY. Exploring barriers to utilization of poison centers: a qualitative study of mothers attending an urban Women, Infants, and Children (WIC) Clinic. Pediatrics 2000; 106:199.
  68. Gardner HG, American Academy of Pediatrics Committee on Injury, Violence, and Poison Prevention. Office-based counseling for unintentional injury prevention. Pediatrics 2007; 119:202.