[Pharmwaste] Childhood Poisoning by Medication on the Rise

DeBiasi, Deborah (DEQ) Deborah.DeBiasi at deq.virginia.gov
Fri Sep 16 14:39:05 EDT 2011


Childhood Poisoning by Medication on the Rise

Study Shows Increase in ER Visits Due to Poisoning From Medicines in Kids Age 5 and Under

By Kathleen Doheny

WebMD Health NewsReviewed by Laura J. Martin, MD Sept. 16, 2011 -- Childhood poisonings by medication are up dramatically, despite repeated messages to adults to keep prescription and over-the-counter medicines out of reach and locked up.

"Overall, the visits to the emergency department for poisoning by medicines [in children age 5 and younger] were up 30%," says G. Randall Bond, MD. Bond is an emergency physician at Cincinnati Children's Hospital Medical Center and medical director of the Cincinnati Drug and Poison Information Center.

The increase occurred over an eight-year period, from 2001 to 2008. During that same time, the number of children age 5 years and under in the U.S. went up only 8%, Bond says.

The majority of the accidents involved a child getting into medicines, not a parent or other caretaker giving a child an incorrect dose, Bond tells WebMD.

The study is published in The Journal of Pediatrics.

Tracking Childhood Poisonings

The researchers evaluated patient records from the National Poison Data System of the American Association of Poison Control Centers. They looked at the years 2001 to 2008 and focused on children age 5 years and younger.

All the children were evaluated at a health care facility after being unintentionally exposed to over-the-counter or prescription medication. The researchers categorized the doses as those the child took by mistake or an error made by an adult giving the child medicine.

The researchers looked at visits to emergency departments, hospital admissions, injuries, and trends.

They evaluated a total of 453,559 records. In 95% of cases, the child got into the medicine. Most problems occurred after children got into prescription medicines.

Children getting into prescription medicines accounted for more than 248,000 emergency department visits, nearly 42,000 hospital admissions, and more than 18,000 injuries.

Most often, the drug ingestions that caused the most serious illnesses involved opioid painkillers, sedatives, and heart medicines.

Over the eight years, 66 deaths occurred, Bond says. More often, he says, ''the injuries were transient, as in they had a coma and recovered, or they had low blood sugar and recovered."

For most, the poisonings had no long-term ill effects, he says.

Explaining the Increase in Childhood Poisonings

The increase in childhood poisonings by medication are easily explained, Bond says. "More medicines are out there for kids to get in to," he says.

For instance, 50% of adults reported taking at least one prescription medicine in a 1998 survey, and 7% five or more, Bond says, citing other research. By 2006, the same researcher found 55% took at least one prescription medicine, and 11% took five or more.

"These are preventable injuries," Bond says. Parents need to be reminded that medications need to be ''out of sight and locked up."

That means immediately after taking them or giving them to children, he says Bond cites cases of children being poisoned after a parent gave them a proper dose, but then left the medication out within reach for a few minutes.

Parents should treat all medicines the same way when it comes to keeping them locked away, Bond says. "Sometimes parents think cold medications are in a different class and are safer," he says. Not true, he tells them.

Soon, more help may be coming from prescription drug manufacturers, Bond says.

He works with the PROTECT Initiative, a collaboration of government agencies such as the CDC, nonprofit organizations, and industry to promote medication safety.

Initially, the project targeted non-prescription medicines. It sponsored a campaign encouraging adults to put medicines up, away, and out of sight.

Next, Bond says, the project will start discussions with pharmaceutical companies about how to help reduce poisonings. Strategies include, for instance, adding a ''flow dispenser'' to liquid medicines. That way, children can't take off the top and drink it all.

Advice for Parents

Adults can keep handy the number of the American Association of Poison Control Centers, 800-222-1222.  All 57 U.S. centers can be reached by the same number. The organization's web site also offers information about an app for the iPhone.

The increase of 30% in emergency department visits for childhood poisonings by medication is termed ''shocking'' by Michael Cohen, RPh, ScD, president of the Institute for Safe Medication Practices.

He reviewed the findings for WebMD.

The new study, he says, ''definitely shows we still have a big problem out there."
Adults can take some simple steps to reduce risk, Cohen says.

Be sure the child-resistant cap is closed correctly. Cohen finds they are often replaced incorrectly.

Treat patches infused with medicines (such as painkillers or nitroglycerin) the same as other medicines. He cites cases of children digging patches out of the trash and applying them. To dispose of them safely, he suggests folding them and putting them in a childproof container. Another option, depending on the manufacturer's instructions, is to flush them, he says.
Be aware of the ''granny syndrome."  When grandparents visit, they may store medicines in a suitcase left on the floor or in their pocketbooks, he says. Parents can remind them to put up and lock up the medicines.  

Store medicines in a cabinet above the children's eye level. Avoid the bathroom, as there is too much moisture. If the cabinet does not have a lock, buy an inexpensive plastic lock at a home supply store.

Deborah L. DeBiasi
Email:   Deborah.DeBiasi at deq.virginia.gov
WEB site address:  www.deq.virginia.gov
Virginia Department of Environmental Quality
Office of Water Permit and Compliance Assistance Programs
Industrial Pretreatment/Whole Effluent Toxicity (WET) Program
PPCPs, EDCs, and Microconstituents 
Mail:          P.O. Box 1105, Richmond, VA  23218
Location:  629 E. Main Street, Richmond, VA  23219
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