Monday, September 28, 2015

When Your Back Is Turned: ER Visits for Medication Ingestions and Unsupervised Children

By: Joann Schulte  DO, MPH; Editorial Board Member 

     Open the bottle by getting through the safety lid, dose appropriately and then have your child swallow the
pill or liquid.   It’s funny how a young child won’t do that when you or your spouse wants that to happen.   And as soon as your back is turned, it’s amazing what a child can get into and swallow.    
     But at least children are doing less unsupervised ingestions of medications   according to new research published this month in Pediatrics.  Lovegrove et al. with the Centers for Disease Control and Prevention (doi: 10.1542/peds.2015-2092) found that the estimated number of pediatric emergency room (ER) visits for unsupervised  medication exposures has declined since 2010.  The Atlanta researchers used data from the National Electronic Injury Surveillance System/Cooperative Adverse Drug Event Surveillance Project for the years 2004-2013.  Their data comes from a public health surveillance system that draws from a nationally representative sample of hospitals with at least six pediatric beds and an ER that operates 24 hours a day.  Since 2010, the number of ER visits has declined an average of 6.7% annually to an estimated total of 59,092 estimated visits in 2013.  The estimated number of visits for an unsupervised ingestion at the peak in 2010 was 75,842.
      The decline in ER visits is good news, but what the children are swallowing is still reason for concern.  Among single substance ingestions in this study, children most frequently swallowed solid prescription medications (45.9^), over the counter (OTC) solid medications (22.3%) and   liquid OTC medications (12.4%).  Nine percent of the ingestions involved more than one medication.
      Among prescription drugs, 260 different medications were swallowed by children, most frequently opioids (13.8%) and benzodiazepines (12.7%).  The OTC liquids most frequently reported were acetaminophen (32.9%), cold/cough remedies (27.5%), ibuprofen (15.7%) and diphenhydramine (15.6%).
     The CDC researchers suggested that OTC oral medications are an important topic for further prevention efforts since only four OTC medications (named in above paragraph) account for 91% of such ingestions.  Most such medications have child resistant packaging, but that packaging requires a parent or other adult to put the safety cap back on the medication and secure it after each use.   Newer products now being tested incorporate passive safety features such as flow restriction and single use packaging which can offer a secondary safety barrier.  The FDA is strongly considering the use of such packaging as a mandate on OTC liquid acetaminophen products. 
      The report showing the decline in  unsupervised pediatric ingestions is good news, but also evidence that more effort is needed to keep young children from still gaining access to medications when a supervising adult or older child is not around.

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