The number of young children admitted to hospitals or seen in emergency departments because they unintentionally took a potentially toxic dose of medication has risen dramatically in recent years, according to a new Cincinnati Children's Hospital Medical Center study.
The rise in exposure to prescription products has been so striking that the U.S. Centers for Disease Control and Prevention has established the PROTECT Initiative, intended to prevent unintended medication overdoses in children.
Randall Bond, MD, an emergency medicine physician at Cincinnati Children's, will present his study on children and pharmaceutical poisonings Sept. 20 at a PROTECT Initiative meeting in Atlanta. The study will be published online Sept. 16 in the Journal of Pediatrics.
"The problem of pediatric medication poisoning is getting worse, not better," says Dr. Bond, who also is medical director of the Drug and Poison Information Center at Cincinnati Children's. "More children are exposed, more are seen in emergency departments, more are admitted to hospitals, and more are harmed each year."
Dr. Bond found that exposure to prescription products accounted for most of the emergency visits (55 percent), admissions (76 percent) and significant harm (71 percent). Levels of ingestion of opioids, most often prescribed to treat pain; sedatives-hypnotics, frequently prescribed as sleep aids; and cardiovascular medications were particularly high.
"Prevention efforts at home have been insufficient," says Dr. Bond. "We need to improve storage devices and child-resistant closures and perhaps require mechanical barriers, such as blister packs. Our efforts can't ignore society's problem with opioid and sedative abuse or misuse."
Dr. Bond studied patient records from 2001 to 2008 in the National Poison Data system -- an electronic database of all calls to members of the American Association of Poison Control Centers. Dr. Bond studied children 5 years old and younger exposed to a potentially toxic dose of a single pharmaceutical agent, either prescription or over-the-counter. A total of 453,559 children were included in the study.
The largest part of increasing admissions, injuries and death was due to children finding and ingesting medication on their own. Therapeutic errors at home were uncommon and increased only minimally.
The most likely explanation for these trends is a rise in the number of medications around small children, he says. A 1998-99 survey found that half of adults had taken at least one prescription medication in the preceding week and 7 percent had taken five or more. In 2006, the same surveyors found that 55 percent had taken at least one prescription medication in the preceding week and 11 percent had taken five or more.
There are 57 poison control centers in the United States. Together they provide free, 24-hour poison expertise and treatment advice by phone. All poison centers can be reached by calling the same telephone number 1-800-222-1222. Poison centers are staffed by pharmacists, physicians, nurses and poison information providers who are toxicology specialists.
The PROTECT Initiative is a collaboration among public health agencies, private sector companies, professional organizations, consumer/patient advocates and academic experts to keep children safe from unintentional medication overdoses. According to the Centers for Disease Control, more than 70,000 emergency visits each year result from unintentional overdoses among children under the age of 18.
- G. Randall Bond, Randall W. Woodward, Mona Ho. The Growing Impact of Pediatric Pharmaceutical Poisoning. The Journal of Pediatrics, 2011; DOI: 10.1016/j.jpeds.2011.07.042
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