Accidental poisonings are a leading public health problem and cause of death from injuries in the United States as reported by the Centers for Disease Control and Prevention, National Center for Health Statistics (1). National Poison Prevention Week is designated in the third week of March every year to highlight the dangers of poisonings and how to prevent them. Caustic Poisons Act of 1927 was applied to approximately 12 acids and alkalies used in household products. More than 90 percent of these poisonings occur in the home. Ingestion represents the primary route of poisoning exposures for all ages, and children are no exception. According to reports of 2010, children younger than 6 years accounted for about half of all the poison exposure calls and adults accounted for 92 percent of all poison-related deaths. Statistically, the number of poison-related deaths among children under 5 years of age decreased from approximately 450 in 1961 to 55 in 1983, an 88% decline, due to the awareness programme. An understanding of the developmental milestones sequence from childhood through adolescence provides insight into the poisoning causes (2, 3).

In a young child, poisoning results from a combination of factors which are child-associated, poison-associated, and environment associated. Children aged 1 and 5 years are in a critical period where their increased mobility allows for exploratory behavior. For 1-year children, it’s period of development of hand-to-mouth activity that predisposes children to self-poisoning. The factors leading up to pediatric poisoning by ingestion are as varied as the substances implicated and the children themselves. “Exploratory ingestion” most accurately describes the motives for unintentional/accidental non-food poisonings in the young child. Further with the development the child masters reaching, grasping, and releasing objects e.g. unscrewing of small bottle caps. Features of the poison itself i.e. product attractiveness, inadequate safeguards and a lack of preventive practices in the home play a role in accidental exposures in the home environment. Easy access increases the risk to a curious toddler. Also “look-alike” poisons, which may appear similar to candy or food items, increase the risk. The development pushes them to increased access to potential poisons, such as prescribed medications and less supervision in the home sets the stage for poisonous exposures. In some cases, risk increases with the underestimation of a child’s will/physical ability to successfully gain access, as well as the inability of the caretaker to recognize what constitutes a potentially harmful product. The majority of non-fatal poisonings occur in children younger than 6 years old. In children age 6 to 12 years, most of the poisonings are attributable to unintentional overdoses. However, a trending increase in the rate of suicidal poisonings in this group due to societal expectations, advancement and easier access to technology, and the gradual decrease of pubertal age of onset is alarming. In fact, unintentional poisonings are almost 10 times that of intentional causes. The periodic age of 6 and 12 years is one of the lowest incidences for poisoning, which is followed by a rise in adolescence. In the adolescence, the development of mental illness and risk-taking behaviors and feelings of invincibility contributes to suicidality. The rise in adolescent suicide has also been due to abuse/misuse of alcohol and other drugs. The developing adolescent brain is highly vulnerable. According to the NPDS 2015 data for all age groups, intentional exposures were significantly less as compared to unintentional except in young people age 13 to 19 years. Of these cases, suicidal intent was significantly more prevalent than intentional misuse or abuse. According to the Centers for Disease Control and Prevention, both adolescent suicide and substance abuse are most ominously on the rise in recent years (4).

Multiple factors which contribute to the unintentional poisoning include caregiver experience, education level, stress level/fatigue at the time of dosing, medical complexity, and clarity of instructions. Various scenarios may result in medication errors. Double dosing and incorrect dosing account for many medication errors and are usually a result of incorrect weight- or age-based dosing. Formulation errors also contribute to medication errors. For example, cardiac medications (eg, verapamil and labetalol) and some immunosuppressant drugs (eg, tacrolimus) have multiple available concentrations. Although medication errors are less prevalent (up to 6%) as compared to exploratory ingestion, the mortality reaches approximately 12% in this age group. There are a few steps which can be followed to avoid accidental ingestion of poisons. Locking pesticides and household chemicals out of the reach of children. Keep poisons in the original packing containers instead of food containers. Old or outdated products should be discarded. Few chemicals like pesticides can be extremely poisonous and can get absorbed through the skin or by inhalation. It’s important to remember that almost anything has the potential to be poisonous if used in the wrong way, in the wrong amount, or by the wrong person. When accidents happen with pesticides, chemicals, medicine or household products, Poison Help numbers should be called and get assistance right away from a local poison expert.

National Poison Prevention Week is a great way to raise awareness about ways to prevent unintentional poisonings. It is the perfect opportunity to inspect home and surroundings for medicines or household products such as detergents, cleaning products, pesticides and fertilizers that may not be stored properly. Steps should be taken immediately to correct the situation by contacting the local poison expert.

References

  1. Mowry JB, Spyker DA, Cantilena Jr. LR, 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(10):949-1229. doi:10.3109/15563 650.2013.863906.
  2. Calello DP, Henretig FM. Pediatric toxicology: specialized approach to the poisoned child. Emerg Med Clin N Am. 2014;32(1):29-52. doi:10.1016/j. emc.2013.09.008.
  3. Sibert JR, Newcombe RG. Accidental ingestion of poisons and child personality. Postgrad SMed J. 1977;53(619):254-256.
  4. Brown RT. Risk factors for substance abuse in adolescents. Pediatr Clin North Am. 2002;49(2):247-255.