About a decade ago, several reports throughout the United States indicated that ED visits were on the rise for unsupervised pediatric medication exposures. “As a result of these studies, clinicians renewed their efforts to improve rates of these exposures,” explains Daniel S. Budnitz, MD, MPH. “Some of the steps were taken included improving safety packaging and increasing education to both healthcare providers and the general public about ways to avoid these exposures. By examining current trends in unsupervised pediatric medication exposures, it’s possible that this data could inform the development of targeted interventions to further reduce the risk of these events.”


Long-Term Trends

For a study published in Pediatrics, Dr. Budnitz and colleagues examined data from the National Electronic Injury Surveillance System–Cooperative Adverse Drug Event Surveillance project to assess trends in ED visits for unsupervised medication exposures among children younger than the age of 6 from 2004 to 2013. The investigators also identified the dosage form and prescription status of implicated medications from 2010 through 2013.

The authors found that approximately 640,000 children were seen in the ED for ingesting drugs between 2004 and 2013. About 70.0% of these children were aged 1 or 2, and nearly 20.0% of this group was hospitalized. The number of pediatric ED visits for unsupervised medication exposures increased by an average of 5.7% annually during the early 2000s and peaked at about 76,000 visits in 2010. After 2010, however, this trend reversed, with the number of ED visits decreasing by an average of 6.7% per year to approximately 59,000 visits in 2013. “While the decreasing trend is encouraging, this figure is still too high,” Dr. Budnitz says.


Common Culprits

Between 2010 and 2013, the research team found that 91.0% of ED visits for unsupervised medication exposures involved ingestion of one drug. The most common of these scenarios (45.9%) involved an oral solid prescription that was available in pill, tablet, or capsule form. In total, more than 260 different prescription solids were implicated in the study. The most common included narcotics (13.8% of visits), such as buprenorphine, oxycodone, or hydrocodone, and benzodiazepines (12.7% of visits), including clonazepam and alprazolam.

Oral over-the-counter (OTC) solid medications (22.3%) and oral OTC liquids (12.4%), such as cough syrups, were other drugs of ingestion commonly involved in unsupervised medication exposures. “Four medications—acetaminophen, cough and cold medicines, ibuprofen, and diphenhydramine—caused more than 91.0% of emergency room visits for OTC liquid medication exposures,” says Dr. Budnitz (Table). In 87.0% of these cases, the medication was a child or infant version of the drug.


More Work Needed

Dr. Budnitz notes that clinicians must still be vigilant about striving to reduce pediatric unsupervised medication exposures. Recent efforts by physicians to warn parents to keep medications out of the reach of children and by manufacturers to add new child-resistant features in packaging appear to be helping decrease risks for unsupervised medication exposures, but there is still room for improvement. “These exposures are preventable, but the key is to ensure that parents take precautions,” Dr. Budnitz says.


Working With Parents

According to Dr. Budnitz, caregivers should instruct parents of young children to keep all medications in a safe location that is too high for them to reach or see. Parents should also be instructed to always relock safety caps on drug bottles and return all medications to a safe storage location after each use. Another important step is to avoid telling children that medication tastes like candy or something good in order to get them to take it.

In addition to these steps, parents should be encouraged to remind family members, babysitters, and other visitors of their homes to keep purses, bags, or coats that have medications in them out of sight and reach when they come to the house. Medications should also be kept in the original child-resistant containers whenever possible because some containers, such as pill organizers or plastic bags, lack child safety features and can be easily opened. Another simple strategy is to have parents program the Poison Help number in their home and cell phones to have it handy should it be needed.

“Ultimately, physicians should recognize that we have a role in this problem,” says Dr. Budnitz. “We need to develop targeted prevention efforts based on the frequency of harm and design feasible interventions to help continue reducing the number of ED visits for pediatric medication exposures. The process has already started with small steps. For example, electronic health records now mandate that liquid formulation medications be dosed in milliliters rather than teaspoons, tablespoons, or some other measurement. This can help with unintentional overdoses from parents. However, other innovative approaches, such as improved safety packaging and targeted educational messages, may be necessary to continue the declines we’ve seen in recent years.”


*This article was posted by Bridgett Cole, daughter of PW Senior Author Chris Cole, on April 28, 2016 for Bring Your Kids to Work Day.