Background and objectives Fatal poisoning is a preventable cause of death among young children. Understanding the factors surrounding these deaths will inform future prevention efforts. Our objective was to describe the characteristics of fatal pediatric poisonings using review data on childhood deaths. Methods: We acquired data from 40 states participating in the National Death Review Case Reporting System on deaths attributed to poisonings among children ≤5 years from 2005 to 2018. We analyzed selected demographic, supervisory, death investigation, and substance-related variables using descriptive statistics. Results: During the study period, 731 poisoning-related deaths were reported through child death reviews to the National Death Review Case Reporting System. More than two-fifths (42.1%, 308 of 731) occurred among infants younger than 1 year, and most deaths (65.1%, 444 of 682) occurred in the child’s home. One-sixth of the children (97 of 581) had an open child protective services case at the time of death. Nearly one-third (32.2%, 203 of 631) of the children were supervised by a person other than the biological parent. Opioids (47.3%, 346 of 731) were the substance most frequently contributing to death, followed by over-the-counter pain, cold, and allergy medications (14.8%, 108 of 731) . Opioids accounted for 24.1% (7 of 29) of substances contributing to deaths in 2005, compared to 52.2% (24 of 46) in 2018 . Conclusions: Opioids were the most common substances contributing to fatal poisonings among young children. Over-the-counter medications continue to be responsible for pediatric deaths even after regulatory changes. These data highlight the importance of personalized prevention measures to further reduce fatal childhood poisonings. |
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Over-the-counter medications also continue to pose fatal risks to young children despite measures to reduce exposure.
Researchers at Children’s Hospital of Philadelphia (CHOP) found that opioids were responsible for more than half of all fatal poisonings in children under age 5, more than double the proportion of fatal poisonings caused by opioids in 2005. Additionally, Over-the-counter medications still contribute to fatal poisonings in this age group despite increased regulation. The findings, published today in the journal Pediatrics , underscore the need for improved intervention to prevent more fatal poisonings.
More than half of all reported poisonings affect children ages 5 and younger, and they have the highest rate of emergency department visits for unintentional drug-related poisonings. While child-resistant packaging for many dangerous medications and products has substantially reduced the number of unintentional fatal poisonings in young children, the growing opioid epidemic in the United States has contributed to recent childhood poisoning deaths.
Studying fatal poisonings in young children on a large scale in the US has been a challenge for researchers. Each state conducts child death reviews, which investigate how and why these deaths occur and what steps can be taken to prevent them. Child death reviews are carried out by teams who often take a multidisciplinary approach when reviewing pediatric deaths. The National Center for Fatality Review and Prevention provides resources for these child death reviews and maintains a reporting system that collects data from these committees.
“By comprehensively evaluating fatal poisonings among children nationwide, we were able to better understand the scale of this tragic and preventable public health problem,” said the study’s first author, Christopher Gaw, MD, a pediatric emergency medicine fellow at the Center of Poison Control. and the Center for Injury Research and Prevention at CHOP. "We were also able to specifically characterize the proportion of poisoning deaths that could be attributed to opioids each year."
The study team used data from 40 states participating in the National Death Review Case Reporting System on deaths attributed to poisoning among children ages 5 and younger between 2005 and 2018. During that period, child death reviews reported 731 deaths related to poisoning.
Researchers found that more than two-fifths of these poisoning deaths occurred among children 1 year old or younger, and more than 65% of these deaths occurred at home.
Nearly a third of children who died from poisoning were supervised by someone other than the biological parent. Opioids were the most common substance contributing to death followed by over-the-counter pain, cold, and allergy medications . In 2005, opioids contributed to 24.1% of deaths, but this proportion increased to 52.2% in 2018.
The authors noted that while efforts focused on reducing opioid prescribing resulted in a transient reduction in these deaths in the early 2010s, in the last decade, new sources of opioids, including heroin and opioids Synthetics, such as fentanyl , have reversed previous advances in public health. Additionally, while medication safety initiatives such as unit-dose packaging have shown promise in reducing these unwanted exposures, the approach does not address all prescription opioids or illicit opioids.
"From these findings, it is clear that prevention of fatal pediatric poisonings requires a multifaceted approach involving caregiver education and community-level interventions," said the study’s lead author, Daniel J. Corwin, MD, MSCE. , attending physician and associate director of research in the Division of Emergency Medicine at CHOP. “One such intervention is improving the availability of naloxone to the public, which can rapidly reverse opioid overdose and is safe and effective for use in children.”
Reference : Gaw et al, "Characteristics of Fatal Poisonings Among Infants and Young Children in the United States." Pediatrics , March 2023. DOI: 10.1542/peds.2022-059016
