Medication Safe - Dr. Ben Tsutaoka

Article published in:

American Family Physician – A peer reviewed journal of the American Academy of Family Physicians

2006 Dec 1;74(11):1864-9.

http://www.aafp.org/afp/20061201/1864.html

Schnitzer PG.

University of Missouri-Columbia Sinclair School of Nursing, Columbia, Missouri 65211, USA.

ABSTRACT

Injuries are the leading cause of death in children and teenagers in the United States. The leading causes of unintentional injury vary by age and include drowning, poisoning, suffocation, fires, burns, falls, and motor vehicle, bicycle, and pedestrian-related crashes. Most injuries are preventable by modifying the child’s environment (e.g., use of stair gates) and having parents engage in safety practices (e.g., keeping matches or lighters out of reach of children). Effective injury prevention methods include the use of childproof caps on medications and household poisons, age-appropriate restraints in motor vehicles (i.e., car seats, booster seats, seat belts), bicycle helmets, and a four-sided fence with a locked gate around residential swimming pools.

EXCERPTS

Childhood injuries are responsible for approximately 16,000 deaths each year in the United States, and more than 70 percent of these deaths are the result of unintentional injuries. Nonfatal unintentional injuries also are a significant cause of childhood morbidity. More than 20 million nonfatal injuries are estimated to occur in U.S. children each year, costing $347 billion and accounting for more than 300,000 hospital admissions.

A shift in semantics from “accident prevention” to “injury prevention and control” was initiated in the 1970s to focus attention on preventable health outcomes. Injury prevention strategies generally are classified into three types: education, engineering and environmental modification, and legislative interventions. Active interventions are those that require action on the part of an individual person to confer protection (e.g., buckling a seatbelt), whereas passive interventions provide automatic protection regardless of individual behavior (e.g., automobile airbags).

Parent-focused and environmental strategies are effective in preventing injuries, particularly those occurring in young children at home. However, most parents cannot identify specific prevention strategies and believe that simply “being careful” is adequate protection from injury. Although little research has addressed the direct effect of counseling parents on the reduction of injury rates, there is evidence that clinical counseling can influence car seat use, at least in the short term, and can positively influence the rates of owning a functioning smoke alarm. The U.S. Preventive Services Task Force found fair evidence to support counseling parents of young children on measures to reduce injury risk. Anticipatory guidance topics should be considered an important component of medical care for children and families.

TODDLERS

Almost one third of injury-related deaths in toddlers result from motor vehicle crashes, and more than one fourth are the result of drowning. Fires and burns also contribute significantly to injury-related mortality rates. Falls and poisonings are the leading causes of nonfatal injuries requiring hospitalization in this age group, followed by scald burns and motor vehicle-related injuries.

POISONING

Poisoning continues to be a leading cause of injury-related hospitalization among toddlers, even after implementation of the Poison Prevention Packaging Act of 1970. The American Association of Pediatrics (AAP) recommends against using syrup of ipecac, which is not effective in completely removing poison from the stomach. Syrup of ipecac often is administered when it is contraindicated or not necessary, and it may result in intractable vomiting that prohibits the use of other orally administered poison treatments, such as activated charcoal and acetylcysteine.
Another ineffective poison prevention strategy for toddlers is the use of “Mr. Yuk” poison warning stickers. These stickers display a green scowling face with a protruding tongue and were designed to be placed on hazardous substances to discourage children from handling the containers or ingesting the poison. However, studies have shown that supplying the stickers to families with young children does not reduce the risk of poisoning. Furthermore, labeling containers with the stickers does not deter young children from touching, holding, or attempting to open the labeled containers.

COUNSELING RECOMMENDATIONS

Priority topics for office-based injury prevention counseling include the use of motor vehicle restraints, smoke detectors, and pool fencing; reducing residential hot water temperature; the hazards of infant walkers; the safe storage of poisons and medications; and parental supervision. The AAP has created the Injury Prevention Program for parents of children 12 years and younger. It can be accessed at http://www.aap.org/family/tippmain.htm. The program includes injury prevention counseling guidelines and schedules for providers, safety surveys designed to assess parents’ specific educational needs, and age-specific parent education handouts for use in providing anticipatory guidance in primary care offices. This program has been shown to be cost-effective.

Everyday at the Poison Control Center we get numerous calls from incredulous parents that their toddler got into a bottle of pills. Here’s a news story I ran across from 2005 that gives a great example showing that these caps are not “childproof”.

The original news story can be found here: http://www.cbsnews.com/stories/2005/08/24/earlyshow/living/ConsumerWatch/main793212.shtml

(CBS) Sometimes, it’s tough for adults to open medicine bottles. But just how quickly would a bunch of kids be able to open them up? The Early Show Consumer Watch correspondent Susan Koeppen wanted to find out, so she put these safety caps to the test.

She gathered a group of preschoolers, ages 3 to 4, at a day care center in New York City.

Koeppen gave them seven bottles to open. The bottles were emptied and sanitized, but mouthwash, iron pills, drain cleaner, Tylenol, aspirin, dish washer detergent and cough syrup were some the products that had been stored in these bottles.

Then, with the parents watching, Koeppen conducted the experiment and the kids were able to open three of the bottles — including the one for the iron pills. These pills are one of the most deadly and poisonous products in the group.

It took one second for 4-year-old Steven to open that bottle. He also popped the top off a red bottle, which had contained drain cleaner — a substance as lethal as arsenic.

Dr. Shari Platt, head of the pediatric emergency department at New York Presbyterian Hospital, has studied child resistant caps and she says more than a million children are accidentally poisoned every year — often by household products and medicines that came in child-resistant containers.

“Parents think the safety cap is going to give them 100 percent security,” Platt says. “They don’t realize how easily children can get into these medicines, but they do.” Every seven minutes, a child under the age of five goes to the emergency room because of an unintentional poisoning.

“The law strikes a balance between keeping the youngest kids who mouth everything they get their hands on with the need for the elderly to access their pills or other medicines,” says Scott Wolfson, of the CPSC.

But some of the parents in Koeppen’s test group say the government standard isn’t strong enough. They saw firsthand that they couldn’t rely on child safety caps to keep kids safe.

“It’s very much an eye opener to me,” one mother says. “You realize that you have to be very prudent about keeping things away from your children. It could be life-threatening.

“A recent study showed that children as young as 2 were able to open bottles with child resistant caps. So parents need to realize these caps are not child proof, just child resistant.

For poison control centers in your area call 1-800-222-1222.

ScienceDaily (May 31, 2008) — According to a new study, knowledge of potentially toxic household substances among primary caregivers for young children is alarmingly poor. The results show that less than one-third of primary caregivers for children under the age of six could correctly estimate the toxicity of household poisons.

Led by Rika N. O’Malley, M.D of the Albert Einstein Medical Center, the study involved screening primary caregivers of young children who visited emergency departments, and asked participants to identify toxic items from a list of common household products.

“Young children are at risk of household chemical ingestion and their caretakers often do not have good understanding how toxic those chemicals are,” says O’Malley. “Parental education needs to be focused more on younger caretakers with more children.”

However, the study did identify a number of factors that increased the likelihood of knowledge of household poisons. These include: more education, responsibility for fewer children and an age greater than twenty-three years.

The research provides practical information about poison prevention. The authors believe that education from primary care physicians can target at-risk populations for poison prevention and education.

The study is being presented at the Society for Academic Emergency Medicine’s 2008 Annual Meeting in Washington, D.C. on May 30, 2008. The presentation is entitled “Caregivers of Young Children Do Not Have Basic Knowledge or Familiarity with Potentially Toxic Household Products.”  Abstracts of the papers presented are published in Vol. 15, No. 5, Supplement 1, May 2008 of the official journal of the SAEM, Academic Emergency Medicine.

Wiley-Blackwell (2008, May 31). Most Caregivers Of Young Children Lack Basic Knowledge Of Potentially Toxic Household Products. ScienceDaily. Retrieved June 7, 2008, from http://www.sciencedaily.com/releases/2008/05/080530074233.htm