POISONING
The death rate from unintentional poisoning among children ages
14 and under has remained approximately the same from 1987 to
1996. While declines have been observed due to child-resistant
packaging, product reformulation, heightened parental awareness,
and appropriate interventions by poison control centers and
health professionals, increases have been noted in the areas of
CO poisoning and substance abuse resulting in unintentional
poisoning. However, children continue to be at significantly
greater risk from unintentional poisoning death and exposure than
adults because they are smaller, have faster metabolic rates, and
are less able to physically handle toxic chemicals. In addition,
their natural curiosity and desire to put everything in their
mouths increase their poisoning risk. Children are poisoned by
medicines, vitamins, household products, lead and carbon monoxide
(CO). The exposure risk to a child is associated with a product's
toxicity, packaging, accessibility, availability and formulation.
DEATHS AND INJURIES
In 1996, 109 children ages 14 and under were fatally poisoned.
Children ages 4 and under accounted for more than half of these
deaths. In 1997, more than 1.1 million unintentional poisonings
among children ages 5 and under were reported to U.S. poison
control centers.
WHEN AND WHERE POISONING DEATHS AND INJURIES
OCCUR
Calls to poison control centers peak between 4 p.m. and 10 p.m.
More than 90 percent of all poison exposures occur in homes.
Medicine and Household Product Poisoning
Each year, 45 children ages 4 and under die from unintentional
exposure to medicines and household products. Among children ages
5 and under, 57 percent of poisoning exposures are by
nonpharmaceutical products such as cosmetics, cleaning
substances, plants, foreign bodies and toys, pesticides, art
supplies and alcohol; 43 percent are by pharmaceuticals. Of the
oral prescription drugs ingested by children ages 4 and under, 23
percent belong to someone who does not live with the child; 17
percent belong to a grandparent or great-grandparent. From 1986
through 1997, more than 218,000 children ages 5 and under
ingested iron preparations, and 46 died. Iron supplements are
responsible for 30 percent of pediatric medicine-related
poisoning deaths. When dispensing over-the-counter medications to
their children, only 30 percent of caregivers are able to
accurately measure a correct dosage.
Lead Poisoning
It is estimated that 890,000 children ages 1 to 5 have elevated
blood lead levels high enough to affect intelligence and
development. Children ages 1 to 2 are at the greatest risk from
lead poisoning. Ingesting dust from deteriorating lead-based
paint is the most common cause of lead poisoning among children.
Currently, more than 80 percent of public and privately owned
housing units built before 1980 contain some lead-based paint.
Children are more likely to suffer elevated blood lead levels if
they are low-income, black, Mexican American, living in large
metropolitan areas or living in older housing. Children receiving
Medicaid are three times as likely to have harmful blood lead
levels as those not receiving Medicaid.
CO Poisoning
Each year, 30 children ages 14 and under are fatally poisoned by
CO, an odorless, colorless gas. In 1997, more than 3,000 cases of
CO poisoning among children ages 5 and under were reported to
poison control centers. The majority of CO exposures occur in the
winter months and the most common source of residential
CO-related poisoning is unvented supplemental heaters.
Three-fourths of all fire-related deaths are from smoke
inhalation, caused by the toxic gases produced as fires develop
and spread. Most smoke-inhalation fire deaths are due exclusively
or primarily to CO.
WHO IS AT RISK
In general, children ages 5 and under are at greatest risk for
nonfatal poisoning, accounting for the majority of all poisoning
exposures. Children ages 2 and under are especially vulnerable.
Male children are more likely than female children to suffer from
poisoning fatalities and exposures. Black children ages 5 and
under have a poisoning death rate that is approximately four
times that of white children.
POISONING PREVENTION LAWS AND REGULATIONS
The Poison Prevention Packaging Act (1970) authorizes the U.S.
Consumer Product Safety Commission to require the use of
child-resistant packaging for toxic substances used in and around
the home. The Food and Drug Administration regulates the labeling
and packaging of all iron-containing drugs and supplements to
protect children from unintentional poisoning. The Lead-Based
Paint Prevention Act (1971) and the Residential Lead-Based Paint
Hazard Reduction Act (1992) are designed to reduce childhood lead
poisoning by restricting sources of lead in the environment. The
state of West Virginia and some local jurisdictions, including
Chicago, St. Louis and Kingston, NY, have passed legislation
requiring the use of CO detectors in the home.
POISONING PREVENTION EFFECTIVENESS
Child-resistant packaging of prescription medications is
effective in reducing the poisoning mortality rate among children
ages 4 and under. An estimated 460 deaths among children ages 4
and under were prevented from 1974 through 1992, a 45 percent
reduction in the mortality rate from levels predicted without
child-resistant requirements. Poison control centers are
effective in handling poison exposures. Seventy-five percent of
cases reported to poison control centers are managed in a
non-health care facility (e.g., site of exposure, the patient's
home). Ipecac syrup and activated charcoal, when used under
medical advice, can reduce the likelihood of severe poisoning,
decrease the costs of a poisoning incident, and prevent the need
for a hospital emergency room visit. The removal of lead from
gasoline, paint and soldered cans has contributed to the
substantial decline in blood lead levels. In the 15 years
following intensive efforts to reduce lead in these consumer
products, a nearly 80 percent decline in the prevalence of
elevated blood lead levels among children ages 1 to 5 was
observed. CO detectors are effective in preventing residential CO
poisoning and it is estimated that the detectors may prevent half
of such deaths.
HEALTH CARE COSTS AND SAVINGS
The total annual cost of poisoning-related death and injury is
nearly $6 billion among children ages 14 and under. Children ages
4 and under account for $4 billion, or two-thirds, of these
costs. The average cost of hospital treatment for a poisoning
exposure is $8,700. Every dollar spent on poison control centers
saves this country almost $7 in medical costs.
PREVENTION TIPS
Store all medications and household products locked out of sight
and out of reach of children. List poison control center and
emergency medical service numbers near every telephone. Keep
ipecac syrup on hand to be used only on the advice of a poison
control center or a physician. Contact your local poison control
center to see if they recommend that you keep activated charcoal
in the home as well. Always read labels, follow directions and
give medicines to children based on their weights and ages and
only use the dispenser that comes packaged with children's
medications. Test children for lead exposure, and test homes
built before 1978 for lead-based paint. Cover lead paint with a
sealant or hire a professional abatement company to remove the
paint. Frequently wash children's hands and faces as well as toys
and pacifiers to reduce the risk of ingesting lead-contaminated
dust. Install CO detectors in your home in every sleeping area,
and on the ceiling at least 15 feet from fuel-burning appliances.
Ensure that space heaters, furnaces, fireplaces and wood-burning
stoves are vented properly and inspected annually.
12/98 This information was compiled by the National SAFE KIDS
Campaign.