BOSTON – Alcohol and illicit drugs account for about one in eight accidental drug poisonings of infants and toddlers in the United States, according to prospective registry data from 31 U.S. toxicology centers.
A review of confirmed poisoning cases from these centers showed that cardiac drugs accounted for 16% of poisonings of children under 2 years of age, followed by psychotropic drugs (15%), and recreational drugs and alcohol (13%), reported Dr. Yaron Finkelstein, a pediatric emergency medicine physician at the University of Toronto.
Dr. Yaron Finkelstein
"Infant and toddler poisonings pose a unique public health concern. They involve among the most helpless and vulnerable populations in our society, partly because of their inability to protect themselves from environmental hazards, or communicate the circumstances of their injury," Dr. Finkelstein said.
Emergency department visits by children aged 5 years and under for poisoning in the United States rose 30% from 2001 to 2008, suggesting that better prevention methods and better data on the extent of the problem are needed, he said at the annual meeting of the Pediatric Academic Societies.
However, the National Poison Data System (NPDS), run by the American Association of Poison Control Centers, relies largely on voluntary information, and reported poisonings are not verified.
"The NPDS system probably underestimates the true magnitude of the problems, since less than 20% of poisoned children who actually present to the emergency department have contacted the regional poison control center," he said.
To get a clearer picture of accidental poisonings in children under 2 years, Dr. Finkelstein and his colleagues reviewed data from the Toxicology Investigators Consortium (ToxIC) Case Registry of the American College of Medical Toxicology (ACMT), a prospective, nationwide toxicology database with 31 U.S. registry sites.
They identified a total of 6,810 poisoning cases from April 2010 through June 2011, 248 (3.6%) of which involved children under age 2 years. The cases were all confirmed by a certified medical toxicologist at bedside.
Of these children, 51% were boys, and 63% were symptomatic at the time of consultation. Slightly more than half of the consultations (54%) occurred when the child was being admitted to the hospital, 42% occurred in the emergency department, and 4% took place in an outpatient setting.
The top seven exposures according to the ToxIC registry were to cardiac drugs , psychotropic agents, street drugs/alcohol, analgesics (9%), cleaning products (6.5%), scorpion stings (4.5%), and toxic alkaloids (3.9%).
In contrast, NPDS data for the same categories implicate, in descending order from most to least frequent, analgesics, cleaning products, psychotropics, alkaloids, cardiac drugs, street drugs, and scorpion stings, Dr. Finkelstein said.
He noted that because the ToxIC registry is a sentinel system based primarily in academic tertiary care centers, it may not be representative of the experience in community or primary care practice settings, but the ToxIC and NPDS registry data complement each other to provide effective real-time surveillance of poisonings in the United States.
The finding that one in eight children presenting with poisoning had been exposed to alcohol or illicit drugs "highlights again the issues of unsafe environment, child neglect, or maltreatment. Additionally, malicious intent should be considered, especially in first-year-of-life exposures," he concluded.
The study was supported by the Toxicology Investigators Consortium. Dr. Finkelstein reported having no relevant financial disclosures.