327: Malicious Use of Nonpharmaceuticals In Children

Abstract

Intentional poisoning of children is not well characterized and is primarily reported as case reports. Case reports suggest that primary motives for administration of nonpharmaceuticals to children include homicide, punishment/injury, and Munchausen's by proxy. The objective of this study was to describe malicious nonpharmaceutical exposures in children reported to US poison centers. We performed a retrospective study of all nonpharmaceutical exposures involving children < 7 years old reported to the US National Poison Data System (NPDS) from 2000-2008 for which the reason for exposure was coded as “malicious.” The American Association of Poison Control Centers definition and categorization of nonpharmaceuticals was used. Data collected for each case included age, sex, month and year of the exposure, the exposed substance or substances, and poison center outcome designation. Intent of ingestion was coded by the specialists receiving the phone calls. Fatality abstracts (summaries of the facts reported to the poison center) were reviewed. Out of approximately 21.4 million exposures reported to NPDS during the study period, 4053 cases involving 4232 nonpharmaceuticals were identified. The mean number of cases per year was 450 (range 409-546) with no linear annual trend (p=0.28). The median age was 3 (1.5, 5) with boys constituting 57%. 4.5% of the cases resulted in moderate or worse outcomes in which the outcome was known. The most commonly reported major categories were household cleaning substances (23%), cosmetics/personal care products (13%), pesticides (8%), other/unknown nondrug substances (6%), foreign bodies/toys/miscellaneous (5%), alcohols (5%), hydrocarbons (4%), lacrimators (4%), and chemicals (4%). Bleaches, acids, and alkalis made up 40% of the cleaning substances group. The proportion of the cases due to each major category was significantly different than the proportion due to each category for all intents in children < 6 in 2008 (p<0.002). Except for cosmetics/personal care products, all other categories were overrepresented in the study cohort. 4 children died and 18 others had life-threatening injuries. Among these 22 children, cleaning substances (7) were the most common major category followed by chemicals (4), alcohols (3), fumes/gases/vapors (2) and six other categories with 1 each. In the only fatality where the presence or absence of associated physical injuries was described, the child had multiple injuries consistent with physical abuse. Malicious administration of nonpharmaceuticals is an important component of child maltreatment with cases being reported consistently to poison centers. Intentional administration should be considered as a possibility when evaluating children exposed to these agents especially when an injury has occurred. Efforts should be made to identify distinguishing characteristics of intentional administration of nonpharmaceuticals.