Do child-resistant caps prevent school age children access to prescription medications?

Abstract

Study objectives: We determine the ability of first- and second-grade children to open prescription medication bottles. Methods: Samples of child-resistant prescription medication bottles were obtained from 3 national vendors (CVS, Walgreen's, Wal-Mart). A convenience sample of first- and second-grade children at a local elementary school were the test subjects. After approval by school administration, parental consent forms were obtained for each participant. On separate occasions, participants present were given 1 style of bottle and asked to open it. Five minutes were allowed, and times were recorded for each child and each type of bottle. Grade level and sex were also noted for each subject. Children were not allowed to discuss opening techniques with other subjects. Results: Three brands of caps were tested. Two were push-down-and-turn style (CVS and Wal-Mart), and 1 (Walgreen's) had a tab that needs to be depressed to open the bottle. For Walgreen's bottles (push tab), 21 subjects attempted to open them. Twenty (95%) of the 21 were successful in an average of 1.8 minutes (range 0.5 to 5 minutes for successful opening). For Wal-Mart (push and turn) bottles, 20 subjects attempted to open them. Twelve (60%) of the 20 were successful in an average of 1.8 minutes (range 0.25 to 4.5 minutes for successful opening). For CVS (push and turn) bottles, 25 subjects attempted to open them. Fourteen (56%) of the 25 were successful in an average of 4.3 minutes (range 0.5 to 4.5 minutes for successful opening). Thirty-five first-grade children attempted to open bottles. Twenty-three (66%) of the 35 were successful in an average of 2.4 minutes (range 0.5 to 4.5 minutes for successful opening). Thirty-nine second-grade children attempted to open bottles. Thirty-two (82%) of 39 were successful in an average of 1.2 minutes (range 0.25 to 4 minutes for successful opening). Twenty-nine boys attempted to open bottles. Twenty-two (76%) of 29 children were successful in an average of 1.6 minutes (range 0.25 to 4 minutes for successful opening). Thirty-two girls attempted to open bottles. Twenty-two (68%) of 32 children were successful in an average of 2.2 minutes (range 0.25 to 5 minutes for successful opening). Conclusion: In a convenience sample of first- and second-grade children, most were able to remove a child-resistant cap in less than 5 minutes. Although children in this age group have some understanding of consequences of taking medications, these data reveal that reliance on resistant caps is not safe. Second-grade children were more adept at opening bottles, although first-grade children had a high success rate. It seems that the medication bottles with child-resistant closures may not provide the degree of safety assumed by many parents. Further testing with preschool children and a senior population is planned.