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Abstract

We thank Bryant et al for sharing data from their local poison center on hospitalizations for unsupervised pediatric exposures. This provides further support for targeting pediatric poisoning prevention messages to grandparents1Wezorek C. Dean B. Krenzelok E. Accidental childhood poisoning: influence of the type of caretaker on etiology and risk.Vet Hum Toxicol. 1988; 30: 574-576PubMed Google Scholar and emphasizes the risk of pediatric medication ingestions when using pill organizers in the presence of young children.2Agarwal M. Lovegrove M.C. Geller R.J. Pomerleau A.C. Sapiano M.R.P. Weidle N.J. et al.Circumstances involved in unsupervised solid dose medication exposures among young children.J Pediatr. 2020; 219: 188-195.e6Abstract Full Text Full Text PDF PubMed Scopus (6) Google Scholar Focusing on exposures requiring hospitalization (ie, those potentially most serious), Bryant et al found that when grandparents were involved, a higher percentage of cases involved medications accessed from pill organizers or involved antihypertensive medications compared with exposures without grandparent involvement. The proportion of cases involving intensive care unit admission was also higher for pediatric exposures with grandparent involvement, although whether the reported differences were statistically significant is unclear. The findings reported by Bryant et al are important and suggest the need for additional studies to further investigate how medication use and storage practices of grandparents contribute to pediatric exposures with severe outcomes. Additional information on why medications are removed from original packaging, why medications are transferred to other containers, and how those containers are stored could help identify innovative interventions that promote both improved medication adherence among adults and improved child safety. Grandparents' medications and pill organizers are only part of the problem of unsupervised pediatric exposures. Bryant et al provide additional evidence that it may be necessary to raise awareness among grandparents that most pill organizers are not child-resistant and can be easily opened by young children, but parents and other caregivers should be reminded of this as well. Targeted messaging could encourage caregivers of young children to keep medicines in child-resistant containers, fully secure child-resistant closures, and keep all medications (including those in purses, pockets, bags, and pill organizers) up and away and out of the sight and reach of young children.3UpAndAway.orgPut your medicines up and away and out of sight.www.upandaway.orgDate accessed: March 9, 2020Google Scholar Pediatric poison center exposures and outcomes in the context of grandparent supervisionThe Journal of PediatricsVol. 222PreviewWe read with interest the report by Agarwal et al.1 Our clinical toxicology service quite frequently manages pediatric poisonings that result from exposures to medications that are not in their original containers. In addition, we regularly manage patients who present in the context of being under the care of a grandparent. We applaud the authors for their timely and consequential study and would like to complement their results with some of our data focusing on outcomes in this patient population. Full-Text PDF