Child-resistant Packaging Research Articles

Standards of Child Resistant Packaging: A Regulatory View

Standards of Child Resistant Packaging: A Regulatory View

A Pilot Study Assessing Common Medication Organizers for Child-Resistant Features

IntroductionPrescription and most over-the-counter medicines are required to have child resistant (CR) packaging and/or labeled with instructions “Keep out of reach of children”. Although medication organizers are not required to have such design features or instructions, these could help prevent unsupervised ingestions (UIs) by children. Commonly purchased medication organizers were evaluated for CR design features and instructions for safe use to prevent UIs. MethodsThe 29 best-selling medication organizers on Amazon.com were identified and product identifiers, design characteristics, and safety characteristics recorded using a standardized instrument. ResultsOf the 29 medication organizers, none claimed to be CR. Only 31% provided a specific warning that the organizer was not CR on the packaging; only 41% communicated “Keep out of reach of children”. Most organizers (59%) provided neither a warning that the organizer was not CR nor instructions to store out of reach of children. The majority of organizers (79%) shared the following characteristics: plastic construction, rectangular shape, non-electronic flip-top opening mechanisms, and 7-day usage. ConclusionsOpportunities exist for manufacturers of medication organizers to improve CR product design, provide information to help prevent UIs (directions to keep the device out of the reach of children), and help to reduce UIs.

Study of clinical profile and outcome of poisoning in children admitted to a tertiary care hospital

Background: A poison is any substance that causes harm to a living being. Children are curious and explore their world with all their senses. Every year thousands of children are admitted to emergency department with poisoning. Poisoning pattern changes according to age group, the nature, dose of the poison, type of exposure. This study is aimed at understanding the incidence, aetiology, manner of poisoning and outcome among children less than 18 years of age admitted to Paediatric emergency department. Methods: This is a Prospective observational study conducted in Paediatrics, MMC and RI, Mysore (Cheluvaba Hospital) between January 2019 to June 2019. After taking ethical committee clearance. 142 children with poisoning admitted to emergency department were included in this study. The age and sex of the patient, poisoning agent, manner of poisoning, duration of hospital stay and outcome of all the patients were recorded and analysed. Results: Out of 142, 78 (54.9%) cases are males, 64 (45.1%) cases are females. 91 (64.1%) cases are <5 years of age, 17 (12%) cases are between 5-10 year, 34 (23.9%) cases are above 10 years. Among all, 38 (26%) cases of drugs consumption. 65 (45.8%) cases of kerosene consumption. 21 (14.8%) cases of insecticides and pesticides poison. Unknown compound 18 (12.7%) cases. 4 (2.8%) cases died- aluminium phosphide poisoning 3 (75%) and Organophosphorous poison 1 (25%). Duration of hospital stay varied from 1 day to more than 15 days. Conclusions: Accidental poisoning is common in children below 5 years of age. Suicidal poisoning incidence is increasing among teenagers either due to exam stress or peer pressure. Accidental poisoning can be reduced by simple measures like parental education, replacing the poisoning agent with one of lower toxicity, legislation regarding the child resistant packaging of necessary poisons.

3D Printed Novel Child-Resistant Packaging

3D Printed Novel Child-Resistant Packaging

Feasibility of Child-Resistant and Senior-Friendly Press-Through Packages: Potential of Different Materials

Press-through packaging (PTP) is the most common type of drug packaging in Japan, and a production procedure for PTP has been established at an acceptable cost. However, unknown problems and new needs with regard to safety among users of various age-groups still need to be examined. Considering accident reports involving children and older adults, the safety and quality of PTP and new forms of PTP, such as child-resistant and senior-friendly (CRSF) packaging, should be evaluated. We conducted an ergonomic study on children and older adults to compare types of commonly used PTP and new varieties of PTP. Opening tests were attempted by children and older adults using a common type of PTP (Type A) and child-resistant (CR) PTP (Types B1 and B2) made from soft aluminum foil. The same opening test was conducted on older patients with rheumatoid arthritis (RA). The results showed that CR PTP was difficult for children to open: only 1 out of 18 children could open Type B1. On the other hand, all eight of the older adults could open Type B1, and eight patients with RA could easily open Types B1 and B2. These findings suggest that the quality of CRSF PTP can be improved with the use of new materials.

A cross-sectional assessment of package labels aimed at children of edible and leaf cannabis discarded in New York City

Background Cannabis is a schedule 1 substance that cannot be possessed within the United States according to federal law. On March 31 2021, New York State legalized cannabis for sale and consumption. This study assesses the safety labeling and packaging aimed at children of cannabis containers during the peri-legalization period in New York City. Methods This is a cross-sectional and descriptive comparative study in which sidewalks in New York City were inspected for labeled cannabis containers during the four months prior and four months post legalization, i.e. from December 2020 until July 2021. Packages were systematically analyzed using a scoring system based on advertising techniques that may appeal to children and the American College of Medical Toxicology’s (ACMT) recommendations on cannabis safety labeling. Results and DiscussionOf the 114 packages, none met ACMT’s recommended safety labeling guidelines. Only 52% of containers indicated their contents, 40% referenced food, and 85% included elements that may appeal to children. Conclusion Precautionary measures such as child-resistant packaging, warning labels, and avoiding marketing to children are uncommon. Policy makers should consider regulating the safety labeling and advertising which appeals to children on cannabis packaging.

MAGNITUDE OF CLINICAL PROBLEM AND CLINICAL PROFILE OF POISONING IN PEDIATRICS

Background: Children are inquisitive and explore their world with all their senses. Poisoning patterns change according to age group, the nature and dose of the poison, type of exposure. This study is aimed at understanding the incidence, aetiology and manner of poisoning, outcome among children less than 18 years admitted to Paediatric department. Methods: Prospectively, 38 poisoning cases admitted to Paediatric intensive care, from August 2021 to May 2022 were included in this study. The age and sex of the patient, poisoning agent, manner of poisoning, duration of hospital stay and outcome of all the patients were recorded and analyzed. Results: Out of 38, 22 (58%) are males, 16 (42%) are females. 13 (34%) cases are <5years of age, 2(5%) cases are between 5-10 year, 23 (61%) cases are above 10 years. Among all, 13 (34%) cases of drugs consumption, among these 11 cases were above 10 years representing purposeful consumption. 5 (13%) cases of kerosene consumption. Out 4 (11%) cases of Organophosphorous poison, 3 cases are above 10 years representing purposeful consumption. 4 (10%) cases of acid consumption. 4 (11%) cases of aluminium phosphide poisoning. 3 (8%) cases of Good night oil consumption. 2 (5%)cases of eucalyptus oil consumption. 3(8%) cases of camphor poisoning. 2 (5%) cases died due to aluminium phosphide poisoning. Duration of hospital stay varied from 1 day to 6 days. Conclusions: Accidental poisoning is common in children below 5 years of age. Suicidal poison incidence is increasing among teenagers. Accidental poisoning can be reduced by simple measures like parental education, replacing the poisoning agent with one of lower toxicity, legislation regarding the child resistant packaging of necessary poisons. Keywords: Camphor, Drugs, Eucalyptus oil, Poisons

PROFILE OF CHILDHOOD POISONING: A RETROSPECTIVE STUDY FROM A TERTIARY CARE HOSPITAL IN ASSAM

Acute poisoning forms a substantial part of emergency visits to a hospital for the pediatric population. It is mostly noted amongst the families in the lower socio-economic strata of the society with limited access to the basic amenities of life. Majority of childhood poisonings are unintentional, occur at home, and home surroundings and hence preventable. It is a retrospective study conducted in the Department of Pediatrics of Fakhruddin AliMETHODOLOGY: Ahmed Medical College & Hospital, Barpeta,Assam. To determine the types of acute childhood poisoning andOBJECTIVE: demographic prole in children admitted Fakhruddin Ali Ahmed Medical College & Hospital. A total of 69 cases ofRESULT: poisoning was reported during the study period. 46 (66.6%) were males while 23 (33.33%) were females. Mineral oil was the most common cause of poisoning (40.5%), followed by organophosphorus compounds (28.9%), drugs (11.5%) and unknown causes (18.8%).Of the 69 cases, 61 (89.8%)were discharged while 8(11.1%) cases went home against medical advice. CONCLUSION: Acute poisoning in children is mostly accidental in nature, with preventable morbidity and mortality.In our study, mineral oil and organophosphorus compounds were the most common causes as the study population comprised of cases of lower socioeconomic strata and mostly related to the agrarian sector. Careful storage of household products and keeping medicines in child-proof containers may reduce poisoning to a great extent.

Poisoning-related emergency department visits: the experience of a Saudi high-volume toxicology center.

BACKGROUND: Acute poisoning is a major contributing factor to mortality and morbidity. There is a lack of research on the epidemiology of acute poisoning risk factors in Saudi Arabia.OBJECTIVES: Descriptive overview of poisoning cases at a tertiary care center.DESIGN: Descriptive, medical record review.SETTINGS: Tertiary care center in Riyadh.PATIENTS AND METHODS: From the electronic medical record system, we collected demographic information, medical history, and the poisoning history on all emergency department visits diagnosed as acute poisoning from January 2016 to January 2021. Patients were classed as children (<18 years old) or adults, and further classified by body mass index.MAIN OUTCOME MEASURES: Intensive care unit (ICU) admission, organ transplantation, and mortality were classified as poor outcomes.SAMPLE SIZE: 492 adults and 1013 children (<18 years old) were identified.RESULTS: The most frequent agent in poisoning for both groups was acetaminophen (n=52, 10.57% and n=100, 9.87%, respectively). The ICU admission rate was 6.7% and 4.8%, and the mortality rate 0.8% and 0.3%, respectively. The accidental poisoning rate was 57.7% among adults (n=284) and 67.6% among children (n=658). The suicide intention rate was 11.2% (n=55) and 7.4% (n=75) among adults and children, respectively. The management for both populations was nonspecific, involving observation, supportive measures, and symptomatic treatment.CONCLUSION: Although the ICU admission rates were consistent with reported data, the mortality rate was marginally lower. The pediatric predominance in the population implies a lack of caregiver education in the region regarding the safe storage of drugs and household products, as well as the use of child-resistant packaging. The high rate of accidental poisoning in both age groups should prompt further investment to promote public health education on the rational use and safe storage of toxic agents and self-protection. The high suicide intention rate needs to be investigated to develop multidisciplinary risk prevention strategies.LIMITATIONS: Single center, retrospective, small population size.CONFLICT OF INTEREST: None.

Perceptions of Medical Cannabis Packaging and Labeling among Middle-Aged and Older Canadians

The use of cannabis for therapeutic purposes is becoming more popular in many countries, including the United States and Canada. In Canada, middle-aged and older adults make up the largest proportion of medical cannabis users. Canadian legislation mandates that medical cannabis be packaged in plain-looking containers with small labels, childproof caps, and required health warnings. This is meant to standardize the way cannabis products are distributed, as well as protect children from accidental ingestion. However, there is limited research on how these regulations affect cannabis users over age 45. In the present study, residents of Winnipeg, Manitoba, Canada aged 45 and older (n=40) were surveyed regarding their experiences with medical cannabis packaging and labeling. Half of the participants (50%) felt they had a hard time opening their medical cannabis container. A majority (60%) thought having an easy-open lid would be helpful. Most participants (78%) reported experiencing difficulties reading the label on their container, and 75% thought it would be helpful to have a printout of the label in a larger font. In addition, 89% of participants who took more than one kind of medical cannabis favored a symbol on their medication bottle that would indicate the type of medical cannabis contained inside. Implications for policy makers and future research are discussed.

Unintended but Hardly Unexpected Consequences of Cannabis Legalization

Unintended but Hardly Unexpected Consequences of Cannabis Legalization

Questionnaire Study Aimed at Disseminating Child-Resistant Packaging and Enlightening Consumers as a Measure to Prevent Accidental Ingestion of Medicines

Questionnaire Study Aimed at Disseminating Child-Resistant Packaging and Enlightening Consumers as a Measure to Prevent Accidental Ingestion of Medicines

Current management of button battery injuries.

Button batteries (BB) are found in common household items and can lead to significant morbidity and mortality in the pediatric population when ingested. BBs are made of various chemistries and have a unique size and shape that yield significant injury when lodged in the pediatric esophagus. BBs create a local tissue pH environment of 10 to 13 and can induce liquefactive necrosis at the negative pole. This initial injury can progress with further tissue breakdown even after removal. Unfortunately, patients may present with vague symptoms similar to viral illnesses and there is not always a known history of ingestion. Plain film X‐ray can be diagnostic. Exposure can lead to caustic injury within 2 hours. Thus, timely endoscopic removal is the mainstay of treatment. Novel mitigation and neutralization strategies have been implemented into treatment guidelines. These include the preremoval ingestion of honey or sucralfate and intraoperative irrigation with acetic acid. Depending on the severity of injury following removal, careful consideration should be given for potential delayed complications including fistulization into major vessels which often leads to death. The National Button Battery Taskforce and several industry members have implemented prevention strategies such as educational safety outreach campaigns, child‐resistant packaging changes, and warning labels. Governmental regulation and industry changes are key to limit not only the amount of BB ingestions, but also the devastating consequences that can result. Anonymous reporting of BB injuries through the Global Injury Research Collaborative has been made convenient and centralized through the advent of a user‐friendly smartphone iOS/App Store and Android/GooglePlay application called the “GIRC App”; all specialists who manage foreign body cases should contribute their cases to help prevent future injuries. BB ingestion must be recognized and treated promptly using a multidisciplinary approach to optimize outcomes for these patients. Ultimately, a safer BB technology is critically needed to reduce or eliminate the severe and life‐threatening injuries in children.Level of Evidence5

Electronic Cigarette Refill Liquids: Nicotine Content, Presence of Child-Resistant Packaging, and in-Shop Compounding

PurposeTo expand on our 2015 study of the nicotine content accuracy of e-liquids, including salts, and the presence of child-resistant packaging. We also describe compounding in shop (CIS). Design and methodsWe analyzed samples from 35 shops. CIS processing was observed. Descriptive statistics summarized the data, and inference was performed. ResultsActual nicotine content was significantly less than the identified content, on average, with a mean percent deviation 34.0% below the identified content. Only 3.8% of the samples' actual nicotine content was within 10% of the identified content; the maximum deviation was 213.2%. Of eight uniquely packaged samples, including designs resembling pop cans, ice cream cones, etc., the mean percent deviation was −39.6%; none were within 10% of the identified content. Eight shops compounded samples. After removing outlier values, significant differences were found in the percent deviations between the CIS and non-CIS free-base samples. A significantly higher percentage of CIS samples had nicotine content > 10% above the identified content, and none were within 10%. One shop visually estimated the nicotine quantities to add, e-liquids were not always relabeled to reflect new nicotine levels, and protective materials were not always worn during compounding. Child-resistant packaging was not present for one third of the samples. ConclusionsLabeling of nicotine content in e-liquids remains inaccurate, child-resistant packaging is inconsistent, and CIS is problematic. Effective e-liquid regulation is needed to protect public health. Practice implicationsNurses should educate families about the serious health risks of e-liquids and advocate for increased e-liquid regulations.

Gripping strategies employed by young children aged 3–5 years when interacting with child-resistant push and turn closures used by pharmacies in the United States

Archived video footage from a previous task analysis study where children attempted to open prescription vials outfitted with 42 mm (diameter) push and turn closures was reviewed and grip postures were characterized based on a grip taxonomy presented by Rowson & Yoxall which investigated adult grips (2011). Video review was conducted to identify the types of grip postures children aged 3–5 years utilized when attempting to open continuous thread polypropylene vials outfitted with push and turn, child-resistant closures and compared with grip postures identified with the adults. Children tended to utilize only 3 grip postures (spherical, cylindrical, and pronated cylindrical grips), while adults utilized seven different postures. If children utilize a more limited set of grip postures when opening child resistant closures than their adult counterparts, this difference could be exploited when designing child resistant packaging systems. That said, our study utilized a limited number of CRC designs and confounds existed between the package sizes the children in the archived video footage attempted to open and those that served as the point of comparison which identified grip postures utilized by adults. As such, further investigation is needed across a range of package diameters. Potential implications for child-resistant packaging design are discussed.

Prevention of Unintentional Medication Overdose Among Children

This Viewpoint discusses the success of US legislation to help prevent medication overdoses in children and suggests strategies to continue to reduce these overdoses, including changes to child-resistant packaging.

Circumstances Involved in Unsupervised Solid Dose Medication Exposures among Young Children

To identify types of containers from which young children accessed solid dose medications (SDMs) during unsupervised medication exposures and the intended recipients of the medications to advance prevention. From February to September 2017, 5 US poison centers enrolled individuals calling about unsupervised solid dose medication exposures by children ≤5years. Study participants answered contextually directed questions about exposure circumstances. Sixty-two percent of eligible callers participated. Among 4496 participants, 71.6% of SDM exposures involved children aged ≤2years; 33.8% involved only prescription medications, 32.8% involved only over-the-counter (OTC) products that require child-resistant packaging, and 29.9% involved ≥1 OTC product that does not require child-resistant packaging. More than one-half of exposures (51.5%) involving prescription medications involved children accessing medications that had previously been removed from original packaging, compared with 20.8% of exposures involving OTC products (aOR, 3.39; 95% CI, 2.87-4.00). Attention deficit hyperactivity disorder medications (49.3%) and opioids (42.6%) were often not in any container when accessed; anticonvulsants (41.1%), hypoglycemic agents (33.8%), and cardiovascular/antithrombotic agents (30.8%) were often transferred to alternate containers. Grandparents' medications were involved in 30.7% of prescription medication exposures, but only 7.8% of OTC product exposures (aOR, 3.99; 95% CI, 3.26-4.87). Efforts to reduce pediatric SDM exposures should also address exposures in which adults, rather than children, remove medications from child-resistant packaging. Packaging/storage innovations designed to encourage adults to keep products within child-resistant packaging and specific educational messages could be targeted based on common exposure circumstances, medication classes, and medication intended recipients.

Innovative Packaging of Medicines

Packaging innovation has a large role to play in the pharmaceutical market. Whether it is to improve pack protection, deliver convenience and ease of delivery or encourage patient compliance, pharmaceutical packaging constant innovation is key to ensure patient safety. In the pharmaceutical industry, efficient and intelligent packaging has much more potential which includes, Compliance Packaging, Anti counterfeit packaging etc. Keeping drugs secure from young children while ensuring user-friendliness to seniors is one of the main objectives of pharmaceutical packaging companies. That is why the new packagings industries are trying to include smart solutions like Child-Resistant Packaging, Prefilled syringe, Diskus Inhaler Technique, Ecofriendly Packaging, CYPAK'S, Marijuanna Extract BilcareOptimaTM, Ecoslide, Catalent's Delpouch. In this series of packaging innovations, we bring to you the recent trends in the pharmaceutical packaging.

Toxicity of agents used for opioid withdrawal: a case-based approach.

Toxicity of agents used for opioid withdrawal: a case-based approach.

Liquid Mosquito Repellent Ingestion in Children.

Hydrocarbons are a common cause of accidental poisoning in children, with kerosene being the most implicated agent in rural parts of India. However, lately, liquid mosquito repellent ingestion is emerging as an important cause of hydrocarbon (kerosene) poisoning in urban households. This is a retrospective case series over a 5-y period (January 2013 - December 2017) of children with accidental liquid mosquito repellent ingestion presenting to the pediatric emergency. Epidemiology, clinical profile, management and outcomes are discussed. Twenty-three children with median (IQR) age of 24 (18.8-32) mo presented after mean (SD) interval of 6 (3) h from ingestion. Majority (20, 87%) were seen during summer months (March-June) and all were from urban background. Sixteen (70%) had mild-moderate acute respiratory distress syndrome (ARDS) requiring supplemental oxygen with or without positive airway pressure for a mean (SD) duration of 3.3 (1.9) d. All except one survived. Children with accidental liquid mosquito repellent ingestion had predominant aspiration pneumonitis due to hydrocarbon content rather than neurological complications attributable to synthetic pyrethroids. Ensuring child-proof containers, appropriate storage, regulatory surveillance and parental awareness are must for prevention.