Child-resistant Packaging Research Articles

Child injury morbidity in New Zealand, 1987-1996.

New Zealand is one of a small number of countries that has a national hospital discharge database. The aim of this study was to use these data to provide an epidemiological description of child injury morbidity and to discuss options for prevention. Using national data, all public hospital admissions for the fiscal year 1995/6 were identified and grouped according to cause. This allowed identification of all children (0-14 years) hospitalized for injury in the period 1987-1996. Causes of injury, diagnoses and injury severity were examined in four age groups. Injury was the second leading cause of public hospital admissions. Children were hospitalized with injury at the rate of 1333 per 100 000 person-years. The victims were predominantly male (61%). In all age groups, falls were the leading cause of morbidity. 'Striking events', motor vehicle traffic crashes and poisoning were also major contributors to the child injury toll. The commonest injury diagnosis was a fracture of the upper limb (25%), followed by intracranial injury (18%). The leading causes of injury morbidity were noted to differ from previously reported leading causes of injury mortality. Review of the data in light of research literature suggests the need for policy changes to make alternatives to motor vehicle transportation safer and to encourage increased use of child restraints in order to reduce road traffic trauma. Legislation requiring child-resistant packaging for all toxic medications and household products is necessary to reduce rates of child poisoning. Further research is required on policies concerning playground equipment heights and surfacing requirements, and on interventions for hot water scalds.

Acute hazards to young children from residential pesticide exposures.

This study assessed acute hazards to young children from pesticides toxic enough to require child-resistant packaging. The names of pesticides meeting acute toxicity criteria were ascertained from the Environmental Protection Agency. Poison Control Center reports identified children younger than 6 years who were exposed to these pesticides. Toxicity category, medical outcome, sex, and age were examined. A higher proportion of children with exposure to the more toxic products had serious medical outcomes. Children 2 years and younger were the predominant age group exposed. Protective measures--substituting less lethal pesticides, reducing the concentration of the active ingredients, and improving packaging and storage--are recommended.

Legislative and Regulatory Strategies to Reduce Childhood Unintentional Injuries

Laws and regulations are among the most effective mechanisms for getting large segments of the population to adopt safety behaviors. These have been applied at both the state and federal levels for diverse injury issues. Certain legal actions are taken to prevent the occurrence of an otherwise injury-producing event, while other legal actions are designed to prevent injury once an event has occurred. At the federal level, effective laws and regulations have been directed at dangers posed by unsafe manufactured products or motor vehicle design. At the state level, effective safety laws and regulations have been directed at encouraging safety behaviors and regulating the use of motor vehicles or other forms of transportation. In this article, six legislative efforts are described to point out pros and cons of the legislative approach to promoting safety. Three such efforts are aimed at preventing injury-producing events from occurring: mandating child-resistant packaging for prescription drugs and other hazardous substances, regulating tap water temperature by presetting a safe hot-water heater temperature at the factory, and graduated licensing. Three other examples illustrate the value and complexities of laws designed to prevent injuries once an injury-producing event does occur: mandatory bicycle helmet use, sleep-wear standards, and child safety seat use. This article concludes with specific recommendations, which include assessing the value of laws and regulations, preventing the rescission of laws and regulations known to work, refining existing laws to eliminate gaps in coverage, developing regulations to adapt to changing technology, exploring new legal means to encourage safe behavior, and increasing funding for basic and applied research and community programs. Further reductions in childhood injury rates will require that leaders working in the field of injury prevention together provide the creativity to devise new safety devices and programs, incentives to persuade the public to adopt a "culture of safety" as a social norm, training and education to develop new leaders and workers, and the political will to challenge the status quo and engage the public interest.

Common culprits in childhood poisoning: epidemiology, treatment and parental advice for prevention.

Unintentional poisoning in children less than 6 years of age is a common occurrence. The majority of cases involve 1- and 2-year-old children who ingest nonpharmaceutical products. Although the clinical outcomes of these exposures is usually favourable, deaths do occur. In the US, the causes of death most commonly reported by the American Association of Poison Control Centers Toxic Exposure Surveillance System (AAPCC TESS) are carbon monoxide and adult formulations of iron. The exposures most commonly reported by the AAPCC TESS are cosmetic/personal care products (e.g. perfume, cologne and aftershave), household cleaning substances (e.g. bleach and alkaline corrosives) and analgesics [e.g. paracetamol (acetaminophen)]. Prevention is important and exposure to poisons should be considered a preventable childhood injury. The use of child-resistant packaging and the secure storage of household substances are the basis of preventing unintentional exposures. Parents and healthcare professionals need to be aware of what constitutes high risk exposure, as well as those exposures which are common but not serious. Poison prevention efforts should also address the appropriate role of the poison information centre.

Ferrous sulfate toxicity: a review of autopsy findings.

Ferrous sulfate is the leading cause of accidental pediatric poisonings. Despite the requirement for child-resistant packaging for any oral iron product with 250 mg or more per container, the incidence has continued to increase. Although the clinical presentation of iron toxicity has been well described, pathologic findings in human tissue and correlation with clinical data are scant. We reviewed autopsies from the Armed Forces Institute of Pathology of 11 children who died from ferrous sulfate toxicity. Clinical data, morphologic changes, and iron levels in tissue were evaluated. The children's ages ranged from 11 to 36 mo. Prominent iron deposition in gastric and small intestinal mucosa was associated with necrosis, with some cases demonstrating prominent vascular iron deposition. The clinical courses were rapid and progressed from Stage I to Stage III. These observations were correlated with increased levels of iron in various tissues, as determined by analytical atomic absorption spectrophotometry. The morphologic and chemical analysis data provide information on the pathogenesis of ferrous sulfate poisoning; the vascular iron deposition may be related to subsequent hemorrhage. In the liver the periportal necrosis is probably a direct cytopathic effect of the highest levels of iron carried to these cells by the portal blood flow.

Paracetamol poisoning in children.

Paracetamol (acetaminophen) has become an antipyretic drug of choice. Due to its widespread use, toxicity secondary to overdose has increased in recent years. Children are especially vulnerable to accidental exposure due to non availability of child proof containers in India. The main clinical features of acute toxicity include anorexia, vomiting, abdominal pain, jaundice, hematuria and metabolic acidoses. Diagnosis is based on history and laboratory findings of acidosis and abnormal liver function tests. N-acetylcysteine is the specific antidote. This article reviews in detail the toxicokinetics, pathophysiology, clinical features and management of paracetamol poisoning in children.

Childhood injuries from artificial nail primer cosmetic products.

Methacrylic acid-containing primers used in artificial nail cosmetic products are typically not contained in child-resistant packaging, although they are sold to the general public. To analyze the type and severity of childhood poisoning injuries involving methacrylic acid-containing artificial nail primers. Secondary analysis of 2 national, population-based injury data sets. The 1991 through 1993 National Electronic Injury Surveillance System data on emergency department visits compiled by the Consumer Product Safety Commission and the 1993 through 1995 Toxic Exposure Surveillance System data on calls to poison control centers compiled by the American Association of Poison Control Centers. Children younger than 6 years with injuries associated with exposures to nail primers. In the National Electronic Injury Surveillance System, there were 769 exposures to nail preparations, 32 (4.2%) of which involved nail primers. Twenty-eight (87.5%) of 32 nail primer exposures involved children younger than 6 years. Of the severe nail primer injuries, 80% involved preschoolers; most of the injuries were dermal burns. In the Toxic Exposure Surveillance System data set, there were 759 methacrylic acid-containing nail product exposures, of which 567 (74.7%) occurred in children younger than 6 years. Of exposures in preschool children, 56 (9.9%) resulted in moderate severity injuries and 3 (0.5%) in "major" injuries; there were no deaths. Artificial nail primers containing methacrylic acid represent a corrosive hazard to young children and have been associated with severe injuries. New product labeling and packaging regulations and public education measures that recognize this hazard are recommended.

Analysis of denatonium benzoate in oregon consumer products by HPLC

Denatonium benzoate (DB) is being added to a variety of consumer products as an aversive agent or denaturant. In 1995, Oregon was the first state to mandate the addition of DB to antifreeze and windshield washer fluids regardless of whether the product was marketed in a bottle with a child-proof cap. We have modified published high pressure liquid chromatography (HPLC) methods to measure the concentration of DB and validated it for use in Oregon consumer products. Analysis of standards showed a linear curve in the range of 1.25 to 50 ppm. This makes it useful for most analytical applications as DB usually is added in the 10 to 30 ppm range according to DB's manufacturer. The peak analyzed was collected and verified as DB by mass spectrometry. The method was applied to a variety of commercially-available products with particular emphasis on antifreeze and windshield washer fluids which are required by Oregon law to contain an aversive agent. Products analyzed were purchased in either 1994 or 1996 and showed a wide variation in concentration of DB ranging from below the limit of detection in many of the windshield washer products to above 30 ppm in many of the antifreeze formulations. There was no significant change in levels of DB after storage of antifreeze or windshield washer fluids at room temperature for six months.

Current activites in the field of child safety within CEN aand ISO

Many countries have implemented safety and performance requirements for children's products. There is, however, a need to harmonize existing legislation and standards to facilitate a uniform flow of trade. At the same time, it is essential to extend existing requirements to restrict certain hazards which have not been covered in the past. In CEN, the European Committee for standardization, several technical committees are developing European Standards for products to be used by or for children. On a global level as well, within ISO, there are standardization projects covering such products. Child safety is the main objective for the standardization work on: •Safety of toys (CENATC 52, ISO/TC 181) • Child use and care articles (CEN/TC 252) •Playground equipment for children LCEN/TC 136/SC 1) • Children's furniture (CEN/TC 207, ISO/TC 136( •Child-resistant packaging (CEN/TC 261/SC 2, ISO/TC 122) Children's products constitute a group of consumer products with large variations between the different products. Nevertheless, since they all come in contact with children (and their parents), several hazards associated with these products are similar for the various products. This is reflected in the work of CEN/TC 252, Child use and care articles, established in 1990. To establish a horizontal framework for the hazard-based approach, CEN/ TC 252 created a working group with the task to specify general and common safety requirements (WG 6). Five working groups started the elaboration of product standards in parallel. The traditional concept of a standardization project was found inadequate and other solutions were sought. Finally, it was decided to combine the results from working group 6 into one guidance document, to be published as a CEN Report.

Acute fluoride toxicity from ingesting home-use dental products in children, birth to 6 years of age.

This paper analyzes reports to the American Association of Poison Control Centers (AAPCC) of suspected overingestion of fluoride by children younger than 6 years of age between 1989 and 1994, and estimates the probably toxic amounts of various home-use fluoride products in children younger than 6 years of age. Annual incidence rates of reported fluoride exposures attributed to dietary supplements, toothpaste, and rinses were calculated. Probably toxic amounts of each product were calculated using the frequently cited dose of 5 mg/kg. Children younger than 6 years of age accounted for more than 80 percent of reports of suspected overingestion. While the outcomes were generally not serious, several hundred children were treated at health care facilities each year. A 10 kg child who ingests 50 mg fluoride (10.1 g 1.1% NaF gel; 32.7 g 0.63% SnF2 gel; 33.3 g 1,500 ppm F toothpaste; 50 g 1,000 ppm F toothpaste; and 221 mL 0.05% NaF rinse) will have ingested a probably toxic dose. Overingestion of fluoride products in the home is preventable. Dentists and other health care providers should educate parents and child care providers about the importance of keeping fluoride products out of reach of children. Manufacturers should be encouraged by the ADA and the FDA to use child-resistant packaging for all fluoride products intended for use in the home.

The Safety Effects of Child-Resistant Packaging for Oral Prescription Drugs

To evaluate the effectiveness of child-resistant packaging in reducing the mortality rate for children younger than 5 years from the unintentional ingestion of oral prescription drugs. Annual mortality rates for children younger than 5 years associated with the unintentional ingestion of oral prescription drugs are constructed for 1964 through 1992. The effect of child-resistant packaging on the child mortality rate during the postintervention period (1974 through 1992) is evaluated with a multivariate time series regression model. The analysis controls for changes in the consumption of oral prescription drugs over time and for long-term safety trends. United States. Children younger than 5 years. Estimated reductions in the child mortality rate associated with the use of child-resistant packaging. After controlling for covariates, the use of child-resistant packaging was associated with an annual reduction in the oral prescription drug-related mortality rate of 1.40 (95% confidence interval, 0.85-1.95) deaths per million children younger than 5 years. This suggests a reduction of about 460 child deaths from 1974, the year oral prescription drugs became subject to child-resistant packaging requirements, through 1992-a mortality rate reduction of about 45% from levels projected without the child-resistant requirements. Child-resistant packaging reduces child mortality from the unintentional ingestion of oral prescription drugs.

The safety effects of child-resistant packaging for oral prescription drugs. Two decades of experience

The safety effects of child-resistant packaging for oral prescription drugs. Two decades of experience

Reduced child mortality with child-resistant packaging

Reduced child mortality with child-resistant packaging

Salicylate Intoxication in an Infant With Ichthyosis Transmitted Through Skin Ointment—A Case Report

Accidental salicylate poisoning is becoming less common than it was three decades ago. There was a dramatic drop in the number of children who had this condition in countries where using childproof caps and limiting the number of pills per package was legalized and implemented.1 In some other countries, salicylate still remains a common cause of accidental poisoning among children.2,3 Salicylate intoxication almost always happens after oral ingestion. Ichthyosis is a group of inherited keratinizing disorders characterized by visible scaling in distinctive patterns of distribution. Lamellar ichthyosis is an autosomal recessive disorder that is usually evident at birth, and is associated with erythroderma.

Epidemiology and prevention of caustic ingestion in children

A total of 102 children less than 16 years of age admitted for caustic ingestion in the period 1976-1991 were registered. The annual incidence rate of hospitalization was 10.8:100,000 for the city of Aarhus, Denmark. Esophageal burns occurred with a frequency of 5.0:100,000 per year. Ninety-four percent of the children were less than 5 years old. For this age group, the incidence rates of admission and esophageal burns were 34.6:100,000 and 15.8:100,000, respectively. All ingestions were accidental. The incidence rates of esophageal burns in children 0-4 years old (p = 0.019) decreased significantly during the period studied. The cause of this decrease is not clear, but a change in the spectrum of household products and the gradual introduction of child-proof caps are possible explanations. To minimize the frequency of accidents, an information campaign directed specifically at parents of toddlers is recommended. Information material should stress that caustics should always be inaccessible to children and stored separately, and should never be decanted.

Pediatric acepromazine poisoning: The importance of child-resistant packaging for veterinary drugs

The first reported case of acepromazine ingestion in a pediatric patient is presented. It is an aliphatic phenothiazine that is structurally similar to chlorpromazine (thorazine). In our case, a 2 1 2 - year-old male ingested 3 to 4 of his 80-pound Doberman's 25-mg tablets. The pills were stored in a vial without a child-resistant closure. The child displayed signs and symptoms of phenothiazine toxicity. There is no federal law which requires veterinary medicines to be dispensed in special packaging. All prescription medications should require child-resistant packaging.

Danger! Grandparents' drugs may be lethal to children

CCOrding to the Centers for Disease Control, randparents' drugs are responsible for 1 in 6 17%) accidental poisonings in which children ingest prescription drugs.l Numerous studies have confirmed that many elderly adults have difficulty opening child-resistant containers and, as a consequence, do not use them, possibly endangering the lives of young household members or visitors. 13 Elders who have trouble opening child-resistant packaging (CRP) are encouraged to solve the problem by requesting non-child-resistant containers when their prescriptions are filled. 4 Obviously this

Elderly patients and their medication: a post-discharge follow-up study.

Fifty-six elderly patients (age range 65-98 years) discharged from a geriatric unit were visited at home on or after the 5th post-discharge day (median day 8) and their medication assessed. By the day of the visit, 15 of the 56 had not had a new prescription issued (27%) and 27 patients (48%) had old prescribed medication at home. Forty-one new scripts, issued by general practitioners, should have contained 128 medications if the general practitioners wished to continue unchanged the medication given on hospital discharge. Fourteen drugs (11%) had been added and 17 drugs (13%) omitted. The number of prescriptions issued unchanged was 26/41 (63%). Inaccurately labelled containers and/or changed drug names were found in 28%. Contrary to hospital advice, 47% of medications were issued in childproof containers. Poor communication between hospital and general practitioners is only part of the problem. Methods to expedite the delivery of new prescriptions should be developed.

Call for child-proof containers for methadone

Call for child-proof containers for methadone

Toxic exposures and ingestions in Honolulu: I. A prospective pediatric ED cohort; II. A prospective poison center cohort

Poisonings and toxic exposures are a frequent cause of preventable morbidity in children requiring emergency care. Ingestions and toxic substance exposures were studied in two prospective cohorts in Hawaii to examine the epidemiology of these events in this community in order to assess the effectiveness of current poison prevention practices and to identify additional measures to further prevent and reduce morbidity and mortality. During a 12-month period ending on 11/30/88, data were collected on 286 pediatric patients visiting a pediatric ED with an ingestion or a toxic substance exposure. Most of the younger children were males with unintentional incidents. Most of the adolescents were females with intentional ingestions. Syrup of ipecac was given in 16% of the patients. When given at home, ipecac was given an average of 1.3 hours after an ingestion. Activated charcoal was given to 32% of the patients. During a 13-month period ending 1/31/90, 14,408 phone calls to the Hawaii Poison Center were analyzed. Twenty-six percent of the callers had ipecac at home. Sixty-eight percent of callers with acute ingestions claimed to have called within 30 minutes of the ingestion, and 77% claimed to have called within 60 minutes of the ingestion. Of those calling within 60 minutes, 36% had ipecac at home. Although ipecac is widely recommended as a pre-hospital intervention, it use is limited owing to unavailability in the home and the short period of time during which it must be given. Since the dispensing of pharmaceuticals in limited quantities and in childproof containers began, it appears that other measures to further reduce morbidity and mortality owing to poisonings have had less additional effect. It appears that serious morbidity and mortality from poisonings in this cohort were uncommon.