October 25, 2001
While poisonings of young children decline, teen self-inflicted cases increase
A significant number of teenagers continue to be admitted to hospitals for poisoning from inappropriate use of medications, or, for children younger than 12, for the ingestion of non-medications, according to an article bu UW researchers in the October issue of the Archives of Pediatrics & Adolescent Medicine.
Dr. France Gauvin, based at Children’s Hospital and Regional Medical Center, and colleagues reviewed a comprehensive database of hospital discharges in Washington state from 1987 to 1997 to determine the changes in the incidence of hospitalization due to poisoning among children younger than 19 years.
The researchers found that there were 7,322 hospitalizations (45 per 100,000 children per year) during the 11-year study period. There was a decline from 56 admissions per 100,000 children in 1987 – 1989 to 40 children per 100,000 in 1994 – 1997.
The type of intoxicant or poison did not change substantially over time. Pharmaceuticals including analgesics (34 percent), antidepressants (12 percent) and psychotropic drugs (8 percent) were involved in 80 percent of the cases. Nonpharmaceutical agents such as alcohol (6 percent), “street” drugs (4 percent), cleaning solutions (3 percent) and fumes (3 percent) were ingested by 22 percent of the children.
The children who were poisoned by agents other than pharmaceuticals were more likely to be younger than 12. More than half (65 percent) of the patients were female; 75 percent were teenagers and pharmaceutical agents were more frequently involved in their poisonings. Nearly half (47 percent) of the children were hospitalized for self-inflicted intoxication.
Mortality was low (0.2 percent). Self-inflicted poisonings were associated with higher costs, length of stay and readmissions.
According to background material in the article, poisonings among young children are declining. In 1950, there were 834 deaths in children younger than 5, compared to less than 50 in 1997. In 1997, 66 U.S. poison centers reported 2,192,088 human exposure cases. Two-thirds of those cases involved people younger than 20.
“The U.S. Childhood Intoxication Prevention Packaging Act of 1972 increased the safety of medications and home products, and significant declines in emergency department visits for intoxication and in the mortality rate were observed,” the authors comment.
“Prevention efforts should be continued to further decrease intoxication-related hospitalizations and deaths. Prevention should include parental education about not transferring medications or household products from their original containers and use of child-resistant containers. Use of a locked cabinet even when children are older and education of grandparents is also important.
“Because female teenagers continue as the highest risk group for a suicide attempt by ingestion of pharmacologic agents, prevention efforts should be targeted to this population. The incidence of self-inflicted intoxications did not decline in the last eight years of our study. Self-inflicted intoxications were associated with the highest costs (hospital charges), length of stay, and number of readmissions among children with poisonings that required hospitalization in Washington. Suicide prevention in teenagers is essential but difficult to realize. Implication of teachers, parents and physicians should be emphasized,” conclude the researchers.
