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Investigators from the Children’s Hospital of Philadelphia, Philadelphia, PA, conducted a retrospective study to describe poisoning deaths in children ≤5 years old. For the study, they reviewed data in US National Center for Fatality Review and Prevention which maintains the National Fatality Review-Case Reporting System (NFR-CRS), a passive surveillance system that collects data from local child death review (CDR) committees in the US. A standard tool is used by the CDRs to report on fatalities in children that have been reviewed. Data on children ≤5 years old with deaths attributed to “poisoning, overdose, or acute intoxication,” that occurred between 2005 and 2018, were analyzed for the study. Information on cases including age, circumstances surrounding the poisoning, including presence of supervision, supervision demographics, history of referral to child protection services (CPS), and/or documented history of maltreatment, and substances contributing to the poisoning death, were abstracted. Categories of contributing substances included opioids, over-the-counter (OTC) pain, cold, or allergy medications, and other illicit drugs; multiple substances could be associated with a single fatality. Study data were analyzed using descriptive statistics. For most analyses, data were missing on a proportion of cases.
A total of 731 children ≤5 years old with deaths attributed to poisoning were reported to the NFR-CRS during the study period. The mean age of these children was 1.3 years, with 42.1% being <1 year old at the time of death. The most common substance contributing to poisoning deaths was opioids (47.3%), followed by OTC pain, cold, or allergy medication (14.8%), and other illicit drugs (14.2%). The percentage of poisoning deaths associated with opioids increased from 24.1% in 2005 to 52.2% in 2018. Data on the circumstances of the poisoning were documented in 72.6% of cases. Of these, 40.7% were classified as accidental overdoses, 17.9% were deliberate, and 41.4% were from other causes (eg, adverse effect). Among those with available data (481 of 731 children), a history of maltreatment was documented in 31.8%. Information on CPS referrals was available on 581 children; of these, 16.7% had an open case at the time of death. Supervision data was documented in 87.3% of cases. In 32.2% of cases (203 of 631) the supervisor was someone other than the biological parent. For 11.9% of deaths, the child was determined to be unsupervised but needing supervision.
The authors conclude that opioids were the most common substance contributing to fatal poisonings in young children.
Dr Doolittle has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.
Pediatric fatalities from overdoses are tragic and potentially preventable. After the Poison Packaging Act of 1970, which mandated child-resistant packaging, fatalities from unintentional poisoning fell greatly.1 However, within the past decade, fatality rates...
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