A study by researchers at the Children’s Hospital of Philadelphia (CHOP) found that opioids were responsible for more than half of all fatal poisonings in children under 5, a number that has more than doubled since 2005. The study also highlights that over-the-counter drugs still contribute to fatal poisonings in this age group despite increased regulation. Researchers highlight the need for improved intervention to prevent further fatal poisonings.
Researchers find rate of fatal opioid poisonings in children more than doubled over 13 years
Over-the-counter drugs also continue to pose life-threatening risks to young children despite measures to reduce exposure.
Researchers at the Children’s Hospital of Philadelphia (CHOP) found that opioids were responsible for more than half of all fatal poisonings in children ages 5 and under, more than double the proportion of fatal poisonings caused by opioids in 2005. Additionally, over-the-counter medications continue to contribute to fatal poisonings in this age group despite increased regulation. The results, published today in the journal Pediatricshighlight the need for better intervention to prevent further fatal poisonings.
More than half of all reported poisonings occur in children 5 and under and have the highest rate of emergency room visits for unintentional drug-related poisonings. While child-resistant packaging for many drugs and hazardous products has dramatically reduced the number of fatal unintentional poisonings in young children, the growing opioid epidemic in the United States has contributed to recent deaths from poisoning of children.
Studying fatal poisonings in young children in the United States on a large scale has been a challenge for researchers. Every state conducts child death reviews, which look at how and why these deaths occur and what steps can be taken to prevent them. Pediatric death reviews are conducted by teams that often take a multidisciplinary approach when reviewing pediatric deaths. The National Center for Fatality Review and Prevention provides resources for these child death reviews and maintains a reporting system that collects data from these committees.
Opioids are a class of drugs commonly used to treat pain. They work by binding to specific receptors in the brain and spinal cord to reduce pain sensation. Opioids may be prescribed by doctors for short-term pain management after surgery or injury, or for chronic painful conditions like cancer or arthritis. However, they can also be very addictive and abused. Commonly used opioids include prescription painkillers like oxycodone and hydrocodone, as well as illegal drugs like heroin. Abuse of opioids can lead to a series of negative health effects, including respiratory depression, overdose, and death.
“By comprehensively assessing fatal poisonings in children at the national level, we were able to better understand the magnitude of this tragic and preventable public health problem,” said study first author Christopher Gaw, MD. pediatric emergency medicine researcher at the Poison Control Center. and CHOP’s Center for Injury Prevention and Research. “We were also able to specifically characterize the proportion of poisoning deaths that could be attributed to opioids each year.”
The study team used data from 40 states participating in the National Fatality Review-Case Reporting System on deaths attributed to poisonings in children age 5 and younger between 2005 and 2018. During that time, 731 deaths linked to poisoning have been reported by reviews of child deaths.
The researchers found that more than two-fifths of these poisoning deaths occurred in children 1 year old or younger, and more than 65% of these deaths occurred at home. Nearly one-third of children who died from poisoning were cared for by someone other than a biological parent. Opioids were the most common substance contributing to death, followed by over-the-counter pain, cold and allergy medications. In 2005, opioids contributed to 24.1% of deaths, but this proportion increased to 52.2% in 2018.
The authors noted that while initiatives focused on reducing opioid prescribing resulted in a transient reduction in these deaths in the early 2010s, over the past decade new sources of opioids, including heroin and synthetic opioids such as
“It is clear from these findings that preventing fatal pediatric poisonings requires a multi-faceted approach involving caregiver education and community-level interventions,” said study lead author Daniel J. Corwin, MD.MSCE, attending physician and associate director of research in CHOP’s Division of Emergency Medicine. “One such intervention is to improve the availability of naloxone to the public, which can rapidly reverse an opioid overdose and is safe and effective for use in children.”
Reference: “Characteristics of Fatal Poisonings in Infants and Young Children in the United States” by Christopher E. Gaw, MD, MBE; Allison E. Curry, Ph.D., MPH; Kevin C. Osterhoudt, MD, MSCE; Joanne N. Wood, MD, MSHP and Daniel J. Corwin, MD, MSCE, March 8, 2023, Pediatrics.
DOI: 10.1542/peds.2022-059016