September 14, 2010

Emergency Department Visits Involving Accidental Ingestion of Drugs by Children Aged 5 or Younger

As soon as infants learn to crawl and especially once they learn to walk, their mobility, curiosity, and tendency to put things in their mouths make many substances in the home a potential danger.¹ While caretakers may be alert to securing obviously dangerous substances such as cleaning products and chemicals, they may be less aware of the danger of leaving pharmaceutical products belonging to parents or other family members in accessible places. This can pose a serious threat of accidental ingestion by infants and toddlers.^2,3

The Drug Abuse Warning Network (DAWN) is a public health surveillance system that monitors drug-related emergency department (ED) visits in the United States. Data are collected from a nationally representative sample of short-term, general, non-Federal hospitals across the Nation. Specialty hospitals, including children's hospitals, are not included in the DAWN sample. To be a DAWN case, the ED visit must have involved a drug, either as the direct cause of the visit or as a contributing factor. DAWN includes drug-related ED visits involving the accidental ingestion of pharmaceuticals and other types of medications (hereafter referred to as "drugs"). This issue of The DAWN Report focuses on ED visits involving accidental drug ingestion among children aged 5 or younger.

In 2008, there were an estimated 100,340 ED visits involving accidental ingestion of drugs, primarily pharmaceuticals. Of these, 69,121 (68.9 percent) were made by patients aged 5 or younger.⁴ Two fifths (42.3 percent) of these ED visits were made by patients aged 2 years old, and 29.5 percent were made by patients aged 1 year old (Figure 1). Males accounted for slightly more than half (55.7 percent) of these ED visits.

Figure 1. Emergency Department (ED) Visits for Accidental Drug Ingestion among Children Aged 5 or Younger, by Age: 2008

Pharmaceuticals were involved in 99.0 percent of the ED visits involving accidental ingestion of drugs among patients aged 5 or younger; alcohol or illicit drugs were involved in 1.0 percent of visits. Drugs that act on the central nervous system (CNS drugs), such as acetaminophen products, ibuprofen products, and benzodiazepines, were involved in 40.8 percent of the ED visits involving accidental ingestion of drugs among patients aged 5 or younger, with the largest percentages coming from pain relievers (21.1 percent) and drugs used to treat anxiety and insomnia (11.6 percent) (Table 1).

Nearly 1 in 6 visits (15.7 percent) involved cardiovascular system medications, and 1 in 10 visits (10.3 percent) involved respiratory system medications. Psychotherapeutic drugs (i.e., antidepressants and antipsychotics) and topical medications each accounted for 8.6 percent of visits, and drugs for metabolic disorders were involved in 5.0 percent of the visits.

For children aged 5 or younger taken to the ED for accidental ingestion of drugs, 85.3 percent were treated and released, whereas 8.7 percent were admitted for inpatient care (Figure 2). Of these, approximately 20 percent were admitted into the intensive or critical care unit. For the patients that were admitted, nearly two fifths (37.3 percent) of the visits involved cardiovascular system medications, while 29.7 percent involved drugs for metabolic disorders, 26.6 percent involved CNS drugs, and 12.3 percent involved psychotherapeutic drugs (Figure 3). Of the patients who were not treated and released or admitted to the hospital (5.9 percent), most (84.1 percent) were transferred to another health care facility.

Figure 2. Disposition of Emergency Department (ED) Visits for Accidental Ingestion among Children Aged 5 or Younger: 2008

Figure 3. Selected Drugs Involved in Emergency Department (ED) Visits for Accidental Ingestion among Children Aged 5 or Younger That Resulted in Inpatient Care: 2008*

Accidental ingestion of drugs by young children is a public health problem affecting thousands of children and families each year. Not only did the number of ED visits from accidental drug ingestion exceed 100,000 in 2008, but almost 7 in 10 (68.9 percent) of the ED visits were for children aged 5 or younger. Further, these ED visits involved a wide variety of drugs, indicating the ability of young children to access and ingest these medications. These findings show a critical need for increased education and awareness among caregivers about the danger of accidental ingestion of drugs, the importance of storing drugs in secure locations, and methods for appropriate disposal of leftover or expired drugs. Education and awareness campaigns should target temporary caregivers (e.g., babysitters) and visitors to the home (e.g., grandparents) as well as immediate family members.

This page was last updated on July 13, 2010.