Ingestion of Over-the-Counter Liquid Medications: Emergency Department Visits by Children Aged Less Than 6 Years, 2012–2015

Abstract

Introduction: Unintentional medication ingestions by young children lead to nearly 60,000 emergency department (ED) visits annually; 15% involve oral liquid medications. Safety packaging improvements have been shown to limit liquid medication ingestions. Estimated rates of ED visits for pediatric ingestions by product were calculated to help target interventions. Methods: Frequencies and rates of ED visits for unintentional pediatric ingestions were estimated using adverse event data from the National Electronic Injury Surveillance System-Cooperative Adverse Drug Event Surveillance project and retail sales/pharmacy dispensing data from Information Resources, Inc. and QuintilesIMS (collected 2012-2015; analyzed 2017). Rates of ED visits for ingestions of over-the-counter (OTC) liquid medications were compared with those for prescription solid medications. Results: Based on 568 cases, an estimated 6,427 ED visits (95% confidence interval: 4,907-7,948) were made annually after a child <6 years accessed one of the four most commonly implicated OTC liquid medications without caregiver oversight. Nearly two-thirds (63.8%) of these visits were made by children aged ≤2 years and 9.0% resulted in hospitalization. Acetaminophen was the most commonly implicated OTC liquid medication (2,515 estimated ED visits annually). Rates of ED visits for liquid diphenhydramine and acetaminophen ingestions (8.1 and 7.4 ED visits per 100,000 bottles sold) were higher than rates for other common OTC liquids and comparable to high rate prescription solid medications (clonidine and buprenorphine/naloxone [11.1 and 10.5 ED visits per 100,000 dispensed prescriptions]). Conclusions: Product-specific rates of ED visits for unintentional ingestions can help prioritize preventive interventions, such as enhancing safety packaging with flow restrictors.

Adverse Events Related to Accidental Unintentional Ingestions From Cough and Cold Medications in Children

“…Liquid medications were the most common formulations involved in AUIs leading to significant AEs. Lovegrove et al 12 reported similar characteristics when describing OTC medication ingestions in children reported to the National Electronic Injury Surveillance System. In more than 6000 emergency department visits for children younger than 6 years from an unintentional ingestion of an OTC medication, liquid formulations had greater emergency department visit rates than solid formulations.…”

“…In more than 6000 emergency department visits for children younger than 6 years from an unintentional ingestion of an OTC medication, liquid formulations had greater emergency department visit rates than solid formulations. 12 Engineering controls, such as flow restrictors, are designed to limit the amount of liquid medication dispensed from a bottle. An initial study evaluating the effectiveness of flow restrictors demonstrated that these devices limit the accessibility of medication content to young children.…”

The difficulties experienced during the preparation and administration of oral drugs by parents at home: a cross-sectional study from Palestine

“…Failure to implement these conditions could cause adverse events [6]. Nonprescription or over-the-counter (OTC) drugs have also become excessively widespread in recent years, and have become major issues in children's health [7][8][9][10]. Lack of parental education and poor counselling or pharmacists' inadequate knowledge and confidence make incorrect administration and drug errors more common in developing countries, because outpatient clinics are very crowded and parents or caregivers are not well educated about health [11,12].…”

The difficulties experienced during the preparation and administration of oral drugs by parents at home: a cross-sectional study from Palestine

“…Failure to implement these conditions could cause adverse events. Non-prescription or over-the-counter (OTC) drugs have also become excessively widespread in recent years, and have become major issues in children's health [1][2][3][4]. Low educational levels and the health culture, make incorrect administration and drug errors more common in developing countries, because outpatient clinics are very crowded and parents or caregivers are not well educated about health [5].…”