Question of the Week
November 8, 2011
Did you read the New York Times article about Poison Centers?
NEW YORK TIMES - November 7, 2011
Poison Centers Facing Greater Risks All Around
By PERRI KLASS, M.D.
As a medical student, I took care of a small child hospitalized for an aspirin overdose. During my residency, I tended to a toddler who took his grandfather’s cardiac pills, which touched off arrhythmias in his heart. From years of taking calls at night, I remember too many children who drank from a bottle of some household cleaning product hidden away under the sink.
These stories stick with me because they always begin with healthy, curious children who are simply looking, touching — and tasting — in order to learn about their world. It’s scary, and sad, when these early explorations turn hazardous, even fatal.
When a child swallows the wrong thing, pediatricians call the poison center. From the emergency room. From the clinic. In the middle of the night when frantic parents call to say, “We found our little boy playing with the bottle of windshield wiper fluid. We don’t know if any of it was in his mouth.”
But the network of poison centers is threatened by state and federal budget cuts. That could be bad news for both families and pediatricians: 51 percent of the more than two million calls the centers handled in 2010 involved children younger than 6.
And these childhood poisonings have changed over time, which we know from the data the poison centers collect from those calls. As prescription drugs become ever more common in American homes, children are being poisoned by an increasingly wide array of painkillers, stimulants, anticonvulsants, antipsychotics and antidepressants.
“We often see kids getting into a sibling’s medications, and sometimes parents get confused and give a medication meant for the older kid to the younger kid,” said Dr. Carl Baum, the director of the Center for Children’s Environmental Toxicology at Yale-New Haven Children’s Hospital.
Toxic ingestions by young children tend to peak during the toddler years (fully one-third of calls to poison centers concern 1- and 2-year-olds), for reasons familiar to parents: curiosity, increasing mobility and a complete lack of common sense. Poisonings rise again during the teenage years, as adolescents experiment with virtually any substance that can be sniffed or swallowed. In recent years, prescription drugs have ranked second only to marijuana as drugs of abuse among adolescents.
According to data compiled by Dr. Alvin C. Bronstein, the director of surveillance for the American Association of Poison Control Centers, and Dr. Daniel A. Spyker of Uniformed Services University of the Health Sciences in Bethesda, Md., three types of exposures have increased most significantly among children ages 10 to 19 during the last decade: ingestions of atypical antipsychotic drugs, up by 543 cases per year on average; ingestions of benzodiazepines (anti-anxiety drugs), which have risen by 328 cases per year; and ingestions of certain antiseizure medications, which have grown by 300 cases a year.
Among children up to age 5, exposures to all those medications are also on the rise, but there have been even larger increases involving nonprescription drugs, including ibuprofen and multivitamin tablets.
“What hasn’t changed is kids getting into pharmaceuticals and household things,” said Dr. Timothy Erickson, a professor of emergency medicine and medical toxicology at the University of Illinois at Chicago. “Now they’re getting into more dangerous prescription drugs.”
The drugs may have changed, but the prevention strategies still emphasize the importance of keeping the medications away from children. The great reform in preventing pediatric poisoning was child-resistant packaging, which was instituted at the beginning of the 1970s — along with an expansion of poison control centers, established to provide expertise both to parents and to doctors.
With the proliferation of pharmaceutical products, the centers are more important than ever. When you call (800) 222-1222, your call is routed to a poison control center for your area, where a specialist will talk you through what to do about pretty much anything that a person might swallow, inhale or otherwise encounter.
The information from that call goes into the National Poison Data System, the huge database, directed by Dr. Bronstein, that provides a kind of real-time look at who is being exposed to what, allowing rapid recognition of problems — a kind of early warning system for toxic exposures.
“A new product comes on the market, and about six weeks later, poison centers start to get calls from parents and caretakers,” said Dr. Alan Woolf, the director of environmental medicine at Children’s Hospital Boston. “You start to get sentinel cases.”
With an increasingly complex array of drugs found in many medicine cabinets, parents need to be reminded all over again about the importance of keeping medications away from the curious explorations of young children and the less innocent experimentation of adolescents.
The poison center system provides the medical expertise to answer new questions as they arise and tracks exposures at the most local level, Dr. Baum said. The local experts often are the only ones who can identify which drugs are sold on the street in a particular town, or which emergency rooms can handle an unusual ingestion.
In the event of certain kinds of terrorist attacks, Dr. Woolf pointed out, “it’s not a stretch to consider it part of the first response.”
Not long after 9/11, I saw an adolescent with an alarming facial rash and wondered about cutaneous anthrax. I called the local poison center, which told me that someone had been selling a homemade acne remedy door to door in the community and that it was causing dramatic lesions.
I asked my patient, and sure enough, she had bought some and applied it.
This question prepared by: Donna Seger, MD Medical Toxicologist