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Reporting a Medication Error

How children frequently get into medicines:  Child-resistant caps that are not childproof, accessible medicines, and climbing

Educational campaigns to keep medicines up and away and out of sight of young children (www.upandaway.org) are widespread. These campaigns, along with packaging changes for some medicines, are making an impact in reducing the number of childhood medicine poisonings. But even today, far too many young children are getting into medicine containers when their parents or caregivers are not looking. US poison control centers receive about 49 calls per hour about medicine poisonings in young children. Every 9 minutes, a young child goes to the emergency department (ED) because they got into a medicine container and took the medicine. Sadly, every hour, a young child is hospitalized because of a medicine poisoning, and every 12 days, a young child dies from the poisoning. So how are young children most often getting into medicines?

Reason 1: Child-resistant caps are not childproof

Child-resistant caps do not fully prevent a child from opening the medicine—they are NOT childproof. Many young children are able to open child-resistant medicine containers. The Poison Prevention Act from the 1970s requires companies to package medicines in a way that makes it more difficult for a young child to open. So, many over-the-counter (OTC) and prescription medicines are sold with a child-resistant cap. In 2018, about half of more than 2,000 parents who were surveyed thought that “child-resistant” meant a child would not be able to get into the medicine container at all. While child-resistant caps have prevented many childhood medicine poisonings, about half of all accidental medicine poisonings involve children getting into medicines with a child-resistant cap.

Child-resistant caps must be child-resistant but also be able to be opened by older adults and people with trouble using their hands. Therefore, companies cannot make it so hard to open medicines for kids that older adults cannot open the containers either. To be considered child-resistant, 85% of tested children under 5 years of age must not be able to open the medicine bottle within 5 minutes. This means that 15% of the young children can open the medicine bottle. In fact, in a test set up by Safe Kids Worldwide, several children between the ages of 3 and 5 were able to open medicine bottles with a child-resistant cap in a few seconds. And if a child has the medicine bottle longer than 10 minutes, they probably will be able to open it. Add to this the fact that children watch other kids or adults opening the caps and quickly learn from them. Sadly, there are numerous tragic cases of young children dying or becoming seriously ill after taking medicine from bottles with child-resistant caps that they were able to open:

· A 5-year-old child died after taking some of his father’s prescription diabetes medicine that was in a bottle with a child-resistant cap.

· A 15-month-old child died after drinking a bottle of her heart medicine, Tambocor (flecainide). Since birth, the child's parents had given her three doses each day to slow her racing heart. The parents were visiting a friend. The medicine was in a diaper bag on the floor. The mother went into the kitchen to get a bottle of milk. In a matter of minutes, the child was able to open the bottle and drink all of the medicine. An overdose of what was once a lifesaving medicine killed the child.

· Twin 3-year-olds climbed onto a kitchen counter and found a prescription medicine bottle with a child-resistant cap stored in a high cabinet. They were able to open the bottle and take the medicine, which made them feel sick. The twins’ mother found the opened medicine bottle and took both children to the hospital. Unfortunately, one of the twins died.

· A 20-month-old child climbed up on a dresser and found her older sister’s medicine for treating attention-deficit/hyperactivity disorder (ADHD). She opened the bottle despite a child-resistant cap and began eating the tablets. Her father found her with the open bottle. She was taken to the hospital in critical condition, but thankfully she recovered.

Reason 2: Accessible medicines in pill boxes or left out between doses

Seniors and other adults taking several medicines each day may sidestep child-resistant caps by using pill boxes that have a slot for each day’s medicines. Unfortunately, the presence of a pill box in the home almost doubles the risk of an accidental childhood medicine poisoning. But even in homes where medicines are normally stored safely, children can quickly get into medicines left out between doses. Parents whose child has been taken to an emergency department (ED) due to an accidental medicine poisoning often say that they only turned their back on the child for a minute—it happens that fast!

Reason 3: Children are climbers

Keeping medicines “up high” may not be enough by itself. Children are curious about their world and will find ways to explore it, even if it requires climbing up high as seen in two of the examples above. In fact, about half of all childhood medicine poisonings in the US involve a child climbing on a chair, toy, or other object to reach the medicine.

You cannot only rely on storing medicines up high and using child-resistant caps to protect your children. Also, it is just not possible to watch children every second. So, other strategies need to be put in place to prevent children from gaining access to medicines.

Check it out!

Protect children from accidental poisonings with medicines by doing the following:

· Buy safety packaging. Buy medicines and vitamins with child-resistant caps or packaging. Replace caps tightly after each use. But remember, child-resistant does NOT mean childproof. Given enough time, children may be able to open the container.

· Keep medicines out of reach. Young children investigate their world by putting most things in their mouths. So store all medicines (including those not in child-resistant containers, such as eye drops, medicine patches, ointments, etc.) in their original containers in a high locked closet or cabinet (not in the bathroom), where children cannot see or reach them.

· Do not forget vitamins. Vitamins are medicines, too. In fact, vitamins with iron can be especially poisonous to children, so be sure to securely store them as well.

· Secure purses. Keep purses, diaper bags, visitors’ bags, and coat pockets (which may contain medicines) up high and out of the reach of children. Be aware of medicines that visitors may bring into your home. Children are curious and may investigate visitors’ bags, purses, coats, and suitcases. Ask your visitors, friends, or family to put any medicines they bring into your house out of the reach and sight of children. And when you visit others, do the same.

· Avoid taking medicine in front of children. Do not open child-resistant caps or take medicines around children. Also, do not give a child medicine while another child is watching. Young children learn by imitating adults.

· Never call medicine candy. Medicines and candy can look alike and children cannot tell the difference. They may eat or drink anything no matter how bad it tastes.

· Alert babysitters. Many poisonings occur when the daily routine has been disrupted. Alert your babysitter to this risk and what to do to prevent medicine poisonings.

· Take the medicine with you. If you are in the process of taking or giving medicine, take it with you to answer the door or phone. Never leave it on the table or counter.

· Put medicines safely away after use. Put medicines up and away and out of reach and sight immediately after every use, even if you need to give another dose in a few hours. Close medicine caps tightly after every use, but remember, child-resistant does NOT mean childproof. If you use pill boxes, be even more cautious about storing them safely.

· Teach children. Frequently remind children to never take medicine unless an adult gives it to them. Also teach them that poisons often look like food (or candy) or drink. Thus, they should ask an adult before eating or drinking anything out of the ordinary.

· Safely dispose of medicines. Regularly clean out your medicine cabinet. Discard old medicines by taking them to a drug take back location (www.ismp.org/ext/800). If there is not a location near you, mix the medicine with an undesirable substance such as used coffee grounds, dirt, or cat litter, in a sealable plastic bag. Then place the sealed bag in your trash. Some medicines can safely be flushed down the toilet. For complete instructions on disposing unused medicines, go to: www.ismp.org/ext/256.

· Call the Poison Help line right away. Program the Poison Help line number (1-800-222-1222) into your cell phone and keep it near your house phone. Make sure babysitters, older siblings, and grandparents have it, too. If you suspect or know your child has taken a medicine, call immediately. Do not give the child anything to eat or drink, or make the child vomit unless told to do so.

· Watch for repeat poisonings. Children who have already taken medicine on their own are more likely to try it again.

Resource: MacKay JM, Samuel E. Safe Medicine Storage: Recent Trends and Insights for Health Educators. Washington D.C.: Safe Kids Worldwide, March 2018. www.ismp.org/ext/844. Accessed February 1, 2022.

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