Research In Action

Research In Action

Child with bottle
Describing Fatal Poisonings Among Infants and Young Children
March 8, 2023

Fatal pediatric poisonings are a tragic yet preventable form of child mortality. To address this public health issue, the US Congress passed the Poison Prevention Packaging Act in 1970, which required child-resistant packaging for many medicines and hazardous products. This legislation led to a rapid and substantial reduction in poisoning deaths, especially among children younger than 5 years of age.

In recent decades, preventing further deaths in this age group has been challenging. Child resistant packaging is effective, but it does not protect children from all substances or root causes of exposure. Also, the factors contributing to fatal poisonings—such as age, substance, and environment—are multifaceted and complex. By better understanding them, we can develop targeted and more effective harm reduction interventions.

In a study I conducted with colleagues at the Center for Injury Research and Prevention and the Poison Control Center at CHOP published today in Pediatrics, we aimed to characterize the demographic and substance-related factors associated with fatal poisonings among children younger than age 5 using child death review data. Our study population was comprised of 731 fatalities from 40 states. Here are highlights of what we found:

Age Associations

  • Poisoning deaths involving the youngest age groups were common. Nearly 2 in 3 fatalities involved children under age 2.
  • For deaths with available circumstance data, 18% were determined to be deliberate. Among these, approximately 3 in 5 occurred among children younger than age 2.

Opioids and Over-the-Counter Medications

  • According to child death reviews, the most common substances contributing to death were opioids (n=346), followed by over-the-counter pain, cold, and allergy medications (n=108).

  • Approximately 3 in 5 fatalities involving opioids and nearly 3 in 4 involving over-the-counter medications occurred in children less than 2 years of age.

  • Opioids accounted for a progressively greater proportion of substances contributing to death over the study period—from 24% in 2005 to 52% in 2018. 

About 3 in 5 fatalities involving opioids occurred in children less than 2 years of age.

Physical and Social Environment

  • Among cases with available data, 80% of children were supervised at the time of incident; 32% were supervised by someone other than a biological parent.
  • A subset of fatal poisonings demonstrated factors associated with child maltreatment, including prior history of maltreatment, illness/disability, or sibling placement outside the home.

Preventing Harm from Poisonings

In our study, opioids were the most common substance contributing to fatal poisonings, highlighting how the opioid epidemic has not spared our nation’s youngest children. Several opportunities exist to address the dangers posed by opioids:

  • Educating caregivers and first responders on how to identify the signs of opioid intoxication
  • Improving the distribution and availability of naloxone throughout our communities
  • Supporting efforts to reduce unnecessary opioid prescribing and to improve treatment of substance use disorders, which can reduce the chance of a child being exposed to opioids in the home
  • Supporting the development of pediatric-specific opioid response initiatives

Many children were supervised at the time of a fatal poisoning, suggesting that supervision alone is not completely protective against harm. Clinicians can counsel families to take additional steps to keep their children safe with these tips:

  • Store medications and other substances out of reach, out of sight, and preferably locked
  • Discuss maintaining a safe home environment with the child’s other caregivers, family, and friends
  • Keep the Poison Help Hotline (1-800-222-1222) stored in family members’ phones for quick access in case of an emergency

For those seeking help with opioid misuse or addiction, the Substance Abuse and Mental Health Services Administration staffs a 24/7 national helpline at 1-800-662-HELP (4357). If you suspect that a child has been exposed to a toxic substance, immediately seek medical help, and call the CHOP Poison Control Hotline at 1-800-222-1222.

Watch A Video About the Findings