To the Editor:
We thank Dr. Bryant et al. for sharing recent local poison center data on hospitalizations for unsupervised pediatric exposures,1 which provide further support for targeting pediatric poisoning prevention messages to grandparents2 and emphasizing the risk of pediatric medication ingestions when using pill organizers in the presence of young children.3
Focusing on exposures requiring hospitalization (i.e., those potentially most serious), Bryant and colleagues found that when grandparents were involved, a higher percentage of cases involved medications accessed from pill organizers or involved antihypertensive medications, compared with exposures without grandparent involvement. The proportion of cases involving ICU admission was also higher for pediatric exposures with grandparent involvement, although it is unclear if the reported differences were statistically significant.
The findings reported by Bryant et al. are important and suggest the need for additional studies to further investigate how medication use and storage practices of grandparents contribute to pediatric exposures with severe outcomes. Additional information on why medications are removed from original packaging, why medications are transferred to other containers, and how those containers are stored could help identify innovative interventions that promote both improved medication adherence among adults and improved child safety.
Grandparents’ medications and pill organizers are only part of the problem of unsupervised pediatric exposures. Bryant et al. provide additional evidence that it may be necessary to raise awareness among grandparents that most pill organizers are not child resistant and can be easily opened by young children, but parents and other caregivers should be reminded as well. Targeted messaging could encourage caregivers of young children to keep medicines in child-resistant containers, fully secure child-resistant closures, and keep all medications (including those in purses, pockets, bags, or pill organizers) up and away and out of the sight and reach of young children.4
Funding/Support:
This work was supported by Centers for Disease Control and Prevention award number 2016-N-17812 to Emory University.
Footnotes
Financial Disclosures: The authors have no financial relationships relevant to this article to disclose.
Disclaimer: The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.
Conflict of Interest Disclosures: The authors have no conflicts of interest relevant to this article to disclose.
References:
- 1.Bryant. et al. submitted letter [Google Scholar]
- 2.Wezorek C, Dean B, Krenzelok E. Accidental childhood poisoning: influence of the type of caretaker on etiology and risk. Vet Hum Toxicol. 1988;30(6):574–576. [PubMed] [Google Scholar]
- 3.Agarwal M, Lovegrove MC, Geller RJ, et al. Circumstances Involved in Unsupervised Solid Dose Medication Exposures among Young Children [published online ahead of print, 2020 Jan 28]. J Pediatr. 2020;S0022-3476(19)31706-8. doi: 10.1016/j.jpeds.2019.12.027. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 4.UpAndAway.org. Put your medicines up and away and out of sight. Available at: www.upandaway.org. Accessed March 9, 2020