PROBLEM
For many, the holidays will include joyous gatherings. However, holiday cheer will quickly fade if a child gets into unsecured medications and requires a trip to the emergency department (ED). This was the case for the family of a 2-year-old child who took 2 to 4 tablets of her grandmother’s amlodipine, which is used to treat high blood pressure and chest pain.1 Initially, the child did not appear to have any symptoms. When she became very drowsy about 45 minutes later, however, the family rushed her to the hospital, but it was too late. Her blood pressure was dangerously low, and despite life-saving efforts, her heart rate kept dropping and she died.

In the United States, approximately 60,000 children are taken to the ED each year because of unsupervised medication exposures.2 According to a national poll conducted in 2012, nearly all parents (97%) with young children and grandparents (98%) have medications in their homes.3 Often, these medications are stored in a way that allows easy access to children. For example, medications may be stored in easy-to-open containers, such as a pillbox. In fact, nearly 1 in 4 grandparents admits storing their prescription and OTC medications in places or containers that young children can easily access.

Family members and friends also may bring medications into the home when visiting. They may put a few doses of a medication in their purse, suitcase, or a container that is not child-resistant. They may even leave a pill or 2 out on the counter, ready to be taken. This is what happened to one family. The parents of a 3-year-old child spent the holiday in an ED after their child took an antiepileptic agent that was left on the sink by an older cousin with epilepsy.4 After a gastric lavage, the child was discharged from the ED.

SAFE PRACTICE RECOMMENDATIONS
Engage patients in discussions about safe storage of medications, including those brought into the home by guests. Important strategies to discuss with patients, parents, and caregivers include the following:
  • Keep all medications in a secure cabinet, locked if possible, up and away from the reach or view of children. Never leave medications on counters or tables (including children’s vitamins or iron supplements), even if they are in containers with child-resistant caps.
  • Avoid keeping medications in purses, backpacks, suitcases, or other places where children may explore, or in pockets where the medication can fall out.
  • Use child-resistant caps on containers and be sure they are closed properly after use.
  • With oral liquid medications, never leave a syringe bottle adaptor in place if it prevents the ability to secure the child-resistant cap.
  • When children visit other homes or when family or friends visit, look out for potential poisoning dangers and intervene before an accident happens. Discuss medication access and safety with hosts or guests.
  • Educate children about medications. Never tell children that medications are candy. Teach them that they should only take medication (or eat candy) when an adult has given them permission.
  • If a child is exhibiting any symptoms or acting strangely for any reason, do not wait. Keep the possibility of a poisoning in mind and seek help immediately.
  • Contact the Poison Help number (1-800-222- 1222) immediately if you think an accidental poisoning has occurred. Encourage your patients to program this number into their cell phones so they have ready access in the event of an emergency.
  • Visit upandaway.org to learn more ways to keep children safe from accidental medication poisonings.

Dr. Gaunt is a medication safety analyst and the editor of ISMP Medication Safety Alert! Community/Ambulatory Care Edition.

References
  1. Long D. 7 drugs that can kill kids in a single pill. ABC Medical Unit, ABC News website. abcnews.go.com/Health/Wellness/accidental-ingestion-common-pills-kill-toddlers/story?id=10130146. Published March 18, 2010. Accessed September 6, 2016.
  2. Lovegrove MC, Weidle NJ, Budnitz DS. Trends in emergency department visits for unsupervised pediatric medication exposures, 2004-2013. Pediatrics. 2015;136(4):e821-e829. doi: 10.1542/peds.2015-2092.
  3. University of Michigan C. S. Mott Children’s Hospital. Easy-access medications a poisoning risk for kids at home. National Poll on Children’s Health. 2012;15(2):1-2.
  4. McTernan S. Home medication safety during the holidays with children. Visiting Nurse Service of New York. December 15, 2011.