posted on 5:16 AM, June 25, 2014
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BY NEIL OSTERWEIL
Elsevier Global Medical News
BOSTON (EGMN) – Alcohol and illicit drugs account for about one in eight accidental drug poisonings of
infants and toddlers in the United States, according to prospective registry data from 31 U.S. toxicology
A review of confirmed poisoning cases from these centers showed that cardiac drugs accounted for 16% of
poisonings of children under 2 years of age, followed by psychotropic drugs (15%), and recreational drugs
and alcohol (13%), reported Dr. Yaron Finkelstein, a pediatric emergency medicine physician at the
University of Toronto.
“Infant and toddler poisonings pose a unique public health concern. They involve among the most helpless
and vulnerable populations in our society, partly because of their inability to protect themselves from
environmental hazards, or communicate the circumstances of their injury,” Dr. Finkelstein said.
Emergency department visits by children aged 5 years and under for poisoning in the United States rose
30% from 2001 to 2008, suggesting that better prevention methods and better data on the extent of the
problem are needed, he said at the annual meeting of the Pediatric Academic Societies.
However, the National Poison Data System (NPDS), run by the American Association of Poison Control
Centers, relies largely on voluntary information, and reported poisonings are not verified.
“The NPDS system probably underestimates the true magnitude of the problems, since less than 20% of
poisoned children who actually present to the emergency department have contacted the regional poison
control center,” he said.
To get a clearer picture of accidental poisonings in children under 2 years, Dr. Finkelstein and his
colleagues reviewed data from the Toxicology Investigators Consortium (ToxIC) Case Registry of the
American College of Medical Toxicology (ACMT), a prospective, nationwide toxicology database with 31
U.S. registry sites.
They identified a total of 6,810 poisoning cases from April 2010 through June 2011, 248 (3.6%) of which
involved children under age 2 years. The cases were all confirmed by a certified medical toxicologist at
Of these children, 51% were boys, and 63% were symptomatic at the time of consultation. Slightly more
than half of the consultations (54%) occurred when the child was being admitted to the hospital, 42%
occurred in the emergency department, and 4% took place in an outpatient setting.
The top seven exposures according to the ToxIC registry were to cardiac drugs , psychotropic agents,
street drugs/alcohol, analgesics (9%), cleaning products (6.5%), scorpion stings (4.5%), and toxic alkaloids
In contrast, NPDS data for the same categories implicate, in descending order from most to least frequent,
analgesics, cleaning products, psychotropics, alkaloids, cardiac drugs, street drugs, and scorpion stings,
Dr. Finkelstein said.
He noted that because the ToxIC registry is a sentinel system based primarily in academic tertiary care
centers, it may not be representative of the experience in community or primary care practice settings, but
the ToxIC and NPDS registry data complement each other to provide effective realtime
poisonings in the United States.
The finding that one in eight children presenting with poisoning had been exposed to alcohol or illicit drugs
“highlights again the issues of unsafe environment, child neglect, or maltreatment. Additionally, malicious
intent should be considered, especially in firstyearoflife
exposures,” he concluded.
The study was supported by the Toxicology Investigators Consortium. Dr. Finkelstein reported having no
relevant financial disclosures.
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