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Perspectives in Disease Prevention and Health Promotion Update: Childhood Poisonings -- United States

Deaths from unintentional ingestion of potentially poisonous substances among children under 5 years of age have decreased from a high of 456 in 1959 to a low of 57 in 1981 (1,2). Mortality data, however, underestimate the magnitude and public health impact of the childhood poisoning problem (Table 1). Data from the National Hospital Discharge Survey (NHDS), conducted by the National Center for Health Statistics (NCHS), show that, for each year between 1979 and 1982, an estimated 20,000 children under 5 years of age were hospitalized in the United States for ingestion of potentially toxic substances. Therefore, for each child death from unintentional poisoning, approximately 300 children were hospitalized. Medicinal substances accounted for 45% of the hospitalizations, and nonmedicinal substances accounted for the remainder. Of the medicinals, aspirin and other analgesics accounted for the most hospitalizations (11.8%). Of the nonmedicinals, products containing lead accounted for an additional 11.7% of hospitalizations.

The number of children hospitalized for unintentional ingestions also underestimates the public health impact of childhood poisonings. The U.S. Consumer Product Safety Commission (CPSC) estimates from its National Electronic Injury Surveillance System (NEISS) that, in 1983, over 110,000 children under 5 years of age were treated in hospital emergency rooms for ingesting potentially toxic substances (3). Thus, for each child hospitalized for unintentional poisoning, an estimated six to eight children are treated in emergency rooms and released. The American Association of Poison Control Centers estimates from poison-control reports about 1.4 million childhood poison exposures in 1983; 91% of these occurred in the home (4). For each child treated in an emergency room for poisoning, about 13 other poison exposures to children are reported to poison-control centers. It is unlikely that even these high figures reflect all poisonings. Many poisonings are not reported to poison-control centers because they are either treated in a physician's office or not treated at all. Reported by Southeastern Regional Office, US Consumer Product Safety Commission, Atlanta, Georgia; Chronic Diseases Div, Center for Environmental Health, CDC.

Editorial Note

Editorial Note: March 17-23, 1985, marks the 24th annual Poison Prevention Week. It is sponsored by the Poison Prevention Week Council (PPWC), a coalition of 31 national organizations representing industry, consumer groups, health professionals, government, and the media. Its purpose is to reduce unintentional poisoning among children by alerting Americans to this preventable problem.

The Poison Prevention Packaging Act (PPPA) of 1970 requires that certain potentially hazardous drugs and household products be sold in child-resistant containers. Currently, 15 product categories are covered by the PPPA, including controlled drugs, turpentine, some petroleum distillates, and prescription drugs. Since the PPPA was implemented, reported incidents of children ingesting regulated products have markedly declined. The PPPA is credited with preventing an estimated 86,000 ingestions between 1974 and 1981 (5). Data from a CPSC study indicate that, for regulated products, rates for emergency-room visits for ingestion by children under 5 years of age declined from 5.7/1,000 children under 5 years of age in 1973 to 3.4/1,000 in 1978. For unregulated products, the rate increased from 1.8/1,000 to 1.9/1,000 during the same period (6).

Although unintentional ingestions and deaths among children have declined considerably since PPPA was enacted, the childhood poisoning problem persists. Possible causes include failure to correctly use child-resistant packaging, improper storage of poisonous substances, ignorance of proper emergency procedures when ingestion occurs, and failure of some pharmacies to dispense prescription drugs in child-resistant containers. A recent survey of pharmacies in one area determined that nearly one-third did not dispense prescription drugs in child-resistant containers (7).

The PPWC and its member organizations advocate a broad-based approach to preventing childhood poisoning. This approach will be enhanced as better information about the circumstances surrounding the poisoning events become available. This information should provide clues for further environmental interventions.


  1. National Office of Vital Statistics, National Center for Health Statistics. Vital statistics of the United States, 1959. Vol II. Mortality statistics for the United States and each state. Washington, D.C.: U.S. Department of Health, Education, and Welfare, Public Health Service, 1961.

  2. Division of Vital Statistics, National Center for Health Statistics. Unpublished data, 1981.

  3. CDC. Poisoning among young children--United States. MMWR 1984;33:129-31.

  4. Veltri JC, Litovitz TL. 1983 annual report of the American Association of Poison Control Centers national data collection system. Am J Emer Med 1984;2:420-43.

  5. National Safety Council. Accident facts, 1982. Chicago: National Safety Council, 1982.

  6. Walton WW. An evaluation of the Poison Prevention Packaging Act. Pediatrics 1982;69:363-70.

  7. New York State Attorney General's Office. Investigation of pharmacies' compliance with the Poison Prevention Packaging Act, 1984. New York: New York State Attorney General's Office, 1984.

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