Does improving poison prevention practices reduce childhood poisoning rates

One of the papers in the current issue by Wynn et al. (2015) concerns poisoning injuries to children, an important vulnerable group for practically all injuries. Indeed, children represent a special vulnerable group for injuries. As was outlined in an earlier editorial (Forjuoh, 2012), children and adults are very different as far as the causation of injuries is concerned due to two basic differences. First, some basic anatomical, physiological-developmental, and psycho-social differences exist between adults and children that increase the susceptibility of the latter to excess and specific injuries such as poisoning. For example, children's small body sizes with relatively smaller airway sizes is a risk factor for several injury types, including entrapment of body parts and being overrepresented in road environment injuries. With relatively larger heads than those of adults, and rounded chests, children's entirely different body proportions make them a risk for some deceleration injuries. The partial flexion posture of children is also a risk factor for falls and fractures. Children also suffer more serious burns due to their larger and thinner surface area-to-volume ratios compared to adults – they burn more quickly and deeply and at a much lower temperature than adults. Developmentally, children pass through different stages that are linked to specific injuries. They also reach for objects when they begin to crawl at around 9 months and put everything into their mouths and other orifices, risking poisoning, suffocation, and introduction of foreign bodies into other body orifices. In fact, their risk for poisoning increases dramatically between 1 and 3 years of age as they grasp practically everything in their way and drink everything.

Wynn et al. (2015) provides an overview of systematic reviews on childhood poisoning in the home, including a systematic review of primary studies. Their information sources included Medline, Embase, CINAHL, ASSIA, PsycINFO, and Web of Science and spanned between the time of inception to January 2012, along with searching a range of other electronic sources in January 2013 and some handsearching. Their search identified 13 systematic reviews, 2 meta-analysis, and 47 primary studies. The interventions uncovered in their review comprised education, provision of cupboard/drawer locks, and poison control centre number stickers. For example, they found that studies that reported the availability of the poison control centre numbers as an intervention were associated with a four-fold improvement in poison prevention practices (odds ratio from meta-analysis of 3.67, 95% CI = 1.84–7.33). Of most importance, while findings from the meta-analysis and primary studies showed that interventions improved poison prevention practices, they found little evidence in support of interventions leading to reduction of childhood poisoning rates.

This finding is in contrast to what has been found historically – a reduction of the mortality rate from childhood poisoning since the 1950s due to several policies including the establishment of local poison control centres and the reformulation and repackaging of children's aspirin, which culminated in the enactment of the 1970 Poison Prevention Packaging Act (PPPA). Following the PPPA, unintentional poisoning from ingestion of children's aspirin was observed to have dropped by almost 50% (Walton, 1982). So, the question still begging for an answer is, does improving poison prevention practices reduce childhood poisoning rates? For most policy-makers, changes in behaviours or practices may be less persuasive than changes in actual rates in morbidity or mortality, albeit altering behaviours of outcomes with many risks is often associated with eventual reduction in the outcomes. A recent meta-analysis (Achana et al., 2015) also shied away from the important question as to whether improving poison prevention practices from interventions translated into actual decline in childhood poisoning rates as have many prior studies (Kendrick et al., 2008). This should indeed be the subject of future inquiry into research on childhood poisoning.

Poisoning and other childhood injuries continue to be a growing public health problem, deserving more attention than is currently given. Researchers must move one step ahead to answer the question as to whether improving poison prevention practices lead to actual reduction of childhood poisoning rates. The resources and the expertise exist in abundance already to do this and we must all do what we can to prevent childhood poisoning and other childhood injuries. In the meantime, we ought to continue to propagate poison prevention tips:

• Keep cleaners and other toxic products out of reach of children,

• Check your purse for potential poisonous hazards,

• Always use original, child-resistant packaging,

• Keep medicines up and away out of reach and out of sight from children,

• Post the poison control centre number in your phone.