Pediatric Poisoning Fatalities: Beyond Cough and Cold Medications
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Pediatric Poisoning Fatalities: Beyond
Cough and Cold Medications
Michele M. Burns, MD, MPH,a Madeline H. Renny, MDb
For more than 10 years, there have inconsistencies in detailed case
been Food and Drug Administration information. Autopsy reports were
recommendations and manufacturer also reviewed, but reports were only
labeling changes in place advising available in 55% of cases.3
against the use of cough and cold Therefore, the expert panel could not
medications (CCMs) in young determine the contributory factors
children.1,2 In this issue of Pediatrics, that led to the child’s death in almost
Halmo et al3 present concerning one-half of fatalities. Thus, these
findings characterizing fatalities limitations likely have led to an
associated with CCMs in recent years. underestimation of CCM-related
Identifying cases through the fatalities and CCM-related fatalities
Pediatric Cough and Cold Safety determined to be due to malicious
a
intent, which may occur even more Harvard Medical Toxicology Fellowship, Division of
Surveillance System and then using Emergency Medicine, Boston Children's Hospital, Harvard
an expert panel for review, the frequently than classified in this study. Medical School, Boston, Massachusetts; and bDepartments
authors report 40 CCM-related of Population Health, Emergency Medicine, and Pediatrics,
The 2019 Annual Report of the Grossman School of Medicine, New York University, New
fatalities in children under 12 years York, New York
American Association of Poison
old that occurred from 2008 to 2016.
Control Centers’ National Poison Opinions expressed in these commentaries are those of
Although overall fatalities associated the authors and not necessarily those of the American
Data System (NPDS) describes a
with CCMs were rare, they found that Academy of Pediatrics or its Committees.
16.3% increase in fatalities in
most fatalities were in childrenexposures as well as from neglect and advocate for screening and may be a key difference.19 In fact, and/or malicious intent, as interventions, such as home analysis of NPDS calls for highlighted in the study by Halmo visitation programs that work with prescription opioids in children
by poisoning, although access to Centers’ National Poison Data System 15. Budnitz DS, Lovegrove MC, Geller RJ. Pre-
testing may be limited. The authors (NPDS): 37th Annual Report. Clin Toxicol vention of unintentional medication over-
are to be applauded for their (Phila). 2020;58(12):1360–1541 dose among children: time for the
efforts in characterizing pediatric 5. Lee VR, Connolly M, Calello DP. Pediatric promise of the Poison Prevention Packag-
fatalities associated with CCMs. poisoning by ingestion: developmental ing Act to come to fruition. JAMA. 2020;
However, further study of trends overview and synopsis of national trends. 324(6):550–551
and detailed factors associated Pediatr Ann. 2017;46(12):e443–e448 16. Biedrzycki OJ, Bevan D, Lucas S. Fatal
with medication-related fatalities 6. Finkelstein Y, Hutson JR, Wax PM, Brent J; overdose due to prescription fentanyl
in young children is necessary to Toxicology Investigators Consortium patches in a patient with sickle cell/beta-
determine the best interventions (ToxIC) Case Registry. Toxicosurveillance thalassemia and acute chest syndrome:
for these vulnerable patients and of infant and toddler poisonings in the a case report and review of the litera-
their preventable deaths. United States. J Med Toxicol. 2012;8(3): ture. Am J Forensic Med Pathol. 2009;
263–266 30(2):188–190
7. Yin S. Malicious use of pharmaceuticals in 17. Teske J, Weller JP, Larsch K, Tr€oger HD,
children. J Pediatr. 2010;157(5):832–836.e1 Karst M. Fatal outcome in a child after
ABBREVIATIONS ingestion of a transdermal fentanyl patch.
8. Yin S. Malicious use of nonpharmaceuti-
CCM: cough and cold medication Int J Legal Med. 2007;121(2):147–151
cals in children. Child Abuse Negl. 2011;
NPDS: National Poison Data 18. Hilado MA, Getz A, Rosenthal R, Im DD.
35(11):924–929
System Fatal transdermal fentanyl patch over-
9. Farrell CA, Fleegler EW, Monuteaux MC,
Wilson CR, Christian CW, Lee LK. Commu- dose in a child. Cureus. 2020;12(1):e6755
nity poverty and child abuse fatalities in 19. Lavonas EJ, Banner W, Bradt P, et al. Root
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PEDIATRICS Volume 148, number 5, Downloaded
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from www.aappublications.org/news by guest on October 31, 2021 3Pediatric Poisoning Fatalities: Beyond Cough and Cold Medications
Michele M. Burns and Madeline H. Renny
Pediatrics originally published online October 4, 2021;
Updated Information & including high resolution figures, can be found at:
Services http://pediatrics.aappublications.org/content/early/2021/10/01/peds.2
021-052189
References This article cites 21 articles, 5 of which you can access for free at:
http://pediatrics.aappublications.org/content/early/2021/10/01/peds.2
021-052189#BIBL
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Downloaded from www.aappublications.org/news by guest on October 31, 2021Pediatric Poisoning Fatalities: Beyond Cough and Cold Medications
Michele M. Burns and Madeline H. Renny
Pediatrics originally published online October 4, 2021;
The online version of this article, along with updated information and services, is
located on the World Wide Web at:
http://pediatrics.aappublications.org/content/early/2021/10/01/peds.2021-052189
Pediatrics is the official journal of the American Academy of Pediatrics. A monthly publication, it
has been published continuously since 1948. Pediatrics is owned, published, and trademarked by
the American Academy of Pediatrics, 345 Park Avenue, Itasca, Illinois, 60143. Copyright © 2021
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