Unintentional child poisoning risk: A review of causal factors and prevention studies

Childhood poisonings: Effects of ambiguous product characteristics on preschool children's categorization of household chemicals

This study investigated preschool children's categorization and risk perception of products with ambiguous product characteristics (e.g., food-like packaging). These characteristics make it difficult for preschool children to categorize household chemicals correctly. This, therefore, increases the risk of unintentional poisoning. We hypothesized that ambiguity arises from different product characteristics, such as the type of packaging, the products' scent, or the packaging's color and transparency. In four behavioral tasks, N = 108 preschool children (M = 43 months, SD = 3) categorized different products and household chemicals with various types of packaging, colors, and scents. Individually wrapped dishwasher tablets were more likely to be categorized as edible than unwrapped ones. Furthermore, children who had interacted with any type of dishwasher tablet in the last 6 months performed better in identifying dishwasher tablets, regardless of packaging type. Household chemicals with a fruity scent were more likely to be categorized as drinkable than those with a chlorine scent. Finally, the children considered black bottles more dangerous and preferred them less than bottles of a different color. In contrast, bottle transparency generally did not seem to affect risk perception and preference. These findings confirm that ambiguous product characteristics influence children's categorization of unknown products and, thus, their risk perception and decision-making. Manufacturers and caregivers are advised to reduce the ambiguity of household chemicals by designing more neutral product packaging and choosing products with more neutral elements, respectively.

Trends in mortality from non-natural causes in children and adolescents (0-19 years) in Europe from 2000 to 2018

BACKGROUND

Non-natural mortality in children and adolescents is a global public health problem that varies widely from country to country. Data on child and adolescent maltreatment are not readily available, and mortality due to violent causes is also underestimated.

METHODS

Injury-related mortality rates (overall and by specific causes) from 2000 to 2018 in selected European countries were analysed to observe mortality patterns in children and adolescents using data from the Eurostat database. Age-standardized mortality rates per 100,000 person-years were calculated for each country. Joinpoint regression analysis with a significance level of 0.05 and 95% confidence intervals was performed for mortality trends.

RESULTS

Children and adolescent mortality from non-natural causes decreased significantly in Europe from 10.48 around 2005 to 5.91 around 2015. The Eastern countries (Romania, Bulgaria, Poland, Slovakia, Czech Republic) had higher rates; while Spain, Denmark, Italy, and the United Kingdom had the lowest. Rates for European Country declined by 5.10% per year over the entire period. Larger downward trends were observed in Ireland, Spain and Portugal; smaller downward trends were observed for Eastern countries (Bulgaria, Czech Republic, Poland, Slovakia) and Finland. Among specific causes of death, the largest decreases were observed for accidental causes (-5.9%) and traffic accidents (-6.8%).

CONCLUSIONS

Mortality among children and adolescents due to non-natural causes has decreased significantly over the past two decades. Accidental events and transport accidents recorded the greatest decline in mortality rates, although there are still some European countries where the number of deaths among children and adolescents from non-natural causes is high. Social, cultural, and health-related reasons may explain the observed differences between countries.

Protecting the children -a virtual reality experiment on consumers' risk perceptions of household chemicals

Warnings on the labels of hazardous household chemicals (e.g. warning pictograms and use instructions) should create risk awareness and thus encourage safe storage, handling and disposal. However, scientific findings have called into question the effectiveness of warnings to prevent accidents, albeit mostly based on consumers' self-reports. This study aimed to contribute to existing data on household chemicals and consumer safety by applying a novel observational method using virtual reality (VR). The study participants (N = 119) were observed after receiving a task to childproof a virtual apartment from various interactable neutral and hazardous objects (i.e. knives, lighters and household chemicals with and without warnings) that were placed in the virtual apartment. For the analysis, the object placement (i.e. accessible or inaccessible to the children) and the level of interaction with the objects were coded, and the observational data were supplemented with data gathered through a questionnaire. The results showed that most hazardous household chemicals were moved to spots that were inaccessible to the children without any interactions of the participants with the warnings. Instead, they used their pre-existing knowledge and intuitive strategies to judge the objects' risks. These potentially misleading intuitive strategies should be increasingly considered in the regulation of hazardous household chemicals. This study also discussed the use and limitations of VR for the observation of human behaviour and decision making under uncertainty.

A Mobile Health Information Behavior Model: Theoretical Development and Mixed-Method Testing in the Context of Mobile Apps on Child Poisoning Prevention

While several studies have explored the use of mobile health applications, few have observed determinants of mobile health information behavior. To develop a model explaining parents' mobile information behavior on child poisoning prevention, we first explored relevant theories to suggest a theoretical model. In that, we combine existing models on risk and health information seeking, such as the Planned Risk Information Seeking Model, with models on the acceptance of mobile technologies, such as the Unified Theory of Acceptance and Use of Technologies. Thereafter, we employed a sequential mixed-method design with an initial qualitative study (four online focus groups with n = 25 parents in total) and a standardized online survey of n = 1,013 parents to evaluate our research model. Results confirm that both, determinants of information seeking and determinants of technology acceptance, contribute to the explanation of mobile information behavior. App use intention was mainly related to the performance expectancy of app use, the subjective information norm, and social influence on app use. To increase the usage of prevention apps and contribute to the reduction of child injuries, communication on poisoning apps should address subdimensions of the performance expectancy, such as their utility and peoples' trust in app providers. Moreover, physicians are important multipliers for these messages.

Trends in mortality related to unintentional poisoning in the South Asian region from 1990 to 2019: analysis of data from the Global Burden of Disease Study

OBJECTIVE

This study aimed to estimate the burden of unintentional poisoning in South Asian countries from 1999 to 2019.

DESIGN

An ecological study conducted at the regional level for South Asian countries, based on data from the Global Burden of Disease Study 2019.

SETTING

We extracted unintentional poisoning data from the Global Burden of Disease Study data set from 1990 to 2019 to assess trends in mortality, disability-adjusted life-years (DALYs), years of life lost, years lived with disability (YLDs) and causative agents in South Asian countries (Bangladesh, Bhutan, India, Nepal and Pakistan).

OUTCOME MEASURES

We determined the per cent change and 95% CI for the period between 1990 and 2019 by age, gender and country. We also conducted Poisson regression to measure the percentage change in the rate per year.

RESULTS

The absolute number of deaths due to unintentional poisoning in South Asia decreased (-32.6%) from 10 558 deaths in 1990 to 7112 deaths in 2019. The age standardised death rate from unintentional poisoning in South Asia has seen a downward trend (-55.88%), declining from 0.87 (0.67-1.01) age-standardised per 100 000 population in 1990 to 0.41 (0.34-0.47) in 2019. Among age groups, under 9 years and 10-19 years have seen downward trends for death and DALYs, accounting for -93.5% and -38.3%, respectively. YLDs have seen an upward trend (5.9%), increasing from 10 461.7 per 100 000 in 1990 to 11 084 per 100 000 in 2019. YLDs in women increased by 7.4%, from 11 558.2 per 100 000 to 12 418.3 per 100 000. The incidence rate ratios (IRRs) adjusted by all age groups and gender for DALYs in all South Asian countries has reduced significantly (IRR 0.97, 95% CI 0.96 to 0.97) from 1990 to 2019.

CONCLUSION

This study showed reduction in death and DALYs due to unintentional poisoning in South Asia except YLDs which is showing an increasing trend. Public health systems should continue efforts to minimise and prevent disabilities arising from unintentional poisoning in South Asia.

Seeing household chemicals through the eyes of children-Investigating influential factors of preschoolers' perception and behavior

INTRODUCTION

Children who encounter household chemicals run the risk of unintentional injury. The aim of this study was to understand which factors heighten children's attention or misguide their decision-making concerning household chemicals. We hypothesized that certain product attributes (i.e., label, packaging, closure types), storage context, and parental beliefs play a role in this setting.

METHOD

We conducted a laboratory study with N = 114 children (M = 45 months, SD = 6.5) and their parents (M = 38 years, SD = 4.92). Children completed a series of behavioral tasks in which they had to choose between products with different attributes, identify products in different storage contexts, and sort household chemicals.

RESULTS

The results confirmed that the children preferred products with cartoon-style labels compared to products without such labels. However, children's decision-making did not differ for products with different closure types (child-resistant vs sprayer-type closures). Regarding the storage context, our results showed that the children particularly struggled to identify dishwashing tabs when they were stored with other food items rather than household chemicals. In terms of parental beliefs, our study found that parents rated more household chemicals as child-safe than their children did.

PRACTICAL APPLICATION

Parents should buy household chemicals with neutral labels and pay attention to how their household chemicals are stored. Manufacturers should consider potential adverse effects when developing new product designs.

Accidental poisoning in children: a single centre case series study in Bangladesh

BACKGROUND

Accidental poisoning is a leading cause of unintentional injuries among children in low-income and middle-income countries (LMICs). The overall aspect of this unintentional poisoning is poorly understood in Bangladesh. The objectives of this study were (1) to explore the socio-demographic factors and circumstantial context of accidental poisoning and (2) the prevalence of the type of substances causing it.

METHODS

A descriptive case series study was conducted from April 2019 to February 2020 at a tertiary level hospital of the capital city Dhaka in Bangladesh. Children under 10 years of age admitted to the hospital with accidental poisoning were enrolled in this study. Parents of hospitalised children were interviewed face-to-face using a structured questionnaire. Descriptive statistics were used for data analysis.

RESULTS

A total of 223 children were recruited in this study. Children between 2 and 5 years (60%), men (61%) and children with agility (65.5%) were among the prevalent victims. The majority of cases occurred (65%) in a nuclear family setting. Most mothers (85%) of these children were non-working and most incidents took place in parents' homes (~82%). Nearly 70% of the poisoning incidents took place in the presence of parents and over half of these occurred in the bedroom. Kerosene was the prevalent cause (33%) of accidental poisoning while insecticide/pesticide ranked second (26.5%) followed by medicines (17%) and household chemicals (12). In one-third (31.4%) of the cases, poisoning chemicals were stored in soft drink bottles while two-thirds (67.3%) of the cases were kept in containers other than original ones. Although over 80 parents somewhat knew that chemicals could be harmful to the children if ingested, most of them did not take the safety measures.

CONCLUSION

In this present study we found that preschool-aged children were more victims of accidental poisoning mostly by ingesting kerosene and a majority of the incidents took place in the bedroom while parents were present at home. Our study findings would serve as a baseline for designing future intervention studies and policies.

Predictive Factors for Recurrence of Serious Arrhythmias in Patients with Acute Digoxin Poisoning

Although digoxin poisoning has declined in the past decades, it still has deleterious outcomes. The hallmark of serious life-threatening arrhythmias remains challenging due to its non-specific initial presentation. Therefore, this study aimed to evaluate the initial predictive factors for recurrent serious arrhythmias and the need for temporary pacing in acute digoxin-poisoned patients. This retrospective cohort study included all patients with acute digoxin poisoning admitted to Tanta University Poison Control Center from 2017 to 2020. Demographic and toxicological data, poisoning severity score (PSS), laboratory investigations, and serial ECG monitoring data were documented. Patients were divided according to their age into a childhood group and adolescence & adulthood group. Each age group was divided into two subgroups according to the presence of recurrent serious arrhythmias. Patient outcomes, including intensive care unit admission, temporary pacing, and in-hospital mortality were recorded. A percentage of 37.34% (n = 31) of the included patients had recurrent serious arrhythmias in both groups. Recurrent serious arrhythmias groups had significantly low heart rate, prolonged PR interval, high PSS, Mobitz II dysrhythmias, elevated serum digoxin, serum potassium and serum creatinine, and increased adverse outcomes compared to other groups. Logistic regression analysis showed that only serum digoxin and potassium levels were significant independent predictors of recurrent serious arrhythmias and temporary pacing. Serum digoxin level had an excellent discriminatory power with the best sensitivity and specificity, followed by serum potassium level in both groups. Thus, monitoring serum digoxin and potassium levels is essential in all patients with acute digoxin poisoning, especially with limited Fab availability.

A RCT Testing If a Storybook Can Teach Children About Home Safety

OBJECTIVE

Unintentional injuries are the leading cause of death for children under 19 years of age. For preschoolers, many injuries occur in the home. Addressing this issue, this study assessed if a storybook about home safety could be effective to increase preschoolers' safety knowledge and reduce their injury-risk behaviors.

METHODS

Applying a randomized controlled trial design, normally developing English speaking preschool children (3.5-5.5 years) in Southwestern Ontario Canada were randomly assigned to the control condition (a storybook about healthy eating, N = 30) or the intervention condition (a storybook about home hazards, N = 29). They read the assigned storybook with their mother for 4 weeks; time spent reading was tracked, and fidelity checks based on home visits were implemented.

RESULTS

Comparing postintervention knowledge, understanding score, and risk behaviors across groups revealed that children who received the intervention were able to identify more hazards, provide more comprehensive safety explanations, and demonstrate fewer risky behaviors compared with children in the control group (ηp2 = 0.13, 0.19, and 0.51, respectively), who showed no significant changes over time in safety knowledge, understanding, or risk behaviors. Compliance with reading the safety book and fidelity in how they did so were very good.

CONCLUSIONS

A storybook can be an effective resource for educating young children about home safety and reducing their hazard-directed risk behaviors.

AVAILABILITY AND STORAGE OF HAZARDOUS PRODUCTS IN HOUSEHOLDS IN THE METROPOLITAN REGION OF MANAUS: A POPULATION-BASED SURVEY, 2015

OBJECTIVE

The availability of hazardous products in households increases the risks of poisoning. The present study aimed to assess the frequency and associated factors of the availability and storage of hazardous products in residences in the metropolitan region of Manaus.

METHODS

Population-based and cross-sectional study conducted in 2015 with adults selected with three-stage probabilistic sampling. Participants were interviewed face-to-face. Prevalence ratio (PR) of the presence of hazardous products (presence of chumbinho [illegal anti-cholinesterase rodenticide], artisanal cleaning products, and unsafe storage of these products and medications) and 95% confidence intervals (95%CI) were calculated with Poisson regression with robust variance, weighted by the complex sampling method adopted.

RESULTS

A total of 4,001 participants was included, of which 53.0% (95%CI 51.5-54.6) reported presence of hazardous products in their households, 36.3% (95%CI 34.8-37.8) had unsafe storage, 16.2% (95%CI 15.1-17.4) had artisanal cleaning products, and 8.2% (95%CI 7.4-9.1) had chumbinho. Households with children ≤5 years old had safer storage (PR=0.78; 95%CI 0.71-0.86) and more artisanal products (PR=1.30; 95%CI 1.11-1.51). Presence of artisanal products was higher in lower educational levels (PR=2.20; 95%CI 1.36-3.57) and lower economic classifications (PR=1.63; 95%CI 1.25-2.13).

CONCLUSIONS

Over half of the households in the metropolitan region of Manaus kept hazardous products; one-third stored them unsafely. Artisanal cleaning products and chumbinho were frequently present. Households with children had safer storage of products, and socioeconomic factors affected the availability of such hazardous products.

The exploration of size and toddler interaction with liquid laundry detergent capsules

Liquid laundry capsules have been involved in multiple poisoning incidents with young children in the home. There are a range of contributing factors for these incidents, including influences from industry, culture, home environments, and parenting/supervision. There also are influences from children’s behaviour and decisions in reaction to potential hazards. Previous research examined the influence of capsule product appearance and colour on children’s behaviour around hazardous household items, but little research examines the influence of product size. This research explored if differences in the size of liquid laundry capsules result in different levels of toddler interaction. We compared two commercially available capsule designs that are identical in physical appearance but differ in physical size. Our research was conducted using three studies: Study 1, forced-choice test in an out-of-context laboratory setting; Study 2, an ecologically-valid, simulated real-world setting replicating a home laundry cabinet with a container of capsules left open; and Study 3, a second ecologically-valid study replicating a home laundry cabinet, this time with a capsule left outside its container. Capsule interaction was measured by grasping choice among samples of 156 toddlers ages 9–36 months. The same sample was used for Studies 1 and 2, and a second identically sized sample recruited for Study 3. Results from Study 1 indicated toddlers selected the small (49.8% selection) and large (50.2%) capsule with nearly identical frequency. Study 2 largely replicated Study 1: Toddlers selected the small capsule or container of small capsules 26.8% of the time and the large capsule or container of large capsules 22.3% of the time. Study 3 also replicated previous findings: Toddlers selected the smaller capsule 18.0% of the time and the larger 19.2%. We discuss study results, which suggest no appreciable difference in toddler’s grasping choice to smaller versus larger laundry capsules.

Trends in US Emergency Department Visits for Pediatric Acute Ocular Injury

Importance

There is a lack of literature describing the incidence of pediatric acute ocular injury and associated likelihood of vision loss in the United States. Understanding national pediatric eye injury trends may inform future efforts to prevent ocular trauma.

Objective

To characterize pediatric acute ocular injury in the United States using data from a stratified, national sample of emergency department (ED) visits.

Design, Setting, and Participants

A retrospective cohort study was conducted. Study participants received care at EDs included in the 2006 to 2014 Nationwide Emergency Department Sample, comprising 376 040 children aged 0 to 17 years with acute traumatic ocular injuries. Data were analyzed from June 2016 to March 2018.

Exposures

International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis codes and external-cause-of-injury codes identified children with acute ocular injuries.

Main Outcomes and Measures

Demographic and clinical characteristics of children with acute traumatic ocular injuries were collected and temporal trends in the incidence of ocular injuries by age, risk of vision loss, and mechanism of injury were explored.

Results

In 2014, there were an estimated 163 431 (95% CI, 151 235-175 627) ED visits for pediatric acute ocular injury. Injured children were more often male (63.0%; 95% CI, 62.5-63.5) and in the youngest age category (birth to 4 years, 35.3%; 95% CI, 34.4-36.2; vs 10-14 years, 20.6%; 95% CI, 20.1-21.1). Injuries commonly resulted from a strike to the eye (22.5%; 95% CI, 21.3-23.8) and affected the adnexa (43.7%; 95% CI, 42.7-44.8). Most injuries had a low risk for vision loss (84.2%; 95% CI, 83.5-85.0), with only 1.3% (95% CI, 1.1-1.5) of injuries being high risk. Between 2006 and 2014, pediatric acute ocular injuries decreased by 26.1% (95% CI, -27.0 to -25.0). This decline existed across all patient demographic characteristics, injury patterns, and vision loss categories and for most mechanisms of injury. There were increases during the study in injuries related to sports (12.8%; 95% CI, 5.4-20.2) and household/domestic activities (20.7%; 95% CI, 16.2-25.2). The greatest decrease in high-risk injuries occurred with motor vehicle crashes (-79.8%; 95% CI, -85.8 to -74.9) and guns (-68.5%; 95% CI, -73.5 to -63.6).

Conclusions and Relevance

This study demonstrated a decline in pediatric acute ocular injuries in the United States between 2006 and 2014. However, pediatric acute ocular injuries continue to be prevalent, and understanding these trends can help establish future prevention strategies.