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Tots Often Foil Child-Resistant Drug Packaging
Clinical Updates
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Tots Often Foil Child-Resistant Drug Packaging Christine Kilgore
Warning: Do not rely on child-resistant medication tops to prevent accidental ingestions.The reason is simple:Too many young children can open them, said Monisha Shah, MD. When Dr. Shah and her colleagues gave young children 5 minutes to open “child-resistant,” over-the-counter medicine bottles, they were surprised at how many children figured out how to open them. The Poison Prevention Packaging Act (PPPA) of 1972 defines child-resistant packaging as packaging that 85% of children less than 5 years of age cannot open within 5 minutes or, conversely, packaging that fewer than 15% can open within 5 minutes. But in Dr. Shah’s study of 213 children, 16% of 3-year-olds and 20% of 4-year-olds were able to open squeeze-off bottle tops (squeeze opposite sides and turn). Even more—43% of 3-year-olds and 63% of 4-year-olds— were able to open twist-off tops (push down and turn). “[Our] anticipatory guidance should focus on limiting access … [not] reliance on safety packaging,” Dr. Shah said at the annual meeting of the Pediatric Academic Societies. When she looked specifically at children aged 42-51 months—the age range covered in testing done for the PPPA—Dr. Shah found that 48% of children were able to open twist-off tops and 24% were able to open the squeeze-off kind.
Counsel Teens cont’d Michael O. Fleming, MD, board chair of the American Academy of Family Physicians, agrees. Physicians have a responsibility to screen all their adolescent patients for drug and alcohol abuse since some may not be savvy enough to figure out which patients might be a high risk, Dr. Fleming said. The first step is to develop a rapport with the patient, even if it’s just during the once-yearly physical, Dr. Fleming said. From there, physicians should try to be nonjudgmental when giving out information. The most important thing is to broach the subject early, said J. Edward Hill, MD, a family physician and president of the American Medical Association. “You don’t get many contacts with teenagers medically,” Dr. Hill said. He recommended taking advantage of the sports physicals that many physicians do for teens to bring up drugs and alcohol. Joan Flender, MD, a pediatrician in Dansville, NY, and head of the department of pediatrics at Noyes Memorial Hospital, asks her patients to fill out the American Medical Association’s Guidelines for Adolescent Preventive Services questionnaire each year.Then she follows up in the exam room. 112
This means that two of the three main types of safety caps on over-the-counter drugs do not meet PPPA standards, said Dr. Shah of New York-Presbyterian HospitalWeill Cornell Medical College in New York. Pop-off bottle tops (align arrows and flip off) were the only type that met the standard of the protective law: only 5% of 3-year-olds and 11% of 4-year-olds were able to open these, she reported. And when it came to 2-year-olds, all cap types met the PPPA criteria, though 8% still could open the twist-off caps. Despite a decline in the late 1970s in the number of accidental ingestions, poison control centers still receive more than a million calls each year about ingestions by children. Poisonings caused by prescription and over-the-counter medications account for more than 50% of deaths from accidental ingestion, according to Dr. Shah.“Pharmaceutical companies may need to re-evaluate safety packaging,” she added. The job isn’t simple, however, since 85% of adults over 50 years have to be able to open “child-resistant” packaging, she noted. The children in the study were randomly tested in an urban pediatric emergency department and clinic.The investigators excluded any child with emergent status, severe developmental delay, upper extremity injury, or altered mental status. Reprinted from Family Practice News, August 15, 2005. © 2005 Elsevier Inc. All rights reserved.
With teens, Dr. Flender will ask the parents to leave the room and then she’ll ask the patients if there are any answers on the survey they’d like to change. Assuring patients that everything they say is confidential is key with teens, she said. Dr. Flender also tries to be practical. For example, she doesn’t advise her patients to just say no to alcohol. Instead, she tries to get them to wait at least until they graduate from high school before they start drinking.While it’s not ideal, 18- and 19-year-olds still make much better decisions than do 13- and 14-year-olds, she said. There isn’t a single correct way to talk to teens about drugs and alcohol, said Alain Joffe, MD, director of the student health center at Johns Hopkins University in Baltimore and chair of the American Academy of Pediatrics’ Committee on Substance Abuse. But he recommended a short questionnaire that can help flag patients who are likely to be abusing drugs and alcohol. The CRAFFT questionnaire asks adolescents six questions ranging from “Do you ever forget things you did while using alcohol or drugs?” to “Do you ever use alcohol/drugs while continued on page 113 September 2005
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Tots Often Foil Child-Resistant Drug Packaging Christine Kilgore
Warning: Do not rely on child-resistant medication tops to prevent accidental ingestions.The reason is simple:Too many young children can open them, said Monisha Shah, MD. When Dr. Shah and her colleagues gave young children 5 minutes to open “child-resistant,” over-the-counter medicine bottles, they were surprised at how many children figured out how to open them. The Poison Prevention Packaging Act (PPPA) of 1972 defines child-resistant packaging as packaging that 85% of children less than 5 years of age cannot open within 5 minutes or, conversely, packaging that fewer than 15% can open within 5 minutes. But in Dr. Shah’s study of 213 children, 16% of 3-year-olds and 20% of 4-year-olds were able to open squeeze-off bottle tops (squeeze opposite sides and turn). Even more—43% of 3-year-olds and 63% of 4-year-olds— were able to open twist-off tops (push down and turn). “[Our] anticipatory guidance should focus on limiting access … [not] reliance on safety packaging,” Dr. Shah said at the annual meeting of the Pediatric Academic Societies. When she looked specifically at children aged 42-51 months—the age range covered in testing done for the PPPA—Dr. Shah found that 48% of children were able to open twist-off tops and 24% were able to open the squeeze-off kind.
Counsel Teens cont’d Michael O. Fleming, MD, board chair of the American Academy of Family Physicians, agrees. Physicians have a responsibility to screen all their adolescent patients for drug and alcohol abuse since some may not be savvy enough to figure out which patients might be a high risk, Dr. Fleming said. The first step is to develop a rapport with the patient, even if it’s just during the once-yearly physical, Dr. Fleming said. From there, physicians should try to be nonjudgmental when giving out information. The most important thing is to broach the subject early, said J. Edward Hill, MD, a family physician and president of the American Medical Association. “You don’t get many contacts with teenagers medically,” Dr. Hill said. He recommended taking advantage of the sports physicals that many physicians do for teens to bring up drugs and alcohol. Joan Flender, MD, a pediatrician in Dansville, NY, and head of the department of pediatrics at Noyes Memorial Hospital, asks her patients to fill out the American Medical Association’s Guidelines for Adolescent Preventive Services questionnaire each year.Then she follows up in the exam room. 112
This means that two of the three main types of safety caps on over-the-counter drugs do not meet PPPA standards, said Dr. Shah of New York-Presbyterian HospitalWeill Cornell Medical College in New York. Pop-off bottle tops (align arrows and flip off) were the only type that met the standard of the protective law: only 5% of 3-year-olds and 11% of 4-year-olds were able to open these, she reported. And when it came to 2-year-olds, all cap types met the PPPA criteria, though 8% still could open the twist-off caps. Despite a decline in the late 1970s in the number of accidental ingestions, poison control centers still receive more than a million calls each year about ingestions by children. Poisonings caused by prescription and over-the-counter medications account for more than 50% of deaths from accidental ingestion, according to Dr. Shah.“Pharmaceutical companies may need to re-evaluate safety packaging,” she added. The job isn’t simple, however, since 85% of adults over 50 years have to be able to open “child-resistant” packaging, she noted. The children in the study were randomly tested in an urban pediatric emergency department and clinic.The investigators excluded any child with emergent status, severe developmental delay, upper extremity injury, or altered mental status. Reprinted from Family Practice News, August 15, 2005. © 2005 Elsevier Inc. All rights reserved.
With teens, Dr. Flender will ask the parents to leave the room and then she’ll ask the patients if there are any answers on the survey they’d like to change. Assuring patients that everything they say is confidential is key with teens, she said. Dr. Flender also tries to be practical. For example, she doesn’t advise her patients to just say no to alcohol. Instead, she tries to get them to wait at least until they graduate from high school before they start drinking.While it’s not ideal, 18- and 19-year-olds still make much better decisions than do 13- and 14-year-olds, she said. There isn’t a single correct way to talk to teens about drugs and alcohol, said Alain Joffe, MD, director of the student health center at Johns Hopkins University in Baltimore and chair of the American Academy of Pediatrics’ Committee on Substance Abuse. But he recommended a short questionnaire that can help flag patients who are likely to be abusing drugs and alcohol. The CRAFFT questionnaire asks adolescents six questions ranging from “Do you ever forget things you did while using alcohol or drugs?” to “Do you ever use alcohol/drugs while continued on page 113 September 2005