Original Article

Descriptive Epidemiology of Infant Ingestion Calls to a Regional Poison Control Center

Authors: Teresa J. Coco, MD, William D. King, RPH, MPH, DRPH, Ann P. Slattery, MPH, DABAT

Abstract

Objective: This study was designed to describe the epidemiology of ingestions in infants 6 months of age or younger.


Methods: A retrospective chart review from a convenience sample of poison center cases in infants younger than 6 months of age from December 28, 2002, to December 28, 2003, was reviewed.


Results: A total of 358 cases were reviewed. Incorrectly measured dose, repeated dosing by different caregivers, incorrect dosing interval, and incorrect route accounted for 41% [95% CI, (36%, 46%)] of caregiver dosing misadventures. Ten cases (3%) were due to pharmacy error, and the wrong medication was given in 32 (9%) cases. The total therapeutic misadventure proportion was 53%. Eight percent were 10-fold dosing errors. Thirty-nine (11%) infants were evaluated in an emergency department and 9 (3%) infants were admitted to a health care facility.


Conclusions: Therapeutic misadventures caused by dosing errors in infants younger than 6 months of age were prevalent. Most errors occurred with inaccurate measurement of the medication, repeated dosing by caregivers, incorrect dosing interval, and incorrect route. Healthcare providers could increase prevention of therapeutic misadventures by educating caregivers on proper administration of medications and by demonstrating the use of appropriate measuring devices.


Key Points


* Infants are at a higher risk for dosing misadventures because of the smaller amounts of medication prescribed, the dependence on a caregiver to deliver the medication, and a nonuniform protocol for dispensing devices given with certain medications.


* Physicians, pharmacists, and other health care providers who dispense medications to infants and children should include appropriate dosing syringes and provide detailed instructions on proper dosing to the caregiver.


* More research is needed for the creation of innovative preventive strategies to reduce therapeutic misadventures in infants and children.

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References

1. Watson WA, Litovitz TL, Klein-Schwartz W, et al. 2003 Annual report of the American Association of Poison Control Centers Toxic Exposure Surveillance System. Am J Emerg Med 2004;22:335–404.
 
2. Shannon M. Ingestion of toxic substances by children. N Engl J Med 2000;342:186–191.
 
3. Committee on Injury, Violence, and Poison Prevention. Poison treatment in the home. Pediatrics2003;112:1182–1185.
 
4. Committee on Drugs and Committee on Hospital Care. Prevention of medication errors in the pediatric inpatient setting. Pediatrics 2003;112: 431–436.
 
5. Tibballs J, McArdle EJ, Brown TC. Drug overdose in children. Aust Paediatr J 1985;21:7–12.
 
6. Osterhoudt KC, Shannon M, Henretig FM. Toxicologic Emergencies. In: Feisher GR, Ludwig S (eds).Pediatric Emergency Medicine. 4th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2000: 887–942.
 
7. Understanding and preventing drug misadventures. Proceedings of a multidisciplinary invitational conference sponsored by the ASHP research and education foundation in cooperation with the American Medical Association, the American Nurses Association, and the American Society of Hospital Pharmacists; 1994 Oct 21–23; Chantilly, Virginia. Am J Health-Syst Pharm 1995;52:369–416.
 
8. Santell JP, Cousins D. Medication errors: documenting and reducing medication errors. US Pharmacist 2003 July [cited 2003 July 15]; 28(7). Available from: URL:http//uspharmacist.com/index.asp?show_article&page_8_1120.htm
 
9. Jonville AP, Autret E, Bavoux F,. Characteristics of medication errors in pediatrics. Ann Pharmacother 1991;25:1113–1117.
 
10. Gunn VL, Taha SH, Leibelt EL, et al. Toxicity of over-the-counter cough and cold medications.Pediatrics 2001;108:e52.
 
11. Li SF, Lacher B, Crain EF. Acetaminophen and ibuprofen dosing by parents. Pediatr Emerg Care2002;16:394–397.
 
12. Seifert SA, Jacobitz K. Pharmacy prescription dispensing errors reported to a regional poison control center. J Toxicol 2002;40:919–923.
 
13. Counsell AM, Geddis DC, Smith AR. Parental perceptions of information about medication prescribed for their children. N Z Med J 1993; 956:205–206.
 
14. Madlon-Kay DJ, Mosch FS. Liquid medication dosing errors. J Fam Pract 2000;49:741–744.
 
15. Batts KF, Munter DW. Metoclopramide toxicity in an infant. Pediatr Emerg Care 1998;14:39–41.
 
16. Hirshfeld AB, Getachew A, Sessions J. Drug Doses. In: Siberry GK, Iannone R (eds). The Harriet Lane Handbook. 15th ed. St Louis, MO: Mosby, Inc; 2000: 771–837.