Accidental Ingestion of Medications in Pediatrics - Case Study Example

Accidental ingestion of medications in pediatrics is attributed to lack of safety precautions in the home. This paper will discuss the prevalence of accidental ingestion in the States and in other parts of the globe. It will also discuss the manifestations, nursing and medical interventions, and preventive measures of accidental ingestion of medications in children. Accidental ingestion of medications in pediatrics is caused by absent or faulty supervision and also caused by the improper storage of medications. The manifestations of and the medical interventions for the accidental ingestion of medications depend on the drug and amount of drug ingested. Accidental ingestion usually manifests symptoms like vomiting, drowsiness, and breathing difficulties. They are usually managed through gastric lavage and administration of charcoal. In the end, there are a variety of preventive measures that parents and caregivers can undertake in order to reduce, if not totally eliminate the incidence of accidental ingestion of medication in children. Accidental Ingestion of Medications in Pediatrics Related to Safety at Home             Accidental ingestion in children is one of the most common causes of deaths from poisoning not just in the United States, but in other countries as well.  The American Association of Poison Control Centers claims that about 30 children across America die each year because of accidental poisoning and more than 2.4 million poisoning incidents are recorded in poison centers across the United States every year (“Accidental Poisoning in Children”).  In India, approximately 40% of accidental poisoning in pediatrics is reported during the second year of life, about 12% in children less than a year old, and about 20% in the third year of life (Siddaraju “Word Press”).  In 2003, Progressive Insurance established that medication swallowing “was most frequent between 18 and 35 months and was the single highest cause of injury for all childhood ages” (“What’s New”).  Latest figures from Safe Kids Worldwide claim that about 91,000 children below the age of 14 are treated in Emergency Rooms for accidental poisoning.  Of these 91,000, 100 usually die.  Their figures also indicate that 90% of toxic poisoning occurs at home, with about 40% of cases attributed to medications (“91,000 Children per Year Treated for Accidental Poisoning”).  Although great strides have been taken towards preventing and managing poisoning due to accidental ingestion, these numbers still remain high and are increasing every year.  They represent a nagging and dangerous threat to children. It is not very comforting to note that these incidents usually occur at home with the caregiver or parent nearby. “The parent finds the child with an empty bottle in the bathroom or kitchen and is unsure how much the child has ingested…” (Meadow, p. 35). In some instances, the child turns out okay, but in some tragic circumstances, the child turns up dead or critically injured. There are many substances in our home that can harm our children. And a few seconds of absent supervision is all it takes for a child to get a hand of an unscrewed medication bottle and pop the contents into his mouth. From then, the consequences may be irreversible. Causes of Accidental Ingestion of Medications in Children             Accidental ingestion in pediatrics, based on a British study, is caused by faulty or absent adult supervision and by improper storage of medicines.  Faulty or absent supervision usually occurs when parents and/or caregivers do not give their undivided attention to children.  Distracted or divided attention between several tasks at one time can cause focus to stray and result to various accidents.  Such is usually the case in large families where harried mothers are saddled with caring for several children at one time. A study revealed that “twenty-three percent of accidental ingestion occurred when the main caregiver was preoccupied with housework and 15% occurred while the caregiver was cooking…eleven percent of the caregivers were sleeping, 9% were having their meals, 8% at laundry, 8% were in the toilet, 6% on the telephone or kitchen and 5% were watching television” (Ho, et.al. “Article”).  Children are naturally curious individuals and do not really understand the concept of danger.  Once they start crawling and walking, they are now able to climb tables, chairs, and cabinets.  They will open cupboards and drawers and take out whatever containers they see in there.  Their curiosity will get the better of them and they will proceed to open these containers.  Once opened, the need to touch, smell, and eventually taste the contents of the container will overcome them.  “Exploring for younger children is often done by mouthing objects which puts them at greater risk of unintentional poisonings” (Bartos “Health & Safety”).  This can happen in the span of a few short seconds, and before long, the child will have already accidentally ingested some dangerous drug mistaken for candy or some cleaning solution, mistaken for juice. Some accidental ingestion incidents also happen while children are in the care of their grandparents. “Grandparents often don’t have child-resistant prescription vials, or may be less careful about leaving loose pills and inhalers sitting out on tables, kitchen counters, or in purses within a child’s reach”(Lopez “Your Health”).                Accidental ingestion is also caused by improperly stored medicines and chemical products.  In various incidents of accidental ingestion of medicines, “most of the medication was kept in unlocked cupboards, others were placed on tables, refrigerators or carelessly in bags either before or after consumption” (Lo, et.al., “Article”).  Medicines not properly kept in child-safety containers contribute greatly to accidental ingestion of drugs in children.  Some medicines are also stored past their expiration dates and are sometimes accidentally administered to children.  Other medicines do not have proper labels and are sometimes wrongly administered to children.  Some parents do not consciously check labels and expiration dates on medicines before giving them to their children. Many parents fail to put child safety locks on cupboards and cabinets and sometimes store cleaning agents under sinks where children can easily reach them.  Drugs are often left at bedsides and look very appealing to children.  It does not help that parents sometimes tell their children that the medicines they are taking are ‘candies’.  With this enticement, determined children who are naturally fond of candies and sweets, will do all they can to get a hold of their parents’ ‘candies’.  Oftentimes, recent moves can also lead to accidental ingestion of chemicals and medicines (Hobbs, et.al., p. 304).  Medicine containers in boxes scattered about during moving days increase the possibility of children finding and accessing dangerous drugs and chemicals. The fact that parents and caregivers are too busy and preoccupied loading and unloading boxes only serves to aggravate the situation.   Manifestations/Symptoms            Common symptoms of accidental ingestion of medications and/or chemicals are the following--vomiting, diarrhea, unusual sleepiness, breathing difficulties, and bleeding.  Symptoms manifested would depend on the chemicals or drugs ingested; and the intensity of their effect would depend on the amount of medication or chemicals ingested.  The length of time which has passed from when the drug was ingested up to the time medical help was sought will determine manifesting symptoms and treatment. Drugs that are often accidentally ingested by children include—iron tablets, contraceptive pills, sleeping tablets, antidepressants, and paracetamol (McEvoy, “Advice and Safety”).  These drugs cause a variety of symptoms when ingested by children. As compared to their adult counterparts, children exhibit a different metabolic and biologic reaction to these drugs. Because of their smaller body size and weight, they cannot tolerate adult doses of medications; nor can their immature organs adequately process and synthesize these drugs (Gahagan “News”). “Poisoning can cause many physical reactions, from sleepiness to pneumonia, to organ damage, to death” (“About Accidental Poisoning”). Methyl salicylate which is an ingredient of aspirin is potentially deadly to children.  As little as 4 ml of methyl salicylate in a child is fatal (Botma, p. 229).  Thyroid hormone imbalance medications when accidentally ingested by children can cause “hyperactive behavior, fever, vomiting, diarrhea, diaphoresis, and flushing” (Golightly).  Accidental iron poisoning is one of the leading causes of accidental deaths for children under 6 in the United States.  Upon ingestion children would immediately manifest “nausea, vomiting, diarrhea, and gastrointestinal bleeding, which can progress to shock, coma and death” (“Preventing Iron Poisoning in Children”).  A child may recover from these symptoms, however, it is possible that after 12 hours or even up to days after ingestion, the child may still exhibit gastrointestinal bleeding, lethargy, and may lapse into a coma. Even if the victims survive, they can still develop problems like extensive liver damage and “damaged stomach lining with pyloric obstruction” (Gahagan, “News”).  Accidental ingestion of antidepressants is serious and potentially fatal for children.  An article in the Professional Safety Online Journal discussed that antidepressants may present anticholinergic and hyperadrenergic effects (Gahagan “News”). Anticholinergic effects manifest as delirium and hyperadrenergic effects can manifest as violent agitation. There can also be tachycardia and hypertension which is followed by hypotension and seizures. The accidental ingestion of sleeping pills usually manifests as drowsiness or sleepiness. Sleeping pills tend to depress respiratory and cardiovascular processes.  Death may result because of decreased oxygen supply (Youngson, p. 1629).   Medical and Nursing Interventions The immediate medical and nursing intervention for accidental ingestion of medicines is to get vital information from the parents or caregivers. The nurse should immediately get the child’s age and weight, the container or bottle of medicine, if available, and ask the parents how long ago the medicine was ingested by the child (“Accidental Poisoning in Children”). It is important, at this point, for the nurses and the medical team to act calmly and quickly. An intravenous catheter is usually immediately inserted into the child’s vein to ensure easy and speedy administration of fluids and medicines to the child. Blood samples are taken from the child in order to establish the level of drug toxicity (“Accidental Poisoning in Children”). The medical interventions for the child would differ from patient to patient, from the type of drug ingested, and from the amount of drug ingested. The initial nursing intervention for accidental ingestion of iron is airway and ventilatory support with oxygen supplementation, cardiac monitoring, fluid volume replacement, blood transfusion if anemic, sodium bicarbonate to treat the acidosis, and maintaining adequate urine output. In order to limit the absorption of the iron into the system, a gastric lavage is performed. Activated charcoal is usually administered to the child in order to bind the toxic substance and to be later excreted. The entire bowel is also irrigated, and a chelation therapy is also performed with intravenous deferoxamine (Aldridge “CE Connection”). The intervention for accidental ingestion of antidepressants is activated charcoal and admission to the intensive care unit for close monitoring and evaluation (Erickson, p. 202). Initial management involves airway management, administration of cooling measures, IVF hydration (if there is no pulmonary edema), and administration of midazolam to control seizures. One mEq/kg of sodium bicarbonate is also usually administered to the child. “The sodium ion specifically helps to reverse the sodium channel blocking effects of TCAs on myocardial cells” (Gahagan “News”). In the accidental ingestion of sleeping pills, the nursing interventions usually involve gastric lavage and the administration of charcoal. Induced vomiting is usually not advisable for unconscious children because this may cause aspiration. Close monitoring and observation is required for these children. In case of ingestion of decongestants, naloxone administration can help reduce CNS depression. Gastric emptying is usually not performed because decongestants are rapidly absorbed in the GI tract and the gastric lavage and emesis would not improve the situation of the patient. Charcoal is also not usually effective in these cases (Erickson, p. 200). Health Teachings and Prevention Measures There are various health teachings that nurses can impart to parents and caregivers in relation to accidental ingestion of medications by children. First and foremost, medication should be locked and kept in a place where children will not be able to see or touch these items. Even if medicines are in child-proof containers, children might still be able to pry them open. So, it is still more important and safe for all medicines and vitamins to be locked and be out of children’s reach. Children should also not be allowed to play with the purses or bags (where medicines may be kept) of their parents, grandparents, or caregivers. Purses or bags of visitors should also be placed out of children’s reach. Medication containers must be thrown out after use. Liquid medications should not be placed within reach of children, and when not totally consumed, they should be disposed of. These liquid and even solid preparations should not be stored in places where food items are kept. Children may eat or drink it mistaking them for food items (“Poisoning in Children”). The numbers of the Poison Control Centers should be visibly written near the phones. Caregivers and other babysitters should be told the child’s current weight and age. Before inducing vomiting in the child, the Poison Control Center should first be called to check if vomiting would be the best course of action for the child. Parents should have poison antidotes (Ipecac) on the ready. Ipecac should also be kept in a locked cabinet and only be used as first aid for accidental ingestion (Gesley “Health”). After disposing of medicines, dustbins and trashcans should be tightly shut in order to prevent children from exploring and retrieving items already disposed of. About once every month, parents should check the contents of the medicine cabinet and assess which medicines are expired and which ones need to be disposed of. Parents should also be instructed to dispose of expired medications, and unexpired oral medications which have been opened and stored for a long period of time. This will help prevent mistakes in the administration of expired, spoiled, or contaminated medicines. Medicines should also not be referred to by parents as ‘candy’ (Hassler, “Nurses’ Corner”). This will help dissuade their eagerness to taste the medicines thinking they are sweet treats. Original labels in medicine containers should not be removed (Stewart “Article”). This will ensure the correct identification of the drug. Medicines should also not be transferred and moved to different containers (Hassler, “Nurses’ Corner”). Labels in the medicines should be visible and clear at all times. Containers with fading labels should be changed. Children should also not be given the responsibility of bringing medications to anyone (Stewart “Article”). When cleaning the house, parents should make sure that medications are moved to a safe area which is still very much away from children. When moving from one house to another, seal the boxes containing the medicines and when in the new place, be sure to keep these boxes out of the reach of children. Children will curiously look into the boxes to see what is inside them. So it is important for parents to keep medicine boxes separate and to immediately store them in locked cabinets. This will help ensure that even if the transferring and unloading of the boxes gets too busy or confusing, the more dangerous substances are kept safe. Accidental ingestion of medications in pediatrics is very much related to safety at home. The incidents of accidental ingestion in children have not been greatly reduced despite various safety devices available in the market. Many of these incidents have fortunately been treated by our emergency centers, but still, there have been some tragic incidents involving accidental ingestion of drugs. These incidents have been caused by faulty and/or absent supervision of children and by improperly stored and administered medications. Upon ingestion, children are known to exhibit a variety of symptoms depending on the drug and the amount of drug they have ingested. The most common manifestations of accidental ingestion of drugs are--vomiting, diarrhea, unusual sleepiness, breathing difficulties, and bleeding. Emergency centers are expected to work calmly and quickly to treat the child. Treatment usually includes gastric lavage, administration of charcoal, and, depending on the drug ingested, administration of the antidote to counter the toxic effects of the drug. In order to prevent accidental ingestion of drugs in the home, parents should keep all drugs out of children’s reach. Drugs should be kept in locked and child-proof containers. Emergency numbers should be visible near the phones. Parents should be aware of their children’s age, weight and height in order to readily provide this vital information in the emergency rooms. Bags and purses should be kept away from children. Finally, the most important thing that a parent can be is an attentive one. Parents should always remain alert and not be distracted by myriad concerns in order to avoid accidents in the home. The safety of children depends on constant and dedicated supervision. Children are vulnerable individuals; they also do not understand the concept of danger. This is why they should be constantly supervised. Works Cited “91, 000 Children per year treated for Accidental poisoning”. Articles. 17 March 2007. Inter- American Children’s Institute. 25 November 2008 “Accidental Ingestion in Children”. Safety and Prevention. June 2007. Health A to Z. 25 November 2008 “Accidental Poisoning in Children”. Emergency Department Factsheet. June 2008. Voctoria Department of Human Services. 25 November 2005. Aldridge, M. “Acute Iron Poisoning: What Every Pediatric Intensive Care Unit Nurse Should Know”. CE Connection. March/ April 2007. Nursing Center. 25 November 2008 “Antidepressant: Maprotoline, Ludiomil”. Medications. 2008 Support 4 Hope. 25 November 2008 Bartos, L. “Prevent Accidental Poisonings-National Poison Prevention Week”. Health and Safety. 2002. University of Nebraska-Lincoln. 25 November 2008 Botma, M. “Laryngeal oedema caused by accidental ingestion of Oil of Wintergreen”.  International Journal of Pediatric Otorhinolaryngology. 25 November 2008 Dart, R & Caravati, E. “Medical Toxicology”. Philadelphia: Lippincott Williams & Wilkins, 2004 Erickson, T., et.al., “Pediatric Toxicology: Diagnosis and Management of the Poisoned Child”. New York: McGraw-Hill Professional, 2004 Gahagan, L. “Delayed Poisoning Emergencies”. News. Professional Safety. 25 November 2008. Gesley, K. “The Trial of the “Terrible Twos””. Health. Palo Alto Community Child Care. 25 November 2008 Golightly, L. “Clinical effects of accidental ingestion levothyroxine ingestion in children”. Archives of Pediatrics and Adolescent Medicine. Vol. 141 No. 9, September 1987 Hassler, J. “Poison Prevention and Treatment in the Home”. Nurses Corner. 2006. Fort Campbell. 25 November 2008 Ho, L. “Accidental Ingestions in Childhood”. Article. Singapore Medical Journal. 25 November 2008.< http://www.sma.org.sg/smj/3901/articles/3901a1.htm> Hobbs, C., et.al. “Child Abuse and Neglect: A Clinicians Handbook”. London: Elsevier Health Sciences. 1999 “Just ask About Accidental Poisoning” Safety. US Pharmacopeia, 25 November 2008 Lopez, K. “Prevent Accidental Poisoning”. Your Health. March 2007. Kentucky Living. 25 November 2008 McEvoy, M. Poison (accidental) Advice and Safety. Great Ormond Street Hospital for Children. 25 November 2008 Meadow, R., et.al. “ABC of Child Protection”. Malden Massachusetts: Blackwell Publishing. 2007 Miall, L., et.al. “Paediatrics at a Glance”. Malden Massachusetts: Blackwell Publishing. 2003 “Safety at Home and Children”. What’s New. June 2003. Progressive Insurance. 25 November 2008 Sidaraju, M. “Poisoning”. Word Press. 2006. Gunny Bag Files. 25 November 2008 “Poisoning in Children”. Parenting Iloveindia.com. 25 November 2008. “Preventing Iron Poisoning in Children”. 15 January 1997. U.S Food and Drug Administration. 25 November 2008 “Safety Tips for you and your family”. Injury Prevention. 2005. Vermont Department of Health. 25 November 2008 Stewart, C. “Protect Your Kids from Coming into Contact with Harmful Chemicals”. Article. 5 February 2008. Suite 101. 26 November 2008 Youngson, R., et.al. “Encyclopedia of Family Health”. New York: Marshall Cavendish Corporation. 2005. FACTSHEET What is Accidental Ingestion of Medications? Accidental ingestion of medications usually occurs in children. It is the unintentional ingestion of medicines which are dangerous and toxic to their body. Children do not know the concept of danger and their natural curiosity usually drives them to explore, to try and to taste everything they see and touch. What causes accidental ingestion of medications in children? Accidental ingestion is usually caused by absent or faulty supervision by parents and caregivers. Caregivers and parents are sometimes busy with various tasks and fail to adequately supervise what children are doing. These short seconds of absent supervision are sufficient for children to find, to open medicine containers, and to ingest the contents. Improperly stored medicine containers can also cause accidental ingestion of medications by children. Medicines left in unlocked cabinets and drawers contribute vastly to incidents of accidental ingestion of medications. What are the most common medications accidentally ingested by children? The most common medications accidentally ingested by children are—iron tablets, paracetamol, antidepressants, sleeping pills, and oral contraceptives What are the symptoms of accidental ingestion of medications? Manifestations of accidental poisoning differ depending on the drug ingested and the amount of drug ingested. The most common manifestations of accidental of medications are: Vomiting Diarrhea Unusual sleepiness of drowsiness Breathing difficulties Bleeding Hyperactive behavior Flushing Tachycardia Hypertension Coma Stomach pain What are the first aid techniques for the child who has accidentally ingested medications? Check what medicine was taken by the child and call the Poison Center immediately. Follow their instructions to the letter. Supply them with information about the child’s weight, height, and age, and what drug was taken by the child. Unless instructed by the Poison Center, do not attempt to make the child vomit When asked to bring the child to the poison center, bring the bottle or container where the medication ingested is being kept. What are the interventions for accidental ingestion of medications? The interventions for accidental ingestion of medications usually depend on the drug that was ingested. But the most common interventions include: Establishment of accurate vital statistics from parents of caregivers which includes: weight, height, age of child, drug ingested, how much of the drug was ingested, time which has lapsed from intake of the drug Insertion of IV line Blood tests to determine toxicity Gastric Lavage Administration of activated charcoal Administration of Ipecac Administration of antidote Close monitoring What are the preventive measures for accidental ingestion of medications? Keep emergency numbers and Poison Centers visibly displayed near the phones Make sure to purchase medication in their child-proof containers Keep medications in locked cabinets or drawers at all times Do not store medications in places where food items are kept Do not refer to medicines as ‘candies’ Keep purses or bags away from children Always check labels and expiration dates of medications before administering them to children Regularly check your medicine cabinets for expired medications and dispose of them immediately. Dispose of medications in tightly lid trash bins Store medications in their original containers Keep children constantly supervised at all times, especially when moving or when doing multiple tasks. Read More