Opioids were the most common contributor to fatal poisonings among children ages 5 and younger in the U.S., according to an analysis of data from 40 states.
In this age group, the proportion of opioids accounting for fatal poisonings increased from 24% in 2005 to 52% in 2018, reported Christopher Gaw, MD, MBE, of the Children's Hospital of Philadelphia, during the American Academy of Pediatrics annual meeting.
"We're assuming that illicit substances such as fentanyl are driving the increasing proportion of [opioid-related] pediatric fatalities that we're seeing," Gaw told MedPage Today.
Illicit and prescription opioids contributed to 42% of all fatal poisonings tracked from 2005-2018, followed by over-the-counter drugs such as painkillers and cold/allergy medications (13%), other/unspecified illicit drugs (13%), other/unspecified over-the-counter or prescription drugs (9%), and other substances/toxins (6%). Carbon monoxide poisoning contributed to 6% of deaths.
Which opioids are contributing the most? The data don't say. "There's a lot of interest in illicit fentanyl in the past couple of years, and it is likely a contributor to the increasing proportion of deaths described in our study," Gaw noted. "But we can't confirm that concretely with the data."
Opioid poisonings are often accidental, he said. "There's maybe an opioid pill on the ground or under the couch, and a lot of the children in this age range are in the oral exploratory stage," he added. "Children weigh much less than adults, so that one pill just gets amplified."
In other cases, children may chew on opioid pain patches or ingest opioids in powder form, he said.
Naloxone (Narcan) is the typical treatment for opioid overdoses in children and adults, he noted. "It's the antidote for severe or life-threatening opioid poisonings for any age."
While other studies have tracked a rise in fatal opioid poisonings in children, this study is notable because it focuses on the youngest children and reviews data from the National Fatality Review-Case Reporting System. Child death review committees examine autopsy reports and medical records to "try to review as many deaths as feasible," Gaw said, although they may miss some in their jurisdictions.
Due to the limitations of their data, the researchers didn't release the total number of poisoning deaths per year. An increase in cases "could simply mean child death reviews were able to review more deaths in a given year or over time" due to factors like funding or participation, Gaw explained. As a result, it's not possible to know whether the rise in opioid-related poisonings have boosted the overall number of deaths.
Of 731 fatal pediatric poisoning cases from 2005-2018, 53% were in boys, 40% were white, 30% were Black, and 16% were Hispanic; 61% occurred at home, and 15% had a history of maltreatment.
Disclosures
Gaw and co-authors reported no conflicts of interest.
Primary Source
American Academy of Pediatrics
Source Reference: Gaw CE, et al "Characteristics of fatal poisonings among infants and young children in the United States" AAP 2022; Abstract PC2126.
