Expert Advice from the CDC about Drug Safety

Drug Safety Tips

There is no doubt that special bonds exist between grandparents and their grandchildren. No grandparent ever wants to put their grandchildren in danger, but easy access to medications (prescriptions and over the counter) is extremely dangerous. And before you say, “I keep my pills where my child or grandchild can’t get them.” What happens if your child is visiting a friend, or at a baby-sitters home and finds a pill that was dropped accidentally on the floor? Keep reading to find out what happened to one families precious little girl.

If you have ever been around young children very often you know that they will put anything in their mouth, and I do mean anything! In 2020, about 35,000 children under the age of 5 years were brought to emergency rooms after getting into medicine that was left within reach. More than 70% of these children were 2 years of age or younger – a stage that involves exploring their surroundings and often putting things into their mouths. (One of my grandchildren loves to see if he can get in the dog food bowl for a snack….yuck!)

The Center for Disease Control

Recently I was contacted by the CDC about medication safety. I sent questions to Maribeth L. Sivilus, MPH, who is an epidemiologist with the Medication Safety Program. What follows is information that every grandparent and parent should know.

What medication do you see as the biggest threat today?

• Based on data from 2017-2020, medications involved in the highest numbers of emergency department (ED) visits for unsupervised medication exposures by children aged 5 or younger included non-prescription pain relievers (like acetaminophen and ibuprofen), herbals/alternative remedies (like melatonin), antidepressants, prescription opioids, and sedating antihistamines (like diphenhydramine).  From 2009-2012 to 2017-2020, ED visits for unsupervised pediatric exposures declined for many medications/classes, but ED visits involving melatonin exposures increased significantly (likely driven by an increase in melatonin use in households with young children).  While all medications can cause harm if taken in the wrong amount or by the wrong person, some medications have a high potential for harm in small amounts (e.g., prescription opioids), and extra care should be taken to keep these medications up and away and out of the sight and reach of young children. A recent article on CDC’s Safe Healthcare Blog by Adam and MaryBeth Gillan shared their tragic story of how their nine-month-old daughter, Maisie, died after ingesting a methadone pill at a neighbor’s house that was on the floor.

Drug Safety for Parents and Grandparents

1. Keep all medicines, vitamins, and other supplements (including gummies) in a location that is up and away and out of children’s reach and sight – such as a high cabinet or high closet shelf.

2. Put medicines away every time.  Never leave loose pills or other medicines out on a kitchen counter or at a sick child’s bedside, even if you have to give them again in a few hours.  To a young child, pills can look like candy and liquid medicines can look (and taste) like fruit drinks.

3. Keep medicines in child-resistant containers and make sure the safety cap is locked. If the bottle has a locking cap that turns, twist it until you hear the click or cannot twist anymore.

4. Teach your children (and grandchildren) about medicine safety.  Teach your children what medicine is and why you or another trusted adult must be the one to give it to them.  Never tell children that medicine is candy to get them to take it, even if they don’t like to take their medicine.

5. Remind guests about medicine safety. Ask family members, houseguests, and other visitors to keep purses, bags, or coats that have medicine in them up and away and out of sight when they are in your home.

6. Take time to sweep or vacuum the floor before young children come to visit. It’s easy for pills to fall on the floor and roll out of sight. Help the young children in your life stay safe — be sure to sweep or vacuum the floor before their next visit.

7. Curious young children can move quickly, and so it’s important to be prepared in case of emergency. Call Poison Help (800.222.1222) right away if you think a child may have gotten into a medicine, vitamin, or other supplement, even if you are not completely sure.  Also make sure that babysitters, older children, grandparents, and frequent family visitors have this information too, in case there’s an emergency when they’re in charge. To learn more about storing medications safely at home or when traveling with young children, visit the Up and Away and Out of Sight campaign website (https://upandaway.org).

What have you seen happen in the past ten years? 

In the early 2000s, ED visits for unsupervised medication exposures were rising. For perspective, a child born in 2007 had approximately a 1 in 54 chance of being brought to an ED for an unintentional medication overdose or exposure by the age of 6 years. In response, in 2008, CDC initiated thePRevention of Overdoses and Treatment Errors in Children Taskforce (PROTECT) Initiative — an innovative collaboration bringing together public health agencies, private sector companies, professional organizations, consumer/patient advocates, and academic experts to develop strategies to keep children safe from unintentional medication overdoses. Over the past decade and a half, PROTECT Initiative activities have helped to achieve safety improvements in each key focus area: 1. packaging improvements to prevent unsupervised exposures; 2. error prevention through standardization of medication labels and dosing devices; and 3. updated educational messages on safe medication use and storage for new generations of parents, grandparents, and other caregivers. Since 2010, there have been substantial declines in ED visits for unsupervised medication exposures, but in 2020, there were still approximately 36,000 estimated ED visits for unsupervised medication exposures by children aged 5 or younger – and so there is still more work to be done.

How can we make the next ten years better? 

• The PROTECT Initiative is a data-driven collaboration, and so we continually monitor trends to determine whether prevention approaches need to be updated to address new or emerging risks.  Over the next 10 years, we hope to continue to support and encourage innovation in medication safety packaging to identify innovative packaging designs that work well at preventing access by young children, while also making it easy for adults (including older adults) to access their medications.  Flow restrictors (adaptors added to the neck of liquid medication bottles to limit access by children) have been voluntarily added to some over-the-counter medications (e.g., products containing acetaminophen) and studies have shown that they have been effective in reducing the number of pediatric exposures and the amount of medication that young children can access. Broader implementation of flow restrictors on other liquid medications that frequently lead to ED visits or poison center calls (e.g., diphenhydramine, cough and cold medications) could help prevent these exposures. Additionally, while the majority of ED visits for medication overdoses in children aged 5 or younger are due to unsupervised exposures (>90%), about 5% are due to medication errors. Clearly and consistently using metric units (i.e., milliliters [mL])-only on liquid medication packaging, labels, and dosing devices (e.g., oral syringes and dosing cups) can reduce errors when measuring and giving doses. Continued efforts to educate parents, grandparents, and other caregivers to use the dosing device that comes with the child’s medicine can help ensure that they get the right amount. We also plan to continue to update educational messages based on current data, and to achieve broader reach of these messages for parents, grandparents, and other caregivers of young children.

Maribeth L. Sivilus, MPH is the lead epidemiologist in CDC’s Medication Safety Program in the Division of Healthcare Quality Promotion, where she has worked since 2009. Her work focuses on using national public health surveillance data to characterize adverse drug events and to target safety interventions. Over the past decade, Ms. Sivilus has focused her attention on developing innovative approaches to preventing medication overdoses in young children and fostering implementation and adoption of these approaches through CDC’s public-private PRevention of Overdoses and Treatment Errors in Children Taskforce (PROTECT) Initiative. She has authored over 35 scientific publications, including articles focused on pediatric overdose prevention, in JAMA, Pediatrics, and American Journal of Preventive Medicine.

You can find more information at the following links: Up and Away Campaign | Medication Safety Program | CDC and Up & Away | Put your Medicines Up and Away and Out of Sight of Children Up & Away | Put your Medicines Out of Sight of Children.