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Decreasing the Size of Bottle Caps: Helping or Hurting Children?
Lauren A DiNardo1, Arunima Vijay2, Alyssa D Reese1
1Jacobs School Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA.
Insights
Plastic bottle cap ingestions in children have significantly increased over the past two decades. This rise in pediatric bottle cap injuries correlates with the trend toward smaller bottle cap sizes.
Area of Science:
- Pediatric Emergency Medicine
- Public Health Surveillance
- Consumer Product Safety
Background:
- Ingestion of foreign bodies is a common pediatric emergency.
- Bottle caps, particularly from plastic bottles, pose a choking and ingestion hazard.
- Changes in product design, such as bottle cap size, may influence injury trends.
Purpose of the Study:
- To determine the association between decreasing bottle cap size and the incidence of pediatric ingestions and injuries.
- To analyze national trends in bottle cap ingestions among children.
Main Methods:
- Retrospective analysis of the National Electronic Injury Surveillance System (NEISS) database.
- Inclusion of data for children aged 0–18 years from 2002 to 2021.
- Collection and analysis of demographic factors, ingestion location, and patient disposition.
Main Results:
- An estimated 11,683 bottle cap ingestion injuries occurred nationally between 2002 and 2021.
- A statistically significant increase in bottle cap ingestions was observed from 2002 to 2021 (P < .001).
- The majority of injuries occurred in males, with a mean age of 10.3 years; most patients were treated and released from the emergency department.
Conclusions:
- Pediatric plastic bottle cap ingestions have markedly increased over the last 20 years.
- This trend coincides with the widespread adoption of smaller bottle cap designs.
- Further research into product safety standards for small ingestible items is warranted.
Objective:
Our study aims to assess if decreasing bottle cap size was associated with more ingestions and injuries nationally. STUDY DESIGN: Retrospective chart review.
Setting:
The National Electronic Injury Surveillance System (NEISS) database.
Methods:
The NEISS was queried for bottle cap ingestions in children 0 to 18 years old between 2002 and 2021. Demographic factors including age, race, and sex of the patient were recorded. The location where the ingestion took place and the disposition of the patient were also analyzed. Data were excluded if the narrative did not specify the ingestion of a cap of a drinking bottle.
Results:
A total of 415 bottle cap ingestion injuries were identified, for a national estimate of 11,683 injuries. The mean age at the time of ingestion was 10.3 ± 5.2 years and the majority of the injuries occurred in males (N = 9129, 78.4%). 46.4% (N = 5398) were Caucasian, 17.6% (N = 2046) were Black or African American, and 2.7% (N = 311) were Hispanic. 55.0% (N = 6405) of injuries occurred at an unknown location, 41.4% (N = 4781) occurred at home, and 2.8% (N = 326) occurred at school. 82.3% (N = 9584) of patients were treated in the emergency department and released, 6.9% (N = 808) were treated and admitted, 6.7% (N = 783) were treated and transferred, and 0.9% (N = 110) were held for observation. From 2002 (N = 6) to 2021 (N = 2291), there was a statistically significant increase in bottle cap ingestions (P < .001).
Conclusion:
Plastic bottle cap ingestions have increased in children over the last 20 years, coincident with the change to smaller bottle caps.
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