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Recent increases in numbers and risk of fatalities in young children ingesting iron preparations
M Berkovitch1, D Matsui, S H Lamm
1Division of Clinical Pharmacology and Toxicology, Hospital for Sick Children, Toronto, Canada.
Insights
Fatalities from iron preparation ingestions in young children significantly increased from 1983-1991. This rise in pediatric iron deaths outpaced ingestion rates, suggesting a need for safer packaging and education.
Area of Science:
- Toxicology
- Pediatric Health
- Public Health
Background:
- Iron preparations are a leading cause of fatal pediatric poisonings.
- A concerning increase in iron-related deaths among young children has been observed.
Purpose of the Study:
- To quantify the rise in pediatric iron fatalities.
- To investigate the reasons behind the increased mortality rates.
Main Methods:
- Utilized data from the American Association of Poison Control Centers.
- Calculated annual mortality rates for iron preparations in the general population and children under 6.
- Recorded changes in ingestion incidence between 1983 and 1991.
Main Results:
- Reported ingestions of iron preparations by toddlers increased 2-3 fold between 1983 and 1991.
- Mortality rates per 100 exposures to iron preparations significantly increased in 1991 for both the general population and children under 6.
- The increase in mortality exceeded that predicted by the rise in ingestions alone.
Conclusions:
- Increased awareness of anemia during pregnancy likely led to greater iron pill use.
- The candy-like appearance of iron pills poses a significant risk to children.
- Legislation for packaging changes, warning labels, child-resistant packaging, and public/physician education are urgently needed.
Abstract:
Iron preparations are the most frequent cause of pediatric ingestion fatalities. The purpose of this study was to quantify the impression of an increase in iron deaths in young children and to postulate on the reasons. Using the data provided by the American Association of Poison Control Centers, overall annual mortality rate from iron preparations and among children < 6 y was calculated and changes in incidence were recorded. Between 1983 and 1991, there was a 2 to 3-fold increase in the numbers of reported ingestions of iron preparations by toddlers. In the general population the annual mortality rate/100 exposures to iron preparations increased from 0.05 during 1983-1990 to 0.116 in 1991 (p < 0.01). A similar trend was noted in children < 6 y with a rate of 0.004 in 1983-1990 compared with 0.12 in 1991 (p < 0.01). Hence, the increase in mortality was beyond what would be predicted from the increased number of ingestions noted. It is likely that increased awareness of pregnancy-induced anemia results in abundant use of iron pills. These pills have the appearance of candies, which should be changed immediately by legislation. During this period, the volume of iron preparations prescribed increased only marginally (16%), suggesting that over-the-counter use of iron pills increased substantially. In addition to warning labels and child-resistant packaging, an aggressive educational plan directed at the general population and physicians should be instituted immediately.