Pediatric Exposure to Laundry Detergent Pods Abstract
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ARTICLE Pediatric Exposure to Laundry Detergent Pods AUTHORS: Amanda L. Valdez, BS,a,b Marcel J. Casavant, WHAT’S KNOWN ON THIS SUBJECT: Case studies, abstracts, and MD,c,d Henry A. Spiller, MS, D.ABAT,c,d Thiphalak small-sample research studies have shown that laundry Chounthirath, MS,a Huiyun Xiang, MD, MPH, PhD,a,d and detergent pods pose important poisoning risks to young children. Gary A. Smith, MD, DrPHa,d,e aCenter for Injury Research and Policy at Nationwide Children’s WHAT THIS STUDY ADDS: From 2012 through 2013, 17 230 Hospital, Columbus, Ohio; bUniversity of Washington School of children exposed to laundry detergent pods were reported to US c Medicine, Seattle, Washington; Central Ohio Poison Center, poison control centers. Among children exposed, 4.4% were Columbus, Ohio; dThe Ohio State University College of Medicine, Columbus, Ohio; and eChild Injury Prevention Alliance, Columbus, hospitalized and 7.5% experienced a moderate or major medical Ohio outcome, including 1 confirmed death. KEY WORDS detergent pod, ingestion, NPDS, poisoning, poison control center ABBREVIATIONS AAPCC—American Association of Poison Control Centers NPDS—National Poison Data System abstract PCC—Poison Control Center OBJECTIVE: Mrs Valdez conducted the data analysis, and drafted and revised Laundry detergent pods are a new product in the US mar- the manuscript; Dr Casavant contributed to conceptualization of ketplace. This study investigates the epidemiologic characteristics and the study, assisted in data access and analysis, and critically outcomes of laundry detergent pod exposures among young children in reviewed the manuscript; Drs Spiller and Xiang contributed to the United States. conceptualization of the study, assisted in data analysis, and critically reviewed the manuscript; Mr Chounthirath assisted in METHODS: Using data from the National Poison Data System, expo- data analysis, and revised the manuscript; Dr Smith contributed sures to laundry detergent pods among children younger than 6 years to conceptualization of the study, assisted in data analysis, and – critically reviewed and revised the manuscript; and all authors of age during 2012 2013 were investigated. approved the final manuscript. RESULTS: There were 17 230 children younger than 6 years exposed to www.pediatrics.org/cgi/doi/10.1542/peds.2014-0057 laundry detergent pods in 2012–2013. From March 2012 to April 2013, doi:10.1542/peds.2014-0057 the monthly number of exposures increased by 645.3%, followed by Accepted for publication Sep 5, 2014 a 25.1% decrease from April to December 2013. Children younger than Address correspondence to Gary A. Smith, MD, DrPH, Director, 3 years accounted for 73.5% of cases. The major route of exposure Center for Injury Research and Policy, The Research Institute at was ingestion, accounting for 79.7% of cases. Among exposed chil- Nationwide Children’s Hospital, 700 Children’s Dr, Columbus, OH dren, 4.4% were hospitalized and 7.5% experienced a moderate or 43205. E-mail: [email protected] major medical outcome. A spectrum of clinical effects from minor to PEDIATRICS (ISSN Numbers: Print, 0031-4005; Online, 1098-4275). serious was seen with ingestion and ocular exposures. There were Copyright © 2014 by the American Academy of Pediatrics 102 patients (0.6%) exposed to a detergent pod via ingestion, aspira- FINANCIAL DISCLOSURE: The authors have indicated they have tion, or a combination of routes, including ingestion, who required no financial relationships relevant to this article to disclose. tracheal intubation. There was 1 confirmed death. FUNDING: Mrs Valdez received a research stipend from the National Student Injury Research Training Program at CONCLUSIONS: Laundry detergent pods pose a serious poisoning risk Nationwide Children’s Hospital, funded by the Centers for to young children. This nationwide study underscores the need for in- Disease Control and Prevention (grant 1R49CE002106) and a research stipend from the Child Injury Prevention Alliance creased efforts to prevent exposure of young children to these prod- while she worked on this study. The interpretations and ucts, which may include improvements in product packaging and conclusions in this article do not necessarily represent those of labeling, development of a voluntary product safety standard, and pub- the funding organizations. lic education. Product constituent reformulation is another potential POTENTIAL CONFLICT OF INTEREST: The authors have indicated strategy to mitigate the severity of clinical effects of laundry detergent they have no potential conflicts of interest to disclose. pod exposure. Pediatrics 2014;134:1–9 PEDIATRICS Volume 134, Number 6, December 2014 1 Downloaded from www.aappublications.org/news by guest on September 28, 2021 In early 2012, a new form of laundry household product since becoming avail- product code. There were 17 287 calls detergent emerged in the consumer able in 2010.13 involving at least 1 laundry detergent market in the United States. Advertised Using a national database, this study pod. The following were excluded from as a clever replacement for the liquid investigates the epidemiologic charac- the study: 5 calls with an incomplete form, detergent “pods” are small, single- teristics of laundry detergent pod expo- list of substances involved in the ex- use packets of concentrated detergent sures and consequences among US posure, 51 calls involving a laundry encased in a water-soluble membrane.1,2 children after these products entered detergent pod and 1 or more non- The colorful, candylike designs of the the US consumer market in 2012. laundry substances, and 1 “confirmed products may have contributed to a re- nonexposure” call.Therewere16623 cent phenomenon involving young chil- METHODS single laundry detergent pod exposure dren gaining access to the detergent Data Sources calls and 607 2-substance exposure calls pods and ingesting them or bursting that had codes for a laundry detergent This study analyzed data from the Na- them open, exposing their skin or eyes pod and another form of laundry de- tional Poison Data System (NPDS). The to the detergent chemicals.2,3 Exposure tergent. E-mail correspondence with the American Association of Poison Control has resulted in hospitalization and me- AAPCC indicated that these 2-substance Centers (AAPCC) receives poison call chanical ventilation for several days.1,4,5 exposure calls were actually a single data from each of the participating Serious medical consequences have laundry detergent pod exposure that had poison control centers (PCCs) that serve been documented, including respiratory been coded with an extra code. Therefore, the United States and its territories and distress, marked lethargy and de- these calls were included in the study by maintains the NPDS to catalog each call fi pression of consciousness, and dam- using the code of the rst-ranked sub- in near real-time. PCCs offer free, con- age to oropharyngeal mucosa.1,4–6 stance. This yielded 17 230 calls for this fidential medical advice and poison in- study, including 2 deaths of children 7 Literature on laundry detergent pod formationthroughthePoisonHelpLine and 16 months of age. The autopsy re- exposure in the United States consists 24 hours per day. For each exposure port for the 7-month-old and an un- largely of case series, abstracts, small- call, PCCs document the product(s) in- official incomplete version of the AAPCC sampledatareportsfromasinglestate, volved in the exposure, the amount death abstract for the 16-month-old were or national data that span only a brief reportedly involved, the route of ex- obtained and reviewed. time period.1,2,4,5,7,8 Case reports have posure, basic demographic data of Variables elucidated some of the most serious the exposed individual, subsequent clinical consequences after detergent medical information related to the Exposure route was grouped into ingestion, pod ingestion.1,4,5 A study using Texas exposure, and other information re- aspiration (with ingestion), dermal, ocular, Poison Center Network data found that garding the incident.14 Quality control inhalation, multiple routes with ingestion more patients were referred to a health measures are in place to ensure ac- (including ingestion combined with care facility and experienced moderate curacy and completeness of the data aspiration,inhalation,ocular,ordermal) or major effects after exposure to de- collected. US Census Bureau data were and other multiple routes (including tergent pods than traditional detergent.2 used to calculate population-based combinations of ocular, dermal, inhala- Countries in Europe have had laundry rates for laundry detergent pod expo- tion, and other). For subanalysis, ex- detergent pods available since 2001. sures in this study.15 posure routes were grouped into oral Studies from the United Kingdom have (including single or multiple routes with characterized the most common routes Case Selection Criteria ingestion and aspiration) and nonoral of pod exposure among children, the NPDS data for all laundry detergent (including dermal, ocular, inhalation, severity of these exposures, and clinical pod exposure calls from 2012 through and other multiple routes). features seen with each route of ex- 2013 among children younger than Exposure site was grouped into resi- posure.6,9,10 Detrimental ocular effects, 6 yearswere requested from the AAPCC. dence (includes patient’s own or other including conjunctivitis, keratitis, and These calls were identified using (1) residence) or other (includes