Blame it on medicines

by Dr. SANJEEV BAGAI

Keep medicines within reach of children.

Accidental ingestion of drugs by children can have serious consequences. One way to prevent this is to have child-resistant packaging, as in the West.

Picture a child fiddling with his granddad's diabetes pills. Imagine how dangerous it would be if he were to swallow these. It could cause the child's blood sugar plummet to dangerously low levels. This is just one of the many scenarios that the accidental ingestion of drugs could possibly lead to. Incidents like these do actually happen. And with alarming regularity.

Nearly 70 per cent cases of poisoning in children are due to accidental ingestion of drugs. According to a study published in the American Journal of Preventive Medicine (September 2009), seven out of 10 cases of paediatric poisoning in the U.S. are due to unintentional drug ingestion. Experts aver that the incidence of poisoning in children due to unsupervised drug ingestion is on the rise in India as well.

“Unsupervised ingestion of drugs by children can have serious consequences and may even prove fatal sometimes. Often children have easy access to their medicines. The child may find the packaging attractive and may, out of curiosity or out of sheer adventurism, ingest a medicine in quantities large enough to cause harm. Of late we have seen a rise in the number of children reporting to us with accidental drug overdose. This is a cause for serious concern. The fact that such incidents are completely preventable makes the rising incidence totally unacceptable.”

Real danger

Unsupervised ingestion of drugs by children is a real danger. Children less than five years of age tend to put everything they find into their mouths. They may also be attracted to brightly coloured pills and syrups. Therefore if medicines are left lying within their grasp, the chances of accidental ingestion and over-dosage increase significantly.

An added danger in case of very young children is their tendency to share these medicines with other children, making the situation even more difficult to handle.

In children younger than five years the risk of accidental ingestion of drugs is more given their tendency to explore. This is not to say that accidental ingestion of drugs will not happen to older children. It can and it does. We could practically neutralise the risk if we could somehow prevent access. This is already happening in the West where child-resistant caps and packaging of a majority of drugs is being made the norm.

Child-resistant caps or Child Resistant Closure (CRC) mechanisms make it hard for children to access the contents of a package. In countries like the U.S., child-resistant packaging is mandatory for most drugs. A similar regulation in India would help bring down the incidence of accidental ingestion of drugs.

In India some companies use CRC packaging but these are mainly meant for export markets.

The commonest forms of CR packaging currently available in India include “push through” or blister packs with thicker foil or paper/foil laminate. These require a greater effort to get the medicine out and ensure that the child gives up after a few attempts. By making CR packaging a must for products that are harmful to children, a large number of incidents of paediatric poisoning due to drug overdose can be avoided.

However, it is also important to ensure that the CRC mechanism in question offers easy accessibility to adults for whom the medicine is intended. It is important, for instance, to ensure that the package is easy to open for an adult who may have a disabling condition like Rheumatoid Arthritis (in which small joints of the fingers are affected and movement may be painful and difficult).

Cost factor

Then there is the cost factor. It has to be ensured that CR packaging does not push up the costs of the products significantly. An ideal thing would be to have a CR packaged product that offers easy access to adults and cost-effective as well.

With the rising incidence of paediatric poisoning due to unsupervised drug ingestion the need for child resistant packaging of drugs is being increasingly felt. The introduction of this concept in the domestic Indian market means that a large number of pharmaceutical companies might already be in the process of lapping it up. This might eventually lead to CR packaging being made mandatory in India. On the other hand it could very well be that CR packaging being made mandatory in India forces these companies to follow suit. Be that as it may, whichever way the tide turns, consumers stand to gain.

The writer is a Sr. Consultant Paediatrician, Neonatologist and Paediatric Nephrologist based in Delhi.