they looked like sweets..

I am not sure how to post this tragic story. There is often debate amongst health care workers regarding the age at which children can swallow tablets. Must evidence suggests that it is around 7 years of age obviously depending on the size and shape of the tablets and the child’s willingness to try. Obviously in an ideal world there would be a pleasant tasting liquid medicine available whenever and wherever a child requires a drug – we don’t live in an ideal world and children are often required to take adult sized tablets.

The story in the news today (http://www.bbc.co.uk/news/uk-england-manchester-29610570) highlights that children aged from 6 months to 6 years swallow lithium button batteries causing life-changing injuries and death in two cases. The reason they swallow them is that they “look like sweets”. This is a recognised danger for medicines where it is critical that children can tell the difference between a medicine and a sweet to avoid accidental ingestion. Within the healthcare industry we can provide child resistant packaging to reduce the risk of accidental ingestion but there are still plenty of cases of overdose in very young children.

in 2011 a study reported cases of overdose with buprenorphine (an alternative to methadone) in children as the tablet looked similar to candy. These children were predominantly under 3 years of age.

Reference:

Pedapati, E.V., Bateman, S.T.
Toddlers requiring pediatric intensive care unit admission following at-home exposure to buprenorphine/naloxone
(2011) Pediatric Critical Care Medicine, 12 (2), pp. e102-e107.

There are three elements for further discussion based on this background; (1) the need for appropriate storage and packaging for medicines to protect children; (2) the need to ensure medicines look distinctly different to sweets and (3) to challenge the belief that children cannot swallow tablets until 7 years of age.

(1) Medicines storage: this is already well thought out and there are many novel packaging solutions to ensure medicines can be child resistant. However, there is a need to educate parents and carers about safe storage of all medicines within the home. Perhaps a grandmother has a dosette box left open in the bathroom or bedroom – the child needs to understand that these medicines are unsafe

(2) Medicines should look different to sweets. Current European guidelines propose that all childrens’ tablets should be white to avoid them looking like candy. This has some merits. However, a disadvantage lies in the lack of ability to identify the different drugs that a child may require. Also in cases of overdose it is important for health care professionals to identify which drugs have been ingested to treat the poisoning effectively.

(3) safe swallowing of solids. There are pill schools and such like that help children learn how to swallow tablets when no liquid medicines are readily available. These can be extremely useful to parents and children to ensure they receive effective therapy.

All these cases raise issues that are important to discuss with children, families and pharmaceutical manufacturers to ensure that safe, age-appropriate medicines are available to children.

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