By: Michelle Place, CRNP-P
There are some kids out there who will not allow a drop of medicine to pass their lips. These are the ones we have to cajole, beg, bribe and finally resort to hiding the drug in chocolate syrup. Then there are the ones like my son who, when diagnosed with an ear infection at the age of 2, never missed a single dose of the antibiotic he was prescribed. This is not because I am any better than anyone else at remembering to give the medicine twice/day, 10 days out. It is because he would constantly ask, “Is it medicine time? Is it medicine time?” and then he cried when the bottle was empty. If I had given him that bottle and a straw he would not have stopped sucking until he was slurping up amoxicillin-flavored air. If you have a child like mine you know that no child-resistant cap is going to stop them for long if they are motivated and given enough time to figure it out.
How do you open this thing?
Medication bottles have been closed with child-resistant caps since the passing of the U.S. Poison Prevention Packaging Act in 1970. Prior to this legislation, poisoning by common household products, including medications, was a leading cause of injuries in children under 5 years. Studies show that these closures do save lives.The caps work by requiring the user to perform two different actions simultaneously (like squeezing while turning). To determine if a product is child-resistant it is tested by a group of, well, children. To mimic the way it would happen in the home, a pair of children between the ages of 42 – 51 months are left with the bottle and given 5 minutes to see if they can open it. If they are unable to accomplish the task they are given one visual demonstration then left for another 5 minutes to try to work it out. If fewer than 20% of the 200 kids tested are able to get it open it is labeled child-resistant. Now, if you have ever tried to get into one of these bottles, especially while your child is crying and burning up with fever, you may feel that they are not only child-resistant but also adult-proof. Believe it or not the packaging is also tested to ensure ease of use by adults. Test subjects are given 5 minutes to open and properly close the product and if 90% of 100 people tested can accomplish this, it passes! Originally they used a test group of adults aged between 18 and 45. This changed when studies showed that children were being poisoned by medicine that belonged to their grandparents. This was a result of the fact that elderly people had a lot of trouble with the caps so they were left loose or off altogether. Now the closures are tested by adults ranging in age from 50-70. (http://www.cpsc.gov//PageFiles/112312/384.pdf)
Child-Resistant not Child-Proof
The important takeaway message is that at least 20% of children can open these bottles if given up to 5 minutes to figure it out. These caps are not meant to be the first line of defense but the last. Their purpose is to slow kids down so that you will have time to catch them before they can ingest any medicine. This is why it is imperative that the bottles are not inadvertently left on kitchen counters or tables that are within easy reach of your child. All medicines should be stored in a cabinet that can be reliably secured. It is important to never refer to any medicine as “candy.” Also, be aware of the environments in which your children spend time. You easily have control of things in your own home. Children may spend a lot of time with grandparents, for example. Some older people request standard caps which are easier to open. Easier for everyone.
Who Ya Gonna Call?
If your child does manage to get into a bottle of yummy grape or bubblegum flavored medicine and dose themselves with a greater than recommended amount, do not waste time googling to find out what you should do. Immediately call the Poison Control Center (http://www.aapcc.org/) at 1-800-222-1222. This emergency hotline is manned 24 hrs a day, 7 days a week by poison specialists. They can advise you quickly on what steps need to be taken. It is a good idea to have this number posted not only next to your home phone along with other emergency numbers but also to program it into your cell phone. It is an easy number to remember unless you are panicking because your child just downed a bottle of something he shouldn’t have.
Always call Poison Control first because they have the most accurate, up-to-date information about almost anything your child may ingest right at their fingertips, however, if after speaking to them you still have questions/concerns do not hesitate to call us at Potomac Pediatrics at 301-279-6750.