Elsevier

The Journal of Pediatrics

Volume 157, Issue 5, November 2010, Pages 832-836.e1
The Journal of Pediatrics

Original Article
Malicious Use of Pharmaceuticals in Children

https://doi.org/10.1016/j.jpeds.2010.05.040Get rights and content

Objective

To describe malicious administration of pharmaceutical agents to children.

Study design

We performed a retrospective study of all pharmaceutical exposures involving children <7 years old reported to the US National Poison Data System from 2000 to 2008 for which the reason for exposure was coded as “malicious.”

Results

A total of 1439 cases met inclusion criteria. The mean number of cases per year was 160 (range, 124 to 189) that showed an increase over time. The median (IQR) age was 2 (1.5) years. Outcome data were available for 1244 (86.4%) patients. Of these exposures, 172 resulted in moderate or major outcomes or death. 9.7% of cases involved >1 exposed substance. The most common reported major pharmaceutical categories were analgesics, stimulants/street drugs, sedatives/hypnotics/antipsychotics, cough and cold preparations, and ethanol. In 51% of cases there was an exposure to at least one sedating agent. There were 18 (1.2%) deaths. Of these, 17 (94%) were exposed to sedating agents, including antihistamines (8 cases) and opioids (8 cases).

Conclusions

Malicious administration of pharmaceuticals should be considered an important form of child abuse.

Section snippets

Methods

This is a retrospective database study characterizing all pharmaceutical exposures in children <7 years old reported to the National Poison Data System (NPDS) and coded as “malicious.” The University of Colorado Institutional Review Board approved this study.

Cases were identified from the NPDS (a database of all calls to US poison centers). A query was performed for the years 2000 to 2008 for all cases meeting the following criteria: the intent was coded as “malicious,” age was <7 years old,

Results

Of approximately 21.4 million exposures reported to NPDS during the study period, 1439 (0.007%) cases met inclusion criteria comprising 1634 total exposures. The mean number of cases per year was 160 (range, 124 to 189). Cases increased over time in a linear model (P = .006). Boys were involved in 56.6% of the cases. The median (IQR) age was 2 years (1.5). Table I shows the distribution of ages and outcomes. Outcome data were available for 1244 (86.4%) patients. Of these cases, 13.8% resulted

Discussion

On average, 160 cases per year were reported to US poison centers during the study period, including an average of two deaths per year. Cases reported to poison centers increased over time. As a practical matter, only exposures to pharmaceuticals were included in this study. This would only underestimate the true incidence of child maltreatment by poisoning as cases with nonpharmaceuticals such as caustic agents,17 rodenticides,18 and ethylene glycol19 have been reported. Although Kempe et al20

References (31)

  • A. Sauvageau et al.

    Child and adolescent victims in forensic autopsy: a 5-year retrospective study

    J Forensic Sci

    (2008)
  • C. Naso et al.

    A study of drug detection in a postmortem pediatric population

    J Forensic Sci

    (2008)
  • I. Giurgea et al.

    Factitious hyperinsulinism leading to pancreatectomy: severe forms of Munchausen syndrome by proxy

    Pediatrics

    (2005)
  • R. Meadow

    Munchausen syndrome by proxy

    Arch Dis Child

    (1982)
  • L. Marinetti et al.

    Over-the-counter cold medications-postmortem findings in infants and the relationship to cause of death

    J Anal Toxicol

    (2005)
  • Cited by (0)

    The authors declare no conflicts of interest.

    View full text