Flow restrictors may reduce accidental swallowing of liquid medicines by young children, study finds
In tests with more than 100 children, US researchers find that flow restrictors are a deterrent to access to medicines
In the US, child-resistant packaging for most medications has contributed to the prevention of thousands of child deaths. Nevertheless, more than 500,000 calls are made to poison control centres each year after accidental ingestion of medications by young children, and the number of emergency department visits for unsupervised medication ingestions is rising.
In a new study published in The Journal of Pediatrics, researchers studied whether adding flow restrictors (adapters added to the neck of a bottle to limit the release of liquid) to bottles can limit the amount of liquid medication a child could access even if child-resistant caps are missing or improperly closed.
Standard child-resistant packaging is designed to prevent or delay young children from opening bottles, giving carers reasonable time to intervene. However, for the packaging to work effectively, Daniel Budnitz and colleagues from the Centers for Disease Control and Prevention, Emory University, and the Georgia Poison Center in the US say: ‘Caregivers must correctly resecure the cap after each and every use. If the cap is not correctly resecured, children can open and drink whatever medication is in the bottle.’
Adding flow restrictors could complement the safety provided by current child-resistant packaging
To address a potential second line of defence, the researchers studied whether flow restrictors had any effect on the ability of children to remove test liquid, as well as how much they were able to remove in a given amount of time. Two tests were conducted with 110 children, aged 3-4 years. In one test, the children were given an uncapped medication bottle with a flow restrictor, and in the other test, the children received either a traditional bottle without a cap or with an incompletely closed child-resistant cap. For each test, the children were given 10 minutes to remove as much test liquid as possible.
Within two minutes, 96% of bottles without caps and 82% of bottles with incompletely closed caps were emptied. In contrast, none of the uncapped bottles with flow restrictors was emptied before six minutes, and only 6% of children were able to empty bottles with flow restrictors within the 10-minute test period. Overall, older children were more successful than younger children at removing liquid from the flow-resistant bottles. None of the youngest children (36–41 months) was able to remove 5mL of test liquid, which is the amount in a standard dose of acetaminophen for a 2 to 3 year-old child.
Manufacturers voluntarily added flow restrictors to over-the-counter infant acetaminophen in 2011. Based on their effectiveness, the authors suggest that flow restrictors could be added to other liquid medications, especially those harmful in small doses.
According to study co-author Maribeth Lovegrove: ‘Flow restrictors are designed as a secondary barrier and carers should not rely on flow restrictors alone; adding flow restrictors could complement the safety provided by current child-resistant packaging.’ Carer education should continue to focus on consistently locking child-resistant caps and storing medications away and out of sight of children.