The unintentional poisoning of NYC children

Photo Credit: “Girl in Blue Top Focus Photo” by nappy from Pexels

Lavette Browne, a 50-something year old mother living in the Brownsville section of Brooklyn, NY, has never heard of a poison control center and is grateful that she has never had to call one for any of her five children.

“I’m a mother and I’ve never had to, thank goodness, knock on wood, had to call a poison control center. I wouldn’t even know if I’m even allowed to call poison control. Isn’t that something EMTs do?”

-Brooklyn mother of 5, Lavette Browne on knowing about calling a poison control center

In March, Browne and a dozen other mothers, who reside at the Langston Hughes Housing Development Apartments and who also periodically visit and/or volunteer at the Center for Health Equity’s Neighborhood Health Action Center three blocks away, sat down and discussed their varied experiences at the center. Despite the center’s many health-themed community events that these mothers organized and/or participated in, some for the past two years, none of the events’ topics have been about the dangers of children exposed to medications or household products or about the regional poison control center.  

The New York City Poison Control Center receives approximately 4,000 calls annually for New York City children younger than 15 years that are then referred to or managed by a health care facility. Most cases of these pediatric poison exposures occur within the city’s poorest neighborhoods like Brownsville. However, most calls per capita to the New York City Poison Control Center (PCC) are made by those who reside in the wealthiest communities of the city’s five boroughs like Queens’ Hunters Point.

Last November, the New York City Department of Health and Mental Hygiene (DOHMH) released PCC data that stated residents in the NYC’s poorer neighborhoods on average call the center 47 percent less frequently than those in wealthier communities even though poison exposure resulting in a hospital admission was higher in high poverty areas in 2016. While hospitalization was a rare event in 2016 (and in years past), when it did occur, the rate of all poisoning calls resulting in hospital admission was higher in very-high-poverty neighborhoods (96 per 100,000 people) compared with the wealthiest neighborhoods (69 per 100,000).

Nearly 300 poisoning calls result in the hospitalization of young children in New York City every year. Fatalities are even more rare in this age group. New York City’s Poison Control Center receives nearly 8,000 “close calls” every year. Close calls are reports of young children exposed to potentially toxic substances who do not require medical treatment. For every call that results in immediate hospitalization, 11 others involve children who are treated and released.

Photo Credit: “White and Red Capsules” by Pixabay

In 2016, 75 percent of calls made to the New York City Poison Control Center were connected to 1- to 4-year-olds ingesting medications used to treat cardiovascular conditions (usually prescribed for adults). However, as stated in the most recent DOHMH report, in 2016, personal care products and household cleaners were the most common products involved in actual poisoning exposures among children younger than 6 years old. There were more than 4,000 cases and this number represents both unintentional and intentional cases. For children under 6 years old, approximately 500 of them were exposed to sedative hypnotics and/or street drug stimulants.

Another problem is overdosing. In children younger than 6 years old, double dosing errors often resulted from multiple caregivers giving medication. One in nine poisoning exposures is related to medication error. In 2016, there were over 1,600 such cases. Cases of unintentional poisoning due to medication error represented 12 percent of the total cases managed by the poison control center in 2016.

Most poisoning cases (98 percent) occur inside the home, according to NYC Vital Signs, a research and statistical fact sheet published by DOHMH. Sometimes the exposure to poisons is intentional; however, most often, it is unintentional.

In 2016, 61 percent of all potential poisoning exposure cases (38,397) were managed at the site of exposure (usually at the young child’s residence) and did not require a visit to a hospital emergency room. 12 percent of all cases were admitted to the hospital, and 13 percent of all cases were treated and released from the emergency room.  Nearly all (96 percent) were unintentional poisoning exposure cases.

These numbers demonstrate a need in high-poverty communities for improved awareness of their regional Poison Control Center, and about the risks of young children ingesting medications and household products at home. That is where the city’s ACS comes in. 

On November 29, 2017, Administration for Children’s Services (ACS) Commissioner David A. Hansell announced a campaign to educate parents, caregivers and community service providers on how to prevent unintentional exposures to high-risk medications and household products in their homes when children are present. This public campaign is a partnership with ACS and the DOHMH and is designed to instruct families and caregivers to contact the NYC Poison Control Center immediately if they suspect that children have ingested any type of medication or household product. Commissioner Hansell announced that the campaign would “empower families and caregivers to create plans to proactively safeguard their medications and household products at home.”

According to a press release about the campaign, ACS said it will engage parents and caregivers, child welfare service providers, child care providers, home care workers, nurses, medical staff, shelter providers, NYPD officers, Fire Department, foster care agencies, and substance use treatment centers and provide them information about the importance of medication safety, with an emphasis on medication storage and proper disposal of high risk medications and household products.

Since the campaign to increase awareness, the incidences of reported exposure to medications has fallen. ACS’s website published that the NYC Poison Center received more than 87,000 calls in 2016 regarding exposure to pharmaceuticals and medications for the five boroughs, Nassau, Suffolk and Westchester counties. For the same period in 2018, the Poison Control Center received less than 78,000 calls regarding exposure to medications.

“There is nothing more important than keeping our children safe, and that includes preventing tragic accidents from happening.”

-New York City’s ACS Commissioner David A. Hansell

With a decrease in the number of calls to the New York City Poison Control Center, one could ask, “Is the decrease due to fewer exposures to poisons, or is the lack of reporting because parents are still not aware?”

“People have to understand that a poison control center exists. And so, if you don’t know it exists, you would never know to call,” Dr. Mark K. Su said in an interview. Dr. Su, MPH, is the director of the New York City Poison Control Center and is a clinical associate professor of emergency medicine at New York University. “There are 55 poison centers in the United States. And if you call that 1-800 number, you’ll get directed to a poison center,” said Dr. Su.  “We are 24/7, 365.” He added that “another barrier” to reporting to a poison control center could be that some of New York’s residents do not speak English.

“We have many different people speaking different languages and that may be a potential barrier, he said. “But we advertise, and we tell people that we have a language service line that can translate over 150 languages.” However, Dr. Su admitted, “We don’t use the language line very often.”

Dr. Su is not willing to permit language to be a barrier to prevent families in need to reach a PCC. This past February, he and some of his national colleagues published research on alternate forms of communicating with the public, focusing on short messaging services (SMS or text messaging). While this research is still in its infancy, according to the report’s abstract, Dr. Su and other medical professionals reported that the most beneficial aspect of SMS “was providing an alternative contact for inquiries”.

More than a year since ACS’s announcement, there are still some parents in Brooklyn’s Brownsville section who still do not know what the region’s center is or how to contact it.

Janell Jenkins, a mother in her 30s, said, “We’ve done events about doing yoga. About diabetes. About asthma. But I never seen anything about poisons. Not around here.”

New York City, Long Island, and Westchester County residents can contact the NYC Poison Control Center at 212-POISONS or 212-764-7667.  The American Association of Poison Control Centers can connect those who are outside of the downstate NY area.  That association’s number is 800-222-1222.

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