Next Article in Journal
Ivabradine–Flecainide as Breakthrough Drug Combination for Congenital Junctional Ectopic Tachycardia: A Case Report and Literature Review
Previous Article in Journal
Relationship between the Appearance of Symptoms and Hospital Visits in Childhood Based on Japanese Statistical Data
Font Type:
Arial Georgia Verdana
Font Size:
Aa Aa Aa
Line Spacing:
Column Width:

Trends in Childhood Poison Exposures and Fatalities: A Retrospective Secondary Data Analysis of the 2009–2019 U.S. National Poison Data System Annual Reports

Biobehavioral and Health Research Center, Department of Doctoral Studies, School of Nursing, Azusa Pacific University, Monrovia, CA 91016, USA
Biobehavioral and Health Research Center, Department of Public Health and Doctoral Studies, School of Nursing, Azusa Pacific University, San Diego, CA 92108, USA
Department of Nursing, California State University, San Bernardino, CA 92407, USA
California Poison Control System, San Diego, CA 92103, USA
Pharmacy Informatics, Eisenhower Medical Center, Rancho Mirage, CA 92270, USA
Department of Emergency Medicine, University of California San Diego Medical Center, San Diego, CA 92093, USA
Author to whom correspondence should be addressed.
Pediatr. Rep. 2021, 13(4), 613-623;
Submission received: 13 October 2021 / Revised: 6 November 2021 / Accepted: 10 November 2021 / Published: 15 November 2021


Despite significant prevention efforts, childhood poison exposures remain a serious public health challenge in the United States. This study aimed to assess annual trends of pharmaceutical vs. non-pharmaceutical poison exposures in the US among children 0–19 years and compare the odds of death by children’s age group. Poison exposure and fatality data were retrospectively extracted from 2009 to 2019 National Poison Data System (NPDS) annual reports for children in all reported age groups. Overall, there was a significant reduction in the annual population-adjusted poison exposures in children (annual percentage change = −2.54%, 95% CI = −3.94% to −1.15%, p < 0.01), but not in poisoning-related fatalities. Children 0–5 had similar odds of dying from exposure to non-pharmaceuticals vs. pharmaceuticals. The odds of children 6–12 dying from non-pharmaceuticals vs. pharmaceuticals was 2.38 (95% CI = 1.58, 3.58), χ2 = 18.53, p < 0.001. In contrast, the odds of children 13–19 dying from pharmaceuticals vs. non-pharmaceuticals was 3.04 (95% CI = 2.51, 3.69), χ2 = 141.16, p < 0.001. Suicidal intent accounted for 40.63% of pharmaceutical deaths in children 6–12, as well as 48.66% of pharmaceutical and 31.15% of non-pharmaceutical deaths in children 13–19. While a significant decline in overall childhood poison exposures was reported, a decrease in poisoning-related fatalities was not observed. Children in different age groups had contrasting relative odds of death from pharmaceutical and non-pharmaceutical exposures. Among older children, a greater proportion of poisoning-related deaths was due to intentional suicide. These findings provide evidence of age-specific trends in childhood poison exposure risk and directions for future poison prevention efforts and behavioral health partnerships.

1. Introduction

Childhood poisoning remains a serious public health challenge in the United States [1,2]. According to the CDC Childhood Injury Report [3], poisoning represented 5% of the fatal and 2% of the non-fatal unintentional injuries among children ages 0–19, with a fatal injury rate of 8 per million children and a non-fatal injury rate of 1680 per million children. Not only do these poisoning-related exposures contribute to loss of life and devastating grief for families, but they may also pose a significant financial impact on communities and society at large. According to the CDC WISQARS, the combined annual medical and work-loss costs associated with unintentional and suicidal poisoning injuries and deaths among children ages 19 and younger accounted for USD 1.65 billion for deaths, USD 494.1 million for hospitalization, and USD 234.1 million for emergency department visits [4].
There is potential for poison exposures during all stages of a child’s life, from infancy through adolescence. Unintentional pharmaceutical poisonings among young children is a common medical issue for emergency departments and poison centers [5,6], causing an estimated number of seven children younger than age six to be seen in emergency departments every hour [7]. Poorly stored non-pharmaceutical household products, such as cosmetics and personal care products, household cleaning substances, foreign bodies or toys [2], and tobacco products also present a danger to young children [8]. A more recent study estimated that nearly one child under age five is sent to the emergency department every 3 h for ingesting cosmetics [9]. For older children such as adolescents, access to prescription and non-prescription medications, as well as illicit drugs, accounted for most of the unintentional and intentional poison exposures [1,10].
To prevent unintentional overdoses, misuse of pharmaceutical substances, and reduce emergency department visits in children, a number of nationwide initiatives were developed and implemented [11,12]. Effective early engineering advancements include the child-resistant packaging of drugs and unit-dose packaging of iron supplements, especially important in younger age groups [13]. Take-back programs are also in existence to safely dispose of medications when prescriptions are completed or outdated [14]. The most promising educational interventions targeting parents include home safety education for safe storage of medicines [15] and cleaning products and accessibility of the telephone number for Poison Control Centers (PCCs) [16].
The design of targeted poison prevention programs for children at various developmental stages requires a detailed investigation of recent national poisoning trends in this population. The purpose of this retrospective secondary data analysis was to detect national trends in poison exposures during childhood (0–19 years) and examine the age-specific odds of children dying from pharmaceutical vs. non-pharmaceutical poison exposures.

2. Methods

2.1. Study Population, Setting, and Data

For this study, National Poison Data System (NPDS) 2009 through 2019 annual reports served as the principal data source. The NPDS was officially launched by the American Association of Poison Control Center (AAPCC) in 2006, which became the only nationwide comprehensive, near real-time poison exposure surveillance database [17]. Specifically, over a 24-h period every day, healthcare and allied health professionals with specialized toxicology training enter all informational and exposure-related calls received at each of the 55 PCCs into the NPDS [18]. The NPDS products database contains a robust generic coding system that consists of 552 pharmaceutical and 562 non-pharmaceutical groups [19]. The pharmaceutical category includes both licit and illicit drugs. Select examples include analgesics, stimulants/street drugs, antidepressants, and antihistamines. The non-pharmaceutical category includes non-medicinal substances. Select examples in this category include fumes/gas/vapors, cosmetics/personal care products, cleaning substances, and alcohol. See Table 1 for a complete list of major generic substance categories of exposures in the NPDS annual report for 2019. The NPDS publishes annual reports of clinical outcomes and other reported details associated with poison exposures across all age groups. Since 2009, cases of exposures in children have been reported using the following AAPCC age categories: 0–5 years, 6–12 years, and 13–19 years.
The study population comprised poison exposure and fatality cases reported in children younger than 20 years between 2009 and 2019. For each year, demographic and poisoning-related circumstances of childhood fatality cases were retrospectively extracted and categorized by age group (0–5, 6–12, 13–19), type of exposure (pharmaceutical, non-pharmaceutical), and suicidal intent of exposure. According to the NPDS, suicidal attempts were poisoning exposures that were reported to be self-destructive by the callers [19]. For the purpose of this study, fatality case definitions were operationalized using NPDS categories to include those with medical outcome coding of both “death” and “death indirect” reports. In addition, fatality classifications included: “undoubtedly responsible”, “probably responsible” and “contributory”. Adjusted annual rates in poison exposure and fatality per 100,000 children were calculated using population estimates from the U.S. Census Bureau [20,21].

2.2. Patient and Public Involvement

Patients were not involved in the design, data extraction, data analysis, or writing of the study.

2.3. Statistical Analysis

By using the reporting year as the independent variable, linear regressions were conducted to detect trends in incidence and annual percentage changes (APCs) in poison exposures and fatalities. Independent sample t-tests were used to determine whether the average APC in poison exposures and fatalities among each age group was statistically different from zero. Paired sample t-tests were performed to compare poison exposure and fatality incidences over the years. In addition, relative age group frequencies (i.e., proportions) of fatal exposures by intentional suicide utilizing pharmaceutical and non-pharmaceutical agents were analyzed. Chi-square tests for independence were used to compute the comparative odds of death from non-pharmaceutical vs. pharmaceutical exposures for each of the three children age groups, utilizing aggregate-level data [22]. All descriptive analyses, t-tests, regression analyses, and chi-square tests were performed with the IBM SPSS Version 27.0 statistic software package. The two-tailed alpha level for statistical significance was set at 0.05.

3. Results

3.1. NPDS Reported Childhood Poison Exposures

Between 2009 and 2019, regional US PCCs received 15,005,684 calls regarding poison exposures for all children ages 0–19. This accounted for 61.21% of all human poison exposures reported during the 11-year period. Children ages 0–5 years accounted for 77.64%, children ages 6–12 years accounted for 10.03%, and children ages 13–19 years accounted for 11.99% of all childhood exposures.
The total annual childhood poison exposures reported to poison centers in the US decreased 24.39% from 1,533,387 in 2009 to 1,159,326 in 2019, representing a 22.86% reduction per 100,000 children 0–19 years of age. The 11-year reduction followed a linear trend (B = −0.95, p < 0.001) with an average population-adjusted APC of −2.54% (95% CI = −3.94% to −1.15%, p < 0.01). The APC in poison exposure slowed down significantly (p < 0.01) over the years, from −6.24% (year 2009 to 2010) to 0.48% (year 2018 to 2019).
A declining trend in poison exposure was observed among children 0–5 (B = −0.97, p < 0.001) and children 6–12 (B = −0.83, p < 0.01). However, an increasing linear trend was observed among children 13–19 (B = 0.73, p = 0.01). The average APC among children 0–5 years was −3.03% (95% CI = −4.43% to −1.63%, p < 0.001). The rates at which reported annual poison exposures changed had gradually declined (p < 0.01), from −6.26% to 0.02% for children 0–5 years.

3.2. Pharmaceutical Poison Exposures

The total annually reported childhood pharmaceutical poison exposures decreased 23.54%, from 724,760 in 2009 to 554,178 in 2019, or a 21.99% reduction per 100,000 children. The 11-year declining trend was significant (B = −0.95, p < 0.001), with an average APC of −2.43% (95% CI = −3.95% to −0.92%, p < 0.01). The annual reduction rate slowed down significantly (p < 0.01), from −6.22% to 1.20%, including 2009 through 2019.
For children 0–5 (B = −0.97, p < 0.001) and 6–12 (B = −0.81, p < 0.01), a significant downward trend in pharmaceutical poison exposures was noted. However, for children 13–19 (B = 0.96, p < 0.001), an upward trend in such poison exposures was identified. Over the 11 years, the annual reduction in reported pharmaceutical exposures among children 0–5 years happened at an average APC of −3.31% (95% CI = −4.78% to −1.84%, p < 0.001). In this age group, the APCs significantly decreased over the years, from −6.13% to 0.83%, p < 0.01. No significant APCs of pharmaceutical exposures were observed among the two older children groups, ps > 0.05. See Figure 1 for linear trends in population-adjusted pharmaceutical poison exposures in all children age groups.

3.3. Non-Pharmaceutical Poison Exposures

Similarly, the total annually reported childhood exposures to non-pharmaceuticals decreased 25.16% from 808,627 in 2009 to 605,148 in 2019, a 23.65% reduction per 100,000 children. This downward trend followed a linear pattern (B = −0.95, p < 0.001), with an average APC of −2.64% (95% CI = −4.12% to −1.16%, p < 0.01). The declining trend was detected for each age group, p < 0.01. Non-pharmaceutical poison exposures decreased at an annual rate of −2.79% (95% CI = −4.35% to −1.22%, p < 0.01) among children 0–5 years. See Figure 1 for linear trends in population-adjusted non-pharmaceutical poison exposures in all children age groups.

3.4. Non-Pharmaceutical vs. Pharmaceutical Poison Exposures

During the 11-year study period, there was an annual average of 300 more non-pharmaceutical (vs. pharmaceutical) exposures reported per 100,000 children under 20 years, p < 0.001. On average, 405 more non-pharmaceutical (vs. pharmaceutical) exposures were reported each year among children 0–5 (p < 0.001) and 22 more among children 6–12 (p = 0.001), per 100,000 children. In contrast, 127 more pharmaceutical (vs. non-pharmaceutical) exposures were reported each year per 100,000 children 13–19, p < 0.001. See Table 2 for 2009–2019 population-adjusted annual rates of poison exposures in children.

3.5. NPDS Childhood Poison Exposure-Related Fatalities

The number of poison-related fatalities among children 0–19 increased by 53.16% from 79 in 2009 to 121 in 2019, or 56.16% per 100,000 children. Pharmaceutical fatalities increased 53.85% from 52 to 80, or 57.05% per 100,000 children; non-pharmaceutical fatalities increased 51.85% from 27 to 41, or 54.94% per 100,000 children. Annual poison fatalities increased marginally for children 6–12 (B = 0.59, p = 0.06) and children 13–19 (B = 0.59, p = 0.06).

3.6. Non-Pharmaceutical vs. Pharmaceutical Poison Fatalities

Overall, there was an annual average of 148 more non-pharmaceutical (vs. pharmaceutical) fatalities reported per one hundred million children under 20 years, p < 0.001. An average of 16 more non-pharmaceutical (vs. pharmaceutical) fatalities were reported each year among children 6–12 (p < 0.001) per one hundred million children. In contrast, 169 more pharmaceutical (vs. non-pharmaceutical) fatalities were reported each year per one hundred million children 13–19, p < 0.001. See Table 3 for 2009–2019 population-adjusted annual rates of poison exposure-related fatalities in children.

3.7. Suicidal Intent in Poison-Related Fatalities

No suicidal intent was reported for non-pharmaceutical fatalities in children 0–5 or 6–12. Suicidal intent was reported in 40.63% of pharmaceutical fatalities in children 6–12, as well as in 31.15% of non-pharmaceutical and 48.66% of pharmaceutical fatalities in children 13–19.

3.8. Childhood Odds of Death by Poison Exposure and Age

Chi-square tests of independence, utilizing aggregate-level data from the 11 study years, demonstrated similar odds of death from non-pharmaceuticals vs. pharmaceuticals among children 0–5, χ2 = 0.87, OR = 0.90 [95% CI = 0.71, 1.13], p > 0.05. The odds of children 6–12 dying from non-pharmaceuticals vs. pharmaceuticals was 2.38 (95% CI = 1.58, 3.58), χ2 = 18.53, p < 0.001. In contrary, the odds of children 13–19 dying from pharmaceuticals vs. non-pharmaceuticals was 3.04 (95% CI = 2.51, 3.69), χ2 = 141.16, p < 0.001.

4. Discussion

Through a retrospective analysis of the 2009 to 2019 NPDS annual reports, the current study examined trends in U.S. poison exposures and related fatalities in children 0–19 years. The findings signal an overall linear decreasing trend in childhood poison exposure to both pharmaceuticals and non-pharmaceutical categories of substances. Of concern, however, is that the number of annually reported fatalities remained largely unchanged for children in all age group categories (0–5, 6–12, and 13–19 years). During the study period, children in age groups of 0–5 and 6–12 years experienced an overall decrease in both types of poison exposures, but children in the 13–19 years age group experienced an increase in pharmaceutical exposures. This increasing rate of pharmaceutical exposures among children 13–19 is consistent with international studies in Australia [23], East Asia [24], and Eastern Europe [25]. Growing numbers of adult prescriptions of analgesic drugs [26], psychoactive drugs [27], and the rising use of non-prescription medications [12] are identified as potential driving factors for this trend. The current study further identified a noteworthy proportion of pharmaceutical exposure-related deaths due to suicidal attempts in age groups of 6–12 and 13–19 years. In the 13–19 years age group, suicidal intent was also reported in non-pharmaceutical fatality cases. Biopsychosocial stressors can be major factors that contribute to suicidal attempts among younger children and adolescents [23,25]. Understanding the environmental, developmental, and biopsychosocial factors across various age groups in children will help to mitigate the risks for unintentional and intentional poison exposures.
Compared to previous findings regarding age-related [28,29] and gender-related [29] patterns for childhood poison exposures, the current study further demonstrated that odds of death by pharmaceuticals vs. non-pharmaceuticals change as children age. Although children 0–5 years were more likely to experience non-pharmaceutical exposures, they had the same odds of death following both types of exposure. Children 6–12 years were more likely to experience non-pharmaceutical exposures and were 138% more likely to die when exposed to non-pharmaceuticals vs. pharmaceuticals. In contrast, children 13–19 were more likely to experience pharmaceutical exposures and were 204% more likely to die, as compared to non-pharmaceutical exposures.
Childhood poison exposures and related injuries and deaths, particularly from suicide attempts, pose a serious public health challenge and take a significant emotional toll on their families and communities [30]. All pediatric healthcare professionals, educators, and caregivers of children must be aware of the developmental risks and the reported age-related odds of death from non-pharmaceutical and pharmaceutical poisons. More specifically, in younger children, increased hand-to-mouth activities, “look-alike” substances, and environmental safety factors should be important targets for poison prevention [6,31,32,33]. In older children and adolescents, safety and educational campaigns should continue to focus on decreasing the risk of unintentional poisonings. Additionally, establishing school-based interventions for suicide attempts [34], considering gender factors [29], and designing age-appropriate health policies [10] are all necessary for addressing intentional exposures in older children and adolescents. Given that school-age children and adolescents are increasingly using the internet and social media platforms to express emotional distress [35] and suicidal ideation [36], there is a critical need to use social networks for the early detection of at-risk populations. Partnering poison centers with social media outlets could be another useful way to expand messaging through prevention initiatives and provide data for identifying trends in at-risk populations. Future explorations researching influences of culture, socioeconomics, and gender along with age-specific associations between exposures and deaths in children could also expand knowledge for prevention strategies and mitigation.
Additionally, future research should investigate risks and protective factors for poison exposures and document individual case-level demographics and health outcome information. Understanding the substance categories most frequently involved in childhood exposures by age group and expanding the trends with a follow-up study will elucidate contributing patterns during the COVID-19 pandemic. Establishing typologies of pharmaceutical and non-pharmaceutical use in self-poisoning in age-specific groups would also be crucial to understanding the extent of variability of substances in suicidal attempts in children [37]. It would also be helpful to delineate prescription vs. non-prescription drugs to see which type and subtypes are more likely to cause fatality among different age groups in children. Future studies to compare specific types of substances, exposure, and pediatric vs. adult poisonings would help to clarify similarities and differences. The information could then be used to shape poison prevention strategies and identify age-related trends beyond childhood.
Overall, community settings such as schools can offer opportunities to disseminate information to students and families, utilizing school nurses [38] and counselors as valued available resources. In addition, given the International Programme on Chemical Safety’s (IPCS) recommendations for promoting and strengthening PCCs [39], using each regional PCC poisoning data and resources in partnership with nearby childcare and healthcare agencies could be an important approach for creating evidence-based prevention efforts. Moreover, an expanded outreach program could be established for increased follow-up with phone consultations to PCC callers. Knowledgeable healthcare providers, such as registered nurses [40] and poison center professionals, would effectively add to the current prevention efforts. Specifically, programs for nurses working with PCCs provide parents an opportunity for individualized assessment of the home environment with highly trusted professionals in the nursing role [38]. These interprofessional collaborative efforts would be key to increasing the impact of prevention programs on poison exposures and ultimately fatalities among all children age groups.
The current study is limited by the reliance on aggregate information from a single data reporting system. The NPDS annual reports do not necessarily represent all exposures and/or poisoning deaths at the national level. Suspected suicide attempts represent what was reported and recorded in the category of “intent”, specified by the NPDS. Exposure reasons of some cases were reported as “undetermined” or “unknown”. The current study also was limited to eleven years of data since specific age groups of childhood poisoning cases have only been available since 2009. Finally, there is increasing usage of the internet and social media platforms for readily available information on topics related to poison exposures [16]. This could be a contributing factor to the declining trend in reported cases in NPDS. Despite these limitations, the findings remain valuable to the literature as it reflects national trends in age-related exposures and fatalities that can contribute to poison prevention efforts among the children population.

5. Conclusions

In summary, from 2009 to 2019, the annual number of reported poison exposures in U.S. children 0–19 years of age decreased significantly while the number of reported fatalities remained largely unchanged. There were age-related contrasting odds of death due to exposure to pharmaceuticals vs. non-pharmaceuticals among children. A significant proportion of pharmaceutical fatalities in children 6–12 and 13–19 and non-pharmaceutical fatalities in adolescents was attributed to suicidal intent. Findings of this 11-year retrospective study of childhood poisoning data support policy development and public health practice for reducing the burden of poison-related injury and mortality among children. Addressing both unintentional and intentional childhood poisonings and outcomes are important considerations for targeted and effective poison and injury prevention programs. Exploration of contributing sociodemographic factors of race, ethnicity, and economics could potentially reduce disparities in poisoning risk and promote equity in poison prevention in vulnerable communities. The current research also supports strengthening interprofessional education on age-specific poison prevention efforts for all communities in order to reduce exposures and fatalities in children equitably.

Author Contributions

Conceptualization, H.L. and T.D.-B.; Data curation, H.L., T.D.-B. and M.L.B.; Formal analysis, H.L.; Investigation, H.L., T.D.-B. and M.L.B.; Methodology, H.L. and T.D.-B.; Project administration, H.L. and T.D.-B.; Writing—original draft, H.L. and T.D.-B.; Writing—review and editing, H.L., T.D.-B., M.L.B., M.B.P., T.E.H. and R.F.C. All authors have read and agreed to the published version of the manuscript.


This research received no external funding. Portions of this research were generously supported by Professional Development Funds from California State University San Bernardino, and the Faculty Research Council Grant from the Azusa Pacific University.

Institutional Review Board Statement

Not required; the investigation only involved the collection of publicly available de-identified case-level data and records provided in NPDS annual reports. Therefore, the Institutional Review Board (IRB) at the lead researcher’s institution approved this retrospective research study as exempt from full or expedited review.

Informed Consent Statement

Not required.

Data Availability Statement

Data are available upon reasonable request.


The authors thank Sheryl Tyson, who provided valuable comments on an earlier draft of the manuscript. The authors would also like to thank Matthew Campos and Alyssa Reyes who assisted in the preparation of the final draft.

Conflicts of Interest

The authors declare no conflict of interest.

Disclosure Statement on AAPCC Data

The American Association of Poison Control Centers (AAPCC) maintains the National Poison Data System (NPDS), which houses de-identified case records of self-reported information collected from callers during exposure management and poison information calls managed by the country’s poison control centers (PCCs). NPDS data do not reflect the entire universe of exposures to a particular substance as additional exposures may go unreported to PCCs; accordingly, NPDS data should not be construed to represent the complete incidence of U.S. exposures to any substance(s). Exposures do not necessarily represent a poisoning or overdose and AAPCC is not able to completely verify the accuracy of every report. Findings based on NPDS data do not necessarily reflect the opinions of AAPCC.


  1. Lowry, J.A.; Burns, M.; Calello, D.P. Pediatric pharmaceutical ingestions. Pediatric Ann. 2017, 46, 459–465. [Google Scholar] [CrossRef]
  2. O’Donnell, K.A. Pediatric toxicology: Household product ingestions. Pediatric Ann. 2017, 46, 449–453. [Google Scholar] [CrossRef]
  3. Borse, N.N.; Gilchrist, J.; Dellinger, A.M.; Rudd, R.A.; Ballesteros, M.F.; Sleet, D.A. CDC Childhood Injury Report: Patterns of Unintentional Injuries Among 0–19 Year Olds in the United States, 2000–2006; Centers for Disease Control and Prevention, National Center for Injury Prevention and Control: Atlanta, GA, USA, 2008. Available online: (accessed on 10 December 2020).
  4. CDC WISQARS. Cost of Injury Reports. 2015. Cost Generated Using Base Year of 2010 Data. Available online: (accessed on 7 August 2021).
  5. Schillie, S.F.; Shehab, N.; Thomas, K.E.; Budnitz, D.S. Medication overdoses leading to emergency department visits among children. Am. J. Prev. Med. 2009, 37, 181–187. [Google Scholar] [CrossRef] [PubMed]
  6. Vilke, G.M.; Douglas, D.J.; Shipp, H.; Stepanski, B.; Smith, A.; Ray, L.U.; Castillo, E.M. Pediatric poisonings in children younger than five years responded to by paramedics. J. Emerg. Med. 2011, 41, 265–269. [Google Scholar] [CrossRef] [PubMed]
  7. Lovegrove, M.C.; Weidle, N.J.; Budnitz, D.S. Trends in emergency department visits for unsupervised pediatric medication exposures, 2004–2013. Pediatrics 2015, 136, 821–829. [Google Scholar] [CrossRef] [Green Version]
  8. Connolly, G.N.; Richter, P.; Aleguas, A., Jr.; Pechacek, T.F.; Stanfill, S.B.; Alpert, H.R. Unintentional child poisonings through ingestion of conventional and novel tobacco products. Pediatrics 2010, 125, 896–899. [Google Scholar] [CrossRef] [PubMed] [Green Version]
  9. Vajda, J.; McAdams, R.J.; Roberts, K.J.; Zhu, M.; McKenzie, L.B. Cosmetic-Related injuries treated in US emergency departments: 2002 to 2016. Clinical Pediatrics 2019, 58, 1493–1501. [Google Scholar] [CrossRef] [PubMed]
  10. Gaither, J.R.; Shabanova, V.; Leventhal, J.M. US national trends in pediatric deaths from prescription and illicit opioids, 1999–2016. JAMA Netw. Open 2018, 1, e186558. [Google Scholar] [CrossRef] [PubMed] [Green Version]
  11. Budnitz, D.S.; Lovegrove, M.C. The last mile: Taking the final steps in preventing pediatric pharmaceutical poisonings. J. Pediatrics 2012, 160, 190–192. [Google Scholar] [CrossRef]
  12. Koren, G. Protecting young children from life-threatening drug toxicity. J. Pediatrics 2013, 163, 1249–1250. [Google Scholar] [CrossRef]
  13. Tenenbein, M. Unit-Dose packaging of iron supplements and reduction of iron poisoning in young children. Arch. Pediatrics Adolesc. Med. 2005, 159, 557–560. [Google Scholar] [CrossRef] [PubMed] [Green Version]
  14. Stoddard, K.I.; Hodge, V.; Maxey, G.; Tiwari, C.; Cready, C.; Huggett, D.B. Investigating research gaps of pharmaceutical take back events: An analysis of take back program participants’ socioeconomic, demographic, and geographic characteristics and the public health benefits of take back programs. Environ. Manag. 2017, 59, 871–884. [Google Scholar] [CrossRef]
  15. Agarwal, M.; Williams, J.; Tavoulareas, D.; Studnek, J.R. A brief educational intervention improves medication safety knowledge in grandparents of young children. AIMS Public Health 2015, 2, 44–55. [Google Scholar] [CrossRef]
  16. Crouch, B.I.; Malheiro, M.C.; Brown, K.B. Study of caregivers regarding pediatric poisoning. Clin. Pediatrics 2019, 58, 1072–1077. [Google Scholar] [CrossRef]
  17. Wolkin, A.F.; Martin, C.A.; Law, R.K.; Schier, J.G.; Bronstein, A.C. Using poison center data for national public health surveillance for chemical and poison exposure and associated illness. Ann. Emerg. Med. 2012, 59, 56–61. [Google Scholar] [CrossRef] [PubMed]
  18. American Association of Poison Control Centers. National Poison Data System (NPDS). Available online: (accessed on 10 December 2020).
  19. Gummin, D.D.; Mowry, J.B.; Beuhler, M.C.; Spyker, D.A.; Brooks, D.E.; Dibert, K.W.; Rivers, L.J.; Pham, N.P.T.; Ryan, M.L. 2019 annual report of the American Association of Poison Control Centers’ National Poison Data System (NPDS): 37th annual report. Clin. Toxicol. 2020, 58, 1360–1541. [Google Scholar] [CrossRef] [PubMed]
  20. U.S. Census Bureau. Intercensal Estimates of the Resident Population by Single Year of Age, Sex, Race, and Hispanic Origin for the United States: April 1, 2000 to July 1, 2010. 2011. Available online:–2010-national.html (accessed on 13 July 2021).
  21. U.S. Census Bureau. Annual Estimates of the Resident Population by Single Year of Age and Sex for the United States: April 1, 2010 to July 1, 2019. 2020. Available online: (accessed on 13 July 2021).
  22. Tripepi, G.; Jager, K.J.; Dekker, F.W.; Wanner, C.; Zoccali, C. Measures of effect: Relative risks, odds ratios, risk differences, and ‘number needed to treat’. Kidney Int. 2007, 72, 789–791. [Google Scholar] [CrossRef] [Green Version]
  23. Cairns, R.; Karanges, E.A.; Wong, A.; Brown, J.A.; Robinson, J.; Pearson, S.-A.; Dawson, A.H.; Buckley, N.A. Trends in self-poisoning and psychotropic drug use in people aged 5–19 years: A population-based retrospective cohort study in Australia. BMJ Open 2019, 9, e026001. [Google Scholar] [CrossRef]
  24. Lee, J.; Fan, N.C.; Yao, T.C.; Hsia, S.H.; Lee, E.P.; Huang, J.L.; Wu, H.-P. Clinical spectrum of acute poisoning in children admitted to the pediatric emergency department. Pediatrics Neonatol. 2019, 60, 59–67. [Google Scholar] [CrossRef] [Green Version]
  25. Barzashka, E.; Atmazhova, O.; Stefanova, K. Medical and social problems in suicide attempts by self-poisoning in childhood. Knowl. Int. J. 2018, 23, 539–544. [Google Scholar]
  26. Burghardt, L.C.; Ayers, J.W.; Brownstein, J.S.; Bronstein, A.C.; Ewald, M.B.; Bourgeois, F.T. Adult prescription drug use and pediatric medication exposures and poisonings. Pediatrics 2013, 132, 18–27. [Google Scholar] [CrossRef] [PubMed] [Green Version]
  27. Friedrich, J.M.; Sun, C.; Geng, X.; Calello, D.P.; Gillam, M.; Medeiros, K.L.; Smith, M.; Ruck, B.; Friedrich, J.M. Child and adolescent benzodiazepine exposure and overdose in the United States: 16 years of poison center data. Clin. Toxicol. 2019, 15, 725–731. [Google Scholar] [CrossRef] [PubMed]
  28. Patel, A.M.; Wheeler, D.C.; Rose, S.R.; Nadpara, P.A.; Pakyz, A.L.; Carrol, N.V. Prevalence and characteristics of pediatric opioid exposures and poisonings in the United States. J. Pediatrics 2019, 206, 148–155. [Google Scholar] [CrossRef] [PubMed]
  29. Spiller, H.A.; Ackerman, J.P.; Piller, N.E.; Casavant, M.J. Sex-and age-specific increases in suicide attempts by self-poisoning in the United States among youth and young adults from 2000 to 2018. J. Pediatrics 2019, 210, 201–208. [Google Scholar] [CrossRef] [PubMed]
  30. CDC. Preventing Suicide. Available online: (accessed on 5 August 2021).
  31. Lee, V.R.; Connolly, M.; Calello, D.P. Pediatric poisoning by ingestion: Developmental overview and synopsis of national trends. Pediatric Ann. 2017, 46, 443–448. [Google Scholar] [CrossRef] [PubMed]
  32. White, N.; Kibalama, W. Prevention of pediatric pharmaceutical poisonings. Am. J. Lifestyle Med. 2018, 12, 117–119. [Google Scholar] [CrossRef]
  33. Wynn, P.M.; Zou, K.; Young, B.; Majsak-Newman, G.; Hawkins, A.; Kay, B.; Wynn, P.M. Prevention of childhood poisoning in the home: Overview of systematic reviews and a systematic review of primary studies. Int. J. Inj. Control. Saf. Promot. 2016, 23, 3–28. [Google Scholar] [CrossRef] [Green Version]
  34. Morken, I.S.; Dahlgren, A.; Lunde, I.; Toven, S. The effects of interventions preventing self-harm and suicide in children and adolescents: An overview of systematic reviews. F1000Res 2019, 8, 890. [Google Scholar] [CrossRef]
  35. Lopez-Castroman, J.; Moulahi, B.; Azé, J.; Bringay, S.; Deninotti, J.; Guillaume, S.; Baca-Garcia, E. Mining social networks to improve suicide prevention: A scoping review. J. Neurosci. Res. 2020, 98, 616–625. [Google Scholar] [CrossRef] [PubMed] [Green Version]
  36. Dyson, M.P.; Hartling, L.; Shulhan, J.; Chisholm, A.; Milne, A.; Sundar, P.; Scott, S.D.; Newton, A.S. A systematic review of social media use to discuss and view deliberate self-harm acts. PLoS ONE 2016, 11, e0155813. [Google Scholar] [CrossRef] [Green Version]
  37. Barton, A.W.; Reinhart, C.A.; Campell, C.C.; Smith, D.C.; Albarracin, D. Opioid use at the transition to emerging adulthood: A latent class analysis of non-medical use of prescription opioids and heroin use. Addict. Behav. 2021, 114, 106757. [Google Scholar] [CrossRef] [PubMed]
  38. Glenn, L. Pick your poison: What’s new in poison control for the preschooler. J. Pediatric Nurs. 2015, 30, 395–401. [Google Scholar] [CrossRef] [PubMed]
  39. World Health Organization. International Programme on Chemical Safety: Poisoning Prevention and Management. Available online: (accessed on 10 December 2020).
  40. Kirsch, S.D.; Wilson, L.S.; Harkins, M.; Albin, D.; Del Beccaro, M.A. Feasibility of using a pediatric call center as part of a quality improvement effort to prevent hospital readmission. J. Pediatric Nurs. 2015, 30, 333–337. [Google Scholar] [CrossRef] [PubMed]
Figure 1. Linear Trends in Population-Adjusted Poison Exposures in U.S. Children, 2009–2019.
Figure 1. Linear Trends in Population-Adjusted Poison Exposures in U.S. Children, 2009–2019.
Pediatrrep 13 00073 g001
Table 1. Major Generic Substance Categories of Exposures in Pharmaceuticals and Non-Pharmaceuticals as listed in 2019 NPDS Annual Report.
Table 1. Major Generic Substance Categories of Exposures in Pharmaceuticals and Non-Pharmaceuticals as listed in 2019 NPDS Annual Report.
Pharmaceuticals (N = 28)Non-Pharmaceuticals (N = 30)
Anticholinergic DrugsArts/Crafts/Office Supplies
AnticoagulantsAutomotive/Aircraft/Boat Products
AntihistaminesBites and Envenomations
AntimicrobialsBuilding and Construction Products
Asthma TherapiesCleaning Substances (Household)
Cardiovascular DrugsCosmetics/Personal Care Products
Cold and Cough PreparationsFumes/Gases/Vapors
Diagnostic AgentsHeavy Metals
Dietary Supplements/Herbals/HomeopathicHydrocarbons
DiureticsIndustrial Cleaners
Electrolytes and MineralsInfectious and ToxinMediated Diseases
Eye/Ear/Nose/Throat PreparationsInformation Calls
Gastrointestinal PreparationsLacrimators
Hormones and Hormone AntagonistsMatches/Fireworks/Explosives
Muscle RelaxantsMiscellaneous Foods
Narcotic AntagonistsOther/Unknown Nondrug Substances
RadiopharmaceuticalsPaints and Stripping Agents
Serums, Toxoids, VaccinesPlants
Stimulants and Street DrugsPolishes and Waxes
Topical PreparationsRadiation
Unknown DrugSporting Equipment
Veterinary DrugsSwimming Pool/Aquarium
VitaminsTobacco/Nicotine/eCigarette Products
Weapons of Mass Destruction
Table 2. Population-adjusted Annual Rates of Poison Exposures per 100,000, by Type and Children Age Range, 2009–2019.
Table 2. Population-adjusted Annual Rates of Poison Exposures per 100,000, by Type and Children Age Range, 2009–2019.
YearPharmaceutical Exposures
(per 100,000 Children)
Non-Pharmaceutical Exposures
(per 100,000 Children)
<66 to 1213 to 19<66 to 1213 to 19
Table 3. Population-adjusted Annual Rates of Poison Exposure-related Fatalities per 100,000, by Type and Children Age Range, 2009–2019.
Table 3. Population-adjusted Annual Rates of Poison Exposure-related Fatalities per 100,000, by Type and Children Age Range, 2009–2019.
YearPharmaceutical Exposure-Related Fatalities (per 100 Million Children)Non-Pharmaceutical Exposure-Related Fatalities (per 100 Million Children)
<66 to 1213 to 19<66 to 1213 to 19
Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Share and Cite

MDPI and ACS Style

Li, H.; Dodd-Butera, T.; Beaman, M.L.; Pritty, M.B.; Heitritter, T.E.; Clark, R.F. Trends in Childhood Poison Exposures and Fatalities: A Retrospective Secondary Data Analysis of the 2009–2019 U.S. National Poison Data System Annual Reports. Pediatr. Rep. 2021, 13, 613-623.

AMA Style

Li H, Dodd-Butera T, Beaman ML, Pritty MB, Heitritter TE, Clark RF. Trends in Childhood Poison Exposures and Fatalities: A Retrospective Secondary Data Analysis of the 2009–2019 U.S. National Poison Data System Annual Reports. Pediatric Reports. 2021; 13(4):613-623.

Chicago/Turabian Style

Li, Hong, Teresa Dodd-Butera, Margaret L. Beaman, Molly Broderick Pritty, Thomas E. Heitritter, and Richard F. Clark. 2021. "Trends in Childhood Poison Exposures and Fatalities: A Retrospective Secondary Data Analysis of the 2009–2019 U.S. National Poison Data System Annual Reports" Pediatric Reports 13, no. 4: 613-623.

Article Metrics

Back to TopTop