Children's deaths by poisoning have fallen 82% over 32 years

The number of children younger than 10 years old dying from poisoning in England and Wales dropped by 82% in the 32 years up to 2000. Improvements in safety in the home, including changes in the packaging of drugs, may be partly responsible.

According to a new report, the number of annual deaths in the under 10s fell from 165 in 1968 to 30 in 2000. The biggest decline was in the youngest children, with the death rate for children under 1 year old almost six times greater in 1968 than in 2000.

The report was published online (ahead of print publication) on 28 July in Forensic Science International (http://dx.doi.org/10.1016/j.forsciint.2004.04.083), and it shows that deaths from aspirin poisoning are now almost non-existent in England and Wales but that opioids and opiates are now more likely than antidepressants to be implicated in fatal poisonings.

“Opioids have now superseded antidepressants as the commonest agents encountered in fatal poisoning with drugs in children,” say the authors of the report, Dr Robert Flanagan of the medical toxicology unit at Guy's and St Thomas' Hospital and colleagues at the Office for National Statistics.

The data show that deaths from taking opioids or opiates alone or with alcohol increased from 14 in the 15 years up to 1983 to 33 in the six years up to 2000. In the same periods, the numbers of deaths involving antidepressants were 56 and 22. Homicide or an open verdict was recorded in 49% of deaths in which opiates or opiates had been taken.

“Presumably this finding reflects not only the toxicity of opioids in young people, but also the availability of these agents in certain homes,” said the authors, “Mortality and morbidity from ingestion of methadone syrup in the home has been of particular concern and this is reflected in our data—eight methadone related deaths between 1993 and 2000.”

The widespread introduction of childproof drug container closures and blister packs; greater emphasis on safety in the home; advances in treatments; and changes in prescribing practices, with a trend towards drugs with lower toxicity in children, may all have contributed to the decline in poisonings. The report says that the withdrawal of hazardous preparations may have helped too.

As non-intentional poisonings are now less common, homicidal poisonings make up an increasing proportion of the total. Over the study period, the numbers of homicides varied between five and 20 a year.

The data on homicidal poisonings are likely to be an underestimate, however: “There is always the possibility that some homicidal poisonings were either missed completely or certified as accidents. For these reasons, the data on homicidal poisonings presented here are probably an underestimate of the true picture.”