Anesthesiologists have a role in Poison Prevention
Alan Jay Schwartz MD, MSEd and Myron Yaster MD
In today’s PAAD, Caren Chesler,1 a writer for the Washington Post, reports on a sharp rise in ER visits by children poisoned by ingesting melatonin products. When I first read this article, I was admittedly stunned by the extent of melatonin poisoning and couldn’t make the connection to why, or if, it may be of interest to the PAAD readership. Dr. Alan Schwartz, a member of the PAAD’s executive council thought it had important lessons for all of us, particularly because this week is National Poison Prevention Week. Myron Yaster MD
Original article
Chesler, C: Sharp rise in ER visits by kids ingesting melatonin products. Washington Post 3/15/2024
“There has been “a 530 percent rise in calls to poison centers for pediatric melatonin exposures between 2012 and 2021, the CDC reported. Also, there were an estimated 10,930 emergency room visits — a rise of 420 percent — based on 295 cases of children younger than 5 ingesting melatonin between 2019 and 2022. This accounted for 7.1 percent of all visits to the emergency department for medication exposures for this age group, according to national data, the CDC said.”1
Melatonin is an unregulated, hormone supplement used very widely to help induce sleep. It is often available as flavored gummies and chewable tablets and packaged without childproof caps. In a letter published in JAMA last year, Cohen et al.2 found that most of the products they sampled contained 20, 30 or 50 percent more melatonin content than what was listed on the label.
It’s not clear what melatonin poisoning does to infants, toddlers, or older children. Regardless of the risk, it underlines the dangers of flavored, candy like drugs distributed in packaging that isn’t child proof.
Among the Center for Disease Control and Prevention suggested tips to keep children safe from poisoning was the admonition, “Never tell children medicine is candy, even if they don’t like to take their medicine.” Don’t we do this in our practice every day? Have you witnessed a child being encouraged to ingest an oral premedication because it tastes like candy?
Have you ever heard a new anesthesiology resident, fellow or colleague say the following when performing a mask induction of a child, “This will smell so good, just like candy.” Do you teach covering the anesthetic mask with “candy flavored” lip balm to “trick” children to more willingly accept inhalation of anesthetic vapors?
In support of National Poison Prevention Week, March 17-23, 2024, we encourage you consider the following:
Remind all of our colleagues in the perioperative environment to avoid equating anesthetic related medications with candy.
Educate everyone about resources that highlight keeping children safe from medication poisoning, such as “Put your medicines Up and Away and out of sight”.
Send your thoughts and comments to Myron who will post in a Friday Reader Response.
References
1. Chesler C. Sharp rise in ER visits by kids ingesting melatonin poducts, CDC says. Washington Post. Washington D.C.: Nash Holdings; 2024.
2. Cohen PA, Avula B, Wang Y-H, Katragunta K, Khan I. Quantity of Melatonin and CBD in Melatonin Gummies Sold in the US. Jama 2023;329(16):1401-1402. DOI: 10.1001/jama.2023.2296.