Based on a recent report by Center on Addiction, this presentation summarizes the available research on the nature, extent, and consequences of young children’s exposure to a range of addictive substances based on data collected by the American Association of Poison Control Centers (AAPCC), as well as other research reports and data sources. It explains why and how such exposures occur, and what the barriers are to preventing them. Finally, it provides a comprehensive approach to addressing the problem of childhood exposures and poisonings.

1. Childhood Poisoning
Safeguarding
Young Children from
Addictive Substances
Linda Richter, Ph.D., & Jason Besser, M.P.P.

2. Why Focus on Early
Childhood Exposure?
• Our Center is dedicated to preventing substance use and
addiction and their harms
• It’s never too early to protect children from the potentially
life-threatening harms of addictive substances
• After prenatal care, it’s the earliest form of prevention
• It exemplifies the three main pillars of prevention:
1. Reducing ease of access
2. Reducing appeal
3. The need for a multi-pronged approach

3. Overview
• Data from the American Association of Poison
Control Centers’ National Poison Data System
• In 2016, 30,520 reports made to poison control
centers of babies and preschoolers exposed to
addictive substances
• Effects can be serious, including seizures,
respiratory problems, and even death
• Prescription drugs and nicotine account for the
largest share of reported exposures
• Past decade increases in childhood exposures to
nicotine, alcohol, caffeine, marijuana,
methamphetamine, and certain opioids

4. Nicotine
• Sharp increase in
exposures to non-
cigarette nicotine products
• Electronic nicotine delivery
systems (e-cigarettes),
dissolvable nicotine, NRT
• Calls to poison centers about
e-cigarettes increased
>1,400% over just 3 years
• E-cigarettes have higher
levels of nicotine than
combustible cigarettes
84
172
812
2,359
2,567
2,075
2011 2012 2013 2014 2015 2016
Exposures to E-Cigarettes,
Children Aged 5 and Younger

5. Addressing Childhood
Nicotine Exposure
Federal Family Smoking Prevention and Tobacco Control
Act (TCA) of 2009
• Does not include e-cigarettes or some other tobacco/
nicotine products
• No restrictions on flavors for non-cigarette products
• Does not adequately address risks of childhood exposure
Federal Child Nicotine Poisoning Prevention Act of 2015
• Child-resistant packaging for liquid nicotine
• Flow restriction - no more than 2ml of e-liquid released at
one time once the bottle is opened and inverted
States and cities have gone beyond federal laws

6. Alcohol
• Alcohol is the most
widely used addictive
substance in the U.S.
• Number of
unintentional
exposures in young
children increased
every year since 2012
• No systematic
approaches to prevent
exposures to alcohol
among young children
1,349
1,437
1,475
1,579
1,849
2012 2013 2014 2015 2016
Exposure to Alcohol,
Children Aged 5 and Younger

7. Caffeine
• 63% of children ages 2-5 consume caffeine on any given day
• Caffeine is added to numerous food and beverage products,
and is present in high doses in energy drinks
• FDA does not have published guidelines on caffeine
consumption for children
1,110
1,228
1,178
1,219
1,269
925
997
985
1,099 1,107
2012 2013 2014 2015 2016
Exposure to Caffeine Products,
Children Aged 5 and Younger
Energy Products Other Caffeine Products

8. Prescription Drugs
• A dramatic increase from 2000-2010 in
exposures among young children
• Since 2011, exposures generally
decreased -- but increased for fentanyl,
oxycodone & buprenorphine
• Exposures to CNS depressants have
been declining since 2009
• Exposures to CNS stimulants increased
each year from 2007-2012 and has
since remained relatively stable

9. Addressing Childhood
Prescription Drug Exposure
• Poison Prevention Packaging Act of 1970
• CDC’s Prevention of Overdoses and Treatment Errors in
Children Taskforce (PROTECT):
• Up and Away and Out of Sight
• Disposal of unused medicines
• National Take-Back Initiative
• FDA warnings
• Health organizations
• American Academy of Pediatrics
• American Medical Association
• Safe Kids Worldwide

10. Marijuana
• Increasingly available
and accessible to
young children
• Popularity of edibles
poses a serious risk of
exposure
• Children develop more
severe symptoms
compared to adults
245
278
337
542
617
2012 2013 2014 2015 2016
Exposure to Marijuana Products,
Children Aged 5 and Younger

11. Can You Tell the Difference?
Source: Children’s Hospital Colorado

12. Addressing Childhood
Marijuana Exposure
• Required child-resistant packaging
• Required use of opaque packaging
• Required clear labeling with warnings
• Limits on THC levels in edibles
• Better regulation of edibles
• Safe storage
• Physician training and awareness

13. Illicit Drugs
• Less accessible to young children, but
can cause serious adverse effects
• Exposures usually represent inability or
failure to safeguard drugs properly
• Over past decade, cocaine &
methamphetamine exposures increased,
while heroin, hallucinogen & club drug
exposures remained relatively stable
• Currently no laws regulating illicit drugs
• Public education initiatives

14. Why Do Exposures Happen?
• Inadequate appreciation of the risks
• Parents who use, misuse, or are addicted to substances
• Natural features of childhood development
• Widespread availability of addictive substances
• Unsafe product design and packaging
• Inadequate policies to address exposure risk

15. Recommendations for Parents
• Educate yourself about addictive substances
• Know the symptoms of exposure
• Be safe, not sorry:
Store and dispose of all addictive substances with care
Limit the amount of addictive products in your home
Set a good example and talk with children of all ages
Be honest with your doctors
Save the phone number for the national Poison Help Hotline

16. Recommendations for
Health Professionals
• Ask about addictive substances in the home
• Discuss risks of childhood poisoning
• Counsel on safe storage and disposal
• SBIRT for parents with addiction
• Prepare for poisoning events –
know the symptoms
• Consider all causes in the event of
unexplained symptoms

17. Recommendations for Educators
• Educate parents and other caregivers about exposures
and safe storage and disposal
• Educate students in age-appropriate ways
• Know the symptoms and how to get help
• Save the phone number for the poison
control center
• Provide health care professionals with
honest, accurate and detailed information
about the exposure

18. Recommendations for
Policymakers
• Get the facts out through public awareness campaigns
• Improve child-resistant packaging requirements
• Require packaging in small, nonfatal doses
• Require warnings on product labels or in packaging inserts
• Fund research on ways to prevent childhood poisoning
• Fund improvements in data collection and surveillance
• Assure legal immunity for parents who report children’s
illegal drug exposure

19. Recommendations for
Policymakers
Nicotine
• Ban all flavors
• Child-resistant packaging and small, nonfatal doses
Caffeine
• Require labeling of caffeine doses
• Standards for recommended daily limit for kids
Marijuana Edibles
• Limit THC levels
• Ban edibles that look like regular food products
• Require opaque and re-sealable packaging for edibles