Flow Restrictors Limit Children’s Access to Liquid Medications

Researchers at the US Centers for Disease Control and Prevention (CDC; Atlanta, GA, USA) conducted a block randomized trial with a convenience sample of 110 3- and 4-year-old children from five preschools from the Atlanta (GA, USA) area. The children attempted to remove test liquid from an uncapped bottle with an FR—an adapter in the neck of the bottle—and a control bottle without an FR, which had no cap at all or an incompletely closed cap.

The results showed that all but one of the 26 bottles without FRs could be emptied within two minutes. Conversely, only 7 of 110 bottles with FRs were emptied during the 10-minute testing period, and none before 6 minutes. The children also removed less liquid from the bottles with FRs than from the open or incompletely closed control bottles without FRs. Additionally, all children assigned open control bottles and 90% of those assigned incompletely closed control bottles removed more than 25 mL of liquid, but only 11% of children removed that amount from uncapped bottles with FRs.

The children used a variety of strategies to remove the liquid from the flow-restricted bottles, with the vast majority (93%) opting to use the dosing syringe. Those who used it were able to remove at least 25 mL from the bottle. Other methods were pouring, shaking, or squeezing from the bottle, with one child using teeth to remove the flow restrictor cap and empty the bottle. Only four children attempted to drink from the bottles with flow restrictors, but the authors suggested that they might have been discouraged from drinking because adults were watching them. The study was published early 0nline on July 26, 2013, in the Journal of Pediatrics.

“Our findings suggest that adding FRs to liquid medicine bottles limits the accessibility of their contents to young children and could complement the safety provided by current child-resistant packaging,” concluded senior author Daniel Budnitz, MD, of the CDC Division of Healthcare Quality Promotion, and colleagues, suggesting that “flow restrictor use be expanded beyond infant acetaminophen to reduce the severity of ingestions and the number of children referred for costly emergency evaluation and treatment.”

Despite the mandatory use of child-resistant packaging, poison centers receive 500,000 calls each year due to medication ingestions in young children, particularly among those younger than five, with peak incidence age at two years. This is due to the fact that although child-resistant packaging requires proper opening to allow access to the medication container, proper closure is also required to re-engage the child-resistant closure.

Related Links:
US Centers for Disease Control and Prevention