Laundry detergent pods are a new product in the US marketplace. This study investigates the epidemiologic characteristics and outcomes of laundry detergent pod exposures among young children in the United States.
Using data from the National Poison Data System, exposures to laundry detergent pods among children younger than 6 years of age during 2012–2013 were investigated.
There were 17 230 children younger than 6 years exposed to laundry detergent pods in 2012–2013. From March 2012 to April 2013, the monthly number of exposures increased by 645.3%, followed by a 25.1% decrease from April to December 2013. Children younger than 3 years accounted for 73.5% of cases. The major route of exposure was ingestion, accounting for 79.7% of cases. Among exposed children, 4.4% were hospitalized and 7.5% experienced a moderate or major medical outcome. A spectrum of clinical effects from minor to serious was seen with ingestion and ocular exposures. There were 102 patients (0.6%) exposed to a detergent pod via ingestion, aspiration, or a combination of routes, including ingestion, who required tracheal intubation. There was 1 confirmed death.
Laundry detergent pods pose a serious poisoning risk to young children. This nationwide study underscores the need for increased efforts to prevent exposure of young children to these products, which may include improvements in product packaging and labeling, development of a voluntary product safety standard, and public education. Product constituent reformulation is another potential strategy to mitigate the severity of clinical effects of laundry detergent pod exposure.
Comments
Author response to eLetters: Pediatric Exposure to Laundry Detergent Pods
The innovative laundry detergent pod products break through ocular surfaces (n=66 eye burns and n=238 corneal abrasions), break through skin (n=46 burns), break through the blood-brain barrier (n=30 comatose children), and requires endotracheal tubes to break through vocal cords (n=102 intubations).
Breakthrough innovation: indeed. Award winner: only if adult convenience outweighs child safety.
We also thank Dr. Ilhan and colleagues for pointing out several recognized and suspected virulence factors of these detergent pods.
We agree with immediate and prolonged irrigation for ocular exposures, but caution that since the pH of these products is surprisingly close to neutral, finding a normal ocular pH is not an adequate endpoint for irrigation. Our poison center advocates for ocular anesthesia and against ocular vasoconstrictors in these cases.
Conflict of Interest:
None declared
Pediatric Exposure To Laundry Detergent Pods
Dear Editor, We congratulate Valdez et al. for their study entitled "Pediatric exposure to laundry detergent pods". The authors investigated the epidemiologic characteristics and results of exposures to laundry detergent pod among young children. We would like to make a contribution to the article.
The authors pointed out the importance of increased number of laundry detergent pod exposures among young children due to candy-like design of the pods .. There are other significant features of them. The size, shape and smooth surface make the swallowing easy. They are covered and encased in a water-soluble material as big as a golf ball. Thus, children cannot get the disgusting taste soon and, therefore, swallow large amounts of chemicals.. They contain more concentrated chemicals than classic detergents After the degradation of the capsule, children may not be able to spit it out, and mucosal surfaces get exposed to massive amounts of chemicals.
Dilution and irrigation are reported as the first step in the management. We want to discuss the management regarding ocular exposure. At first, parents and/or emergency staff should be aware that sensation and pain might be reduced in case of damage in the corneal stromal nerve endings. This may cause to underestimate the clinical significance. It must be kept in mind that this unrealistic fake well-being might be in contradiction with the severity of the injury. The primary goal after an ocular exposure is to get rid of chemicals and regain the normal pH in the ocular surface as soon as possible to prevent further exposure and tissue damage. Irrigation must be started by the first person facing the event. Waiting for medical staff or ophthalmologist is entirely a waste of time and dramatically downgrades the clinical outcome. Tap water can be useful at residences, but health-care staff should prefer buffered solutions to reach desired pH more quickly. Irrigation should be maintained at least 15 minutes. A pH indicator paper stick may be used to determine the length of irrigation.
Topical or general anesthesia may be taken into consideration to clean the ocular surface thoroughly in infants who cannot cooperate with the treatment. General anesthesia also gives a chance to examine the eye in detail. General practitioners widely use phenylephrine to dilate the pupil and examine posterior segment in routine clinical practice. However, it should be avoided in such cases because phenylephrine may increase the risk of ischemia in both ocular surface and deep ocular structures.
Finally, we express our gratitude to the authors that they put emphasis on a serious public health problem. We hope that these warnings will help pediatricians in the management of such cases.
Conflict of Interest:
None declared
Laundry Pods: A Breakthrough Innovation Award Winner? Too Tantalizing To A Toddler
I read with interest "Pediatric Exposure to Laundry Detergent Pods" by Valdez et al.1 The authors underscore the seriousness of this poisoning after oral and ocular exposure. They also stress the need for improved product packaging and labeling in an effort to decrease accidental exposure in children.
Tide Pods (Procter and Gamble) was recently selected for a Nielsen Breakthrough Innovation Award because of distinctiveness, relevance and endurance.2 Children are attracted to these pods because of their bright color and ease of handling. A child would not be able to distinguish a pod from a toy.
It is profoundly concerning that the Nielsen Innovative Practice group would award Procter and Gamble for its laundry pod. Perhaps the award for breakthrough innovation should go to the individual who determines how to make this product less attractive to a child. In the interim beware of accidental pediatric exposures and the associated morbidity from this attractive product.
References
1 Valdez AL, Casavant MJ, Spiller HA, et al. Pediatric exposure to laundry detergent pods. Pediatrics DOI: 10.1542/peds.2014-0057
2 Wohl J. Kraft, Mondelez products make Nielsen 'Breakthrough Innovation' list. Chicago Tribune. June 23, 2014
Conflict of Interest:
None declared