This study analyzes and compares pediatric exposures to packet and nonpacket forms of laundry and dishwasher detergents in the United States.
Data from the National Poison Data System involving exposures to laundry and dishwasher detergents among children younger than 6 years old from 2013 through 2014 were analyzed.
There were 62 254 children younger than 6 years old exposed to laundry and dishwasher detergents from 2013 to 2014. The number of exposures to detergent increased over the study period, but the increase was greatest for laundry detergent packets (17.0%) and dishwasher detergent packets (14.0%). Eighty-five percent of children were exposed through ingestion. The odds of clinical effects (3.9–8.2), hospitalization (4.8–23.5), intubation (6.9–71.3), and serious medical outcomes (8.4–22.6) were significantly higher for laundry detergent packet exposures than for other types of detergent. There were 117 children who required intubation, and 104 of these were exposed to laundry detergent packets. There were 2 deaths, and both were associated with laundry detergent packets.
This national study demonstrates that pediatric laundry detergent packet exposures are more severe than laundry detergent nonpacket and dishwasher detergent (packet and nonpacket) exposures. Pediatric exposures to laundry detergent packets increased by 17% during the study period nationally and should be closely monitored to assess the effectiveness of the newly adopted voluntary safety standard; this standard should be strengthened if the number of exposures does not demonstrate a substantial decrease.
Comments
RE: Pediatric Exposures to Laundry and Dishwasher Detergents
We thank our colleagues for restating the limitations - common to all studies depending on National Poison Data System (NPDS) data - of our study comparing laundry and dishwasher detergent product toxicities (1), for sharing our concerns about toxicity of these detergents, and for their service on the front lines helping the victims of exposure to these common household products.
1. Davis MG, Casavant MJ, Spiller HA, Chounthirath T, Smith GA. Pediatric Exposures to Laundry and Dishwasher Detergents in the United States: 2013-4. Pediatrics 137 (5): e20154529 (2016).
RE: pediatric exposures to laundry and dishwasher detergents
We read with interest the article regarding pediatric exposures to laundry and dishwasher detergents in the May issue of Pediatrics. As clinical toxicologists, we were on the front line when these “pods” were first marketed and began to cause toxicity. Although we agree with the authors’ concerns for toxicity from these agents, and the need for awareness and regulation, there are a few points that we would like to raise in regards to this paper.
It must be noted that data obtained from the National Poison Data system comes with significant limitations. It is passively collected and relies on, a parent, caregiver, or healthcare provider to report the exposure. A majority of these calls were managed at home, without any further knowledge of the outcome. On the other hand, those cases called in by healthcare providers have biased outcomes based on poison center recommendations. With time and as more cases are seen, reporting fatigue occurs. So it is difficult to determine if a decrease in exposures is due from better awareness of the toxicity and improved storage of the product, or just the fact that healthcare providers are more comfortable in caring for these patients and do not call the cases into the poison control center.
There must also be a distinction made between an exposure and true ingestion. A parents or healthcare provider can call in an exposure, but ultimately there is no confirmatory testing performed. The child may have been seen siting near the pod without actually having ingested the product. The simple fact that there is no reported toxicity in the vast majority of these patients may be due to the fact that there was no ingestion at all.
We agree with the belief the laundry pods pose a risk to children, but the above limitations of the data should be known in order to interpret the findings of the study.