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Toddlers Choking On Liquid Detergent Capsules

A growing number of toddlers are inadvertently swallowing liquid detergent capsules, known as Liquitabs, doctors from the Royal Hospital for Sick Children, Glasgow, UK, Scotland reported in Archives of Childhood Diseases. In what the authors describe as a "significant public health issue", they urge detergent makers and packagers to review their packaging and safety warnings.

Laundry and dishwasher detergent Liquitabs should have childproof packaging and better safety warnings, after several reports have come in of young children swallowing contents of the capsules, the authors explained.

Over a period of 18 months, five children had to be treated for swallowing the liquitab capsule contents in one hospital in Glasgow alone; they ranged in age from 10 months to 24 months. When they were hospitalized they had a high pitched wheeze (stridor), which is usually a sign of some airway blockage.

Liquitabs contain alkaline cleaning agents which have a strong solvent action that can damage tissue, cause inflammation and painful swelling.

In severe cases the airways can become completely blocked; there is also the risk of lung damage as tissue in the esophagus is eroded - a potentially fatal complication.

The oldest patient, a 24-month old child, was treated with steroids and antibiotics. The other four younger ones needed to be intubated for several days to treat ulceration and swelling. One of them required surgery because the swelling and ulceration was so extensive.

Detergent capsules are 'appealing' to toddlers. Although all the patients in Glasgow made full recoveries, the authors wrote that the incidents had "a catastrophic impact on the child and family", as well as using up valuable intensive care resources.

In 2011, in the United Kingdom alone, 647 phone calls were received at the National Poisoning Information Service regarding the swallowing or eating of liquid detergent capsules. The Service also received 4,000 website visits on this theme.

The authors explained that over the last five years, the number of inquiries regarding children swallowing washing machine or dishwasher Liquitabs has more than doubled. Detergent capsules are not childproof Liquitabs do not currently come in childproof containers. At the moment, manufacturers and packaging companies are encouraged to comply to safety standards, but the whole scheme is voluntary, there is nothing legally binding them to adhere to any strict national standards. The doctors said that the contents of these capsules also place young children at risk of severe eye injury.

The authors, who have written to manufacturers alerting them to the current problems, said:

"To help prevent future potentially life threatening injuries, improved safety warnings and childproof packaging are urgently required."

It is not only the manufacturers' responsibility to keep these products out of children's reach, parents should also be extremely careful.

They wrote "Dishwasher and washing machine Liquitabs are now a common finding in most homes, but unfortunately, seem very attractive to young children due to their bright colouring and soft sweetie-like texture. We feel that the increasing trend in liquid detergent capsule ingestion poses a significant public health issue."

American authorities have warned about the dangers According to the American Association of Poison Control Centers (AAPCC), almost 2,200 children under the age of 5 years either got detergent from laundry packets into their eyes or swallowed them during the first six months of 2012.

In May 2012 the AAPCC, as well as experts from the USA's 57 poison centers issued a warning to parents to make sure they kept the single dose packs of laundry detergent well out of the reach of children.

Debbie Carr, AAPCC executive director said that the country's poison centers are reporting an increase in calls from parents about exposures of children to laundry detergents packaged in small, single-dose packets. She explained that some toddlers swallow them and become extremely ill and need to be admitted to hospital, while others have suffered severe eye irritation. In some cases the capsules burst inside the children's mouths, she added.

Below are some examples of injuries reported by the AAPCC: A 20-month old toddler swallowed a detergent capsule. Within ten minutes the child vomited profusely, wheezed, gasped for air and passed out. The patient became unresponsive even to painful stimuli.
A 15-month old child who had swallowed a mouthful of detergent liquid after biting into a capsule had to be rushed to hospital and put on a ventilator.
A 17-month old child bit into a capsule and then became very drowsy, vomited, inhaled the product into the lungs, and had to be placed on a ventilator. Dr. Michael Beuhler, medical director of the Carolinas Poison Center, said:

"The rapid onset of significant symptoms is pretty scary. Other laundry detergents cause only mild stomach upset or even no symptoms at all. Although we aren't certain what in the product is making the children sick, we urge all parents and caregivers to make sure laundry detergent packs are not accessible to young kids."

As in the UK, in the USA all safety measures are encouraged, but adherence to recommendations are done on a voluntary basis. The AAPCC recommends the following: Lock detergents away. Make sure they are out of the reach of children Follow the disposal instructions on the label carefully Reports are published periodically from various parts of the world regarding different detergent products and injuries to children. A 2005 article in The Lancet informed of the danger posed by liquid tablet forms of washing detergents being a new household risk for kids.

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