poison control

Laundry Detergent Pods: The Newest Danger Under the Sink

Jessica Tomaszewski, MD

Valdez AL, Casavant MJ, Spiller HA, Chounthirath T, Xiang H, Smith GA. Pediatric exposure to laundry detergent pods. Pediatrics. 2014;134(6):1127-1135.

Laundry detergent pods entered the U.S. consumer market in 2012, although they have been available in Europe since 2001. Their bright colors and small size make them attractive to toddlers, who may ingest the pods or burst them open. 

The consequences of such pediatric exposures have ranged from minor effects managed completely at home to ventilator-dependent respiratory failure and even death.

In their recent study,1 Amanda L. Valdez and colleagues reviewed data from the National Poison Data System (NPDS), a database maintained by the American Association of Poison Control Centers that catalogs every call to U.S. poison control centers (PCCs). Using NPDS data from January 2012 to December 2013 on reported exposures to laundry detergent pods among children younger than 6 years, the researchers investigated the epidemiologic characteristics of laundry pod exposures and their consequences among U.S. children after these products entered the consumer market.

Data on 17,230 calls to PCCs for pediatric exposure to laundry pods were analyzed, including incidents that led to the deaths of 2 children. Exposures were grouped into ingestions, aspirations, dermal exposures, ocular exposures, inhalations, and multiple exposure routes with and without ingestion. Other examined variables included exposure sites (eg, home, school), medical outcomes, patients’ age and gender, and management sites (eg, home, hospital).

Characteristics of Exposures

Reported exposure to laundry pods was highest among 1- and 2-year-olds, accounting for 33.3% and 31.5% of cases, respectively. Incidence by gender was nearly even, with boys representing 51.8% of cases. The most common exposure route was ingestion at 79.7%, followed by multiple routes with ingestion (10.4%) and ocular exposure (7.2%). Most exposures occurred at a residence. Approximately half of cases did not require treatment at a health care facility.

Importantly, 904 cases included specific data about the circumstances of the child’s access to the laundry pods. The pods had been stored within sight of the child in 42.3% of these cases, or the pod container had been temporarily left out while in use (10.7% of cases), stored inappropriately (9.1% of cases), or stored in a low, unlocked cabinet (6% of cases). Safe storage and use of laundry pods as part of the home childproofing process clearly is an area in which health care providers can offer guidance.

Effects of Exposures on Children

More than 700 children whose exposure prompted a call to a U.S. PCC in 2012 and 2013 were admitted to the hospital and experienced serious clinical effects. The most common effects were vomiting (48%), coughing/choking (13.3%), ocular irritation/pain (10.9%), drowsiness (7%), and red eye/conjunctivitis (6.7%). Other noteworthy effects in a small number of cases were coma, seizures, hematemesis, pulmonary edema, respiratory arrest, and gastric burns.

The most common therapy was dilution/irrigation/wash (75.1% of cases). Of note, 102 patients required tracheal intubation and ventilation. Compared with exposures in general, pediatric patients exposed to laundry detergent pods required higher levels of care at health care facilities, were more likely to be admitted to a hospital, and were more likely to be admitted to a critical care unit.

The hazards of laundry detergent pods require pediatric clinicians to ask families about the presence of these products in the home, especially those with toddlers.

The researchers noted a decline in laundry pod exposures beginning in April 2013 and note a possible link with packaging changes made by Procter & Gamble (which has the largest share of U.S. laundry pod sales), including opaque wrappers, larger warning labels, and container latches. The authors call for international safety standards for laundry pod packaging and labeling, the development of a voluntary product safety standard, public education, and, possibly, product reformulation to lessen the severity of clinical effects of exposure. Until then, our good counseling will have to suffice. 

Jessica Tomaszewski, MD, is an assistant clinical professor of pediatrics at the Sidney Kimmel Medical College at Thomas Jefferson University in Philadelphia, Pennsylvania, and a hospitalist pediatrician at Nemours/Alfred I. duPont Hospital for Children in Wilmington, Delaware.

Charles A. Pohl, MD—Series Editor, is a professor of pediatrics, senior associate dean of student affairs and career counseling, and associate provost for student affairs at the Sidney Kimmel Medical College at Thomas Jefferson University in Philadelphia, Pennsylvania.

References

1. Valdez AL, Casavant MJ, Spiller HA, Chounthirath T, Xiang H, Smith GA. Pediatric exposure to laundry detergent pods. Pediatrics. 2014;134(6):1127-1135.