Key Words: Accidental drug poisoning, children, risk factor

With the explicit stretching of health services in Jordan provided by different health provisions, one expects an escalated risk of drug poisoning due to increased availability (1), A rich medical literature surrounding this issue is found.
Poisoning per se is considered to be a common medical emergency in childhood particularly in the preschool age group worldwide (2); the severity and frequency of poisoning is reduced by different preventive measures, however, we still need more effective and safer means of prevention as well as treatment (3).

Given the lack of poisoning incidents registry in this hospital, the author retrospectively collected and reviewed all medical records of children who were diagnosed and admitted as cases of drug poisoning to princess Haya military hospital in Aqaba - a city south of Jordan, with a population of around 200,000 - during the period from February 2004 to February 2006. All cases were admitted to the pediatric ward or intensive care unit.

Age, sex, type of drug ingested, and history of the circumstances that lead to poisoning were recorded. Toxicological screenings of blood or urine were not executed. The study excluded cases of poisoning caused by all other substances. Munchausen's by proxy syndrome and subjects above 14 years of age were also excluded (hospital policy regards pediatric age group as up to 14 year of age).

The sample involved a total of 56 children (n=56). Thirty-two (57%) of them were males and twenty four (43%) were females. Male: female ratio was 1.3:1 .The youngest child in the studied sample was aged 10 months, while the eldest aged 13 years. However the proportion of age groups within the sample varied, most of the cases occurred in younger age group, the commonest age group was that aged less than six years n= 44 (78.5%), while the older age group from eleven to fourteen years constituted the least n= 3 (5%), Table 1.

It was also found that Acetaminophen was the most frequent drug involved accounting for (12.5%) of cases ,which is comparable to the findings in studies done worldwide (2,4,5) , to be followed by different antibiotics (10.7%) and antihistamine preparations (7.1%) . Aminophlline recorded the least in the list, Table 2.

The average hospital stay was one to three days. Only two cases were rushed to the intensive care unit due to their critical condition. No deaths were recorded.

The proportion of such medical emergencies in the pediatric hospital admissions in our retrospective study reached 3.7%, despite the fact that this study dealt with poisoning due to drugs only while most literature focused on poisoning due to medicinal and non-medicinal agents. However, such conditions seem to be major health issues as the incidence sequalae, are considered to be quite high (6).
The highest risk age group in our sample was found to be those aged less than six years, which is globally agreed upon in regard to poisoning by different agents. (2, 4, 7) Most researchers thought that such findings could be attributed to the exploratory nature of the developmental stage in this age group (1, 8).

One point of interest is the temptation of the flavoring additives, the coloring, and the attractive smell that some children may think drugs are candies. (9) Some parents prompt resentful children to take medications, telling them that it is a delicious candy (8). Most medications are unfortunately dispensed in non child-proof containers, a fact that should be considered with care in future.

The author believes such explanations are applicable in this study sample. Other factors are also important, such as the easy reach children have to medications, leaving children unattended for a relatively long period of time, availability of medications, the improvement of medical services and coverage of larger groups of populations that made drugs more available.

Some researchers found the family size to be a determinant factor in increased risk of incidence (8), a similar finding applied to this study. This study found that 57.1% of children came from large sized families (five or above).

The author couldn't find any particular data in regard to the family circumstances passed through (pregnant mother, death of a family member, divorce, new comer, illness of a sibling, change of residence etc, that may increase the incidence of accidental poisoning, while some researchers did find so (10 ,11).

The educational level of the caregivers (8) and the presence of an adult with chronic medical illness within the family (7) that may be considered as risk factors were not studied by the author which was a limitation of this study.

As formerly mentioned, analgesic, antipyretic and antibiotic preparations were incriminated to be the commonest causative drugs; they seem to be the most dispensed medications to children given the fact that infectious conditions are common and unfortunately, as the author believes, some physicians tend to over prescribe antibiotics.

The relative ease in reaching emergency services enabled such condition to be handled early, Most cases reached casual\ty within less than two to three hours after the ingestion of the drug and only two cases warranted ICU admissions.
Despite the fact that the study wasn't primarily interested in methods of parent's discovery of poisoning, most cases were discovered accidentally i.e. lips or clothing soiled with treatments, empty or reduced amount in medication containers, presence of child witness,etc. Less commonly children were discovered after developing significant features of poisoning.

Accidental drug poisoning in children is conspicuously a crucial health concern to all health workers and pediatricians in particular, pharmacy industry and lay community. There has been a generous medical literature concerning preventive and safety measures surrounding this issue. The author believes that adoption of such measures should be continuously refined see Box 1.Further in-depth studies will add more to our knowledge and alertness.

The author is aware that the national poison control center has been recently established in Jordan, affiliated to Jordan University Hospital, however, this centre needs to be more advocated to refer to expert advice and collaboration.

• Keep all medications in a secure cabinet out of reach of children and use Child-resistant proof containers
• Keep medications in the original containers and discard all residual or expired drugs.
• Never interchange dosages among different drugs.
• Avoid calling drugs candies.
• Education of parents and lay community, pediatricians, family doctors, and GP's awareness.
• Don't take your medications in front of children.