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Drops, Sprays Put Curious Kids at Risk

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It's every parent's nightmare: Your back is turned, and your child swallows something toxic. It happens with products that you may not think of as dangerous. Take over-the-counter (OTC) eye drops used to relieve redness or nasal decongestant sprays.

"In the hands of young children who are apt to swallow them, they can cause serious health consequences," says pharmacist Yelena Maslov, Pharm.D., at the Food and Drug Administration (FDA).

FDA is warning the public to keep these products—which contain the active ingredients tetrahydrozoline, oxymetazoline, or naphazoline (known as imidazoline derivatives)—out of the reach of children at all times. The products are sold under various brand names such as Visine, Dristan and Mucinex, as well as in generic and store brands.

Maslov explains that one teaspoon of eye drops or nasal spays containing imidazoline derivatives is equal to about 5 mL, and that harm has been reported from swallowing as little as 1 mL to 2 mL. "Children who swallow even miniscule amounts of these products can have serious adverse effects," she says.

Between 1985 and 2012, FDA identified 96 cases in which children ranging from 1 month to 5 years accidentally swallowed products containing these ingredients. Cases were reported by both consumers and manufacturers to government databases monitored by FDA. According to some case reports, children were chewing or sucking on the bottles or were found with an empty bottle next to them.

There were no deaths reported, but more than half of the cases (53) reported hospitalization because of symptoms that included nausea, vomiting, lethargy (sleepiness), tachycardia (fast heart beat), and coma.

"Underreporting of these types of events is common, so it is possible there are additional cases that we may not be aware of," says Maslov.

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A Call for Child-Proof Packaging

These products are only meant for use in the eyes or nose. In the eyes, the ingredients work by narrowing blood vessels to relieve redness from minor eye irritations. In the nose, they constrict blood vessels to relieve nasal congestion due to the common cold, hay fever, or allergies.

In January, 2012, the U.S. Consumer Product Safety Commission (CPSC) proposed a rule to require child-resistant packaging for all products containing at least 0.08 mg of an imidazoline derivative. However, this rule has not been finalized. In addition, FDA's Division of Medication Error Prevention and Analysis (DMEPA) is partnering with CPSC to warn consumers about the need to keep these products safely out of the reach of children.

According to Up and Away and Out of Sight—an educational initiative to remind families of the importance of safe medicine storage, in which FDA is a partner—more than 60,000 young children end up in emergency departments every year because they got into medicines while their parent or caregiver was not looking.

Up and Away literature suggests that parents explain to their children what medicine is and why parents must be the ones to give it to the child. In addition, never tell a child that medicine is candy to get him or her to take it, even if the child does not like to take the medicine. 

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Out of Harm’s Reach

If a child accidentally swallows OTC redness-relief eye drops or nasal decongestant spray, call your local poison control center (1-800-222-1222) immediately. Experts are available all day, every day at these centers. If necessary, poison center staff will immediately help get emergency medical services to your home. Program this number into your home and cell phones so you will have it when you need it. Post it on the fridge so it is in plain sight.

To help avoid a child's accidental exposure to any medication, parents and other caregivers should:

  • Store medicines in a safe location that is too high for young children to reach or see.
  • Never leave medicines or vitamins out on a kitchen counter or at a sick child's bedside.
  • If a medicine bottle does have a safety cap, be sure to relock it each time you use it.
  • Remind babysitters, houseguests, and visitors to keep purses, bags, or coats that have medicines in them away and out of sight when they are in your home.
  • Avoid taking medicines in front of young children because they like to mimic adults.

October 25, 2012

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For more about food, medicine, cosmetic safety and other topics for your health, visit FDA.gov/ForConsumers.
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