The number of poison-related deaths among children under 5 years of age decreased from approximately 450 in 1961 to 55 in 1983, an 88% decline (Figure 1) (1,2). This decrease is due in part to increased awareness concerning poisons, facilitated in 1961 by the passage of Public Law 87-319 (75 Stat. 681), which designated the third week of March as National Poison Prevention Week (NPPW). March 16-22, 1986, marks the 25th anniversary of NPPW. BACKGROUND

Early Awareness of the Poison Problem. In 1927, Congress passed the Caustic Poisons Act, which applied to approximately 12 acids and alkalies used in household products. The Act required a warning on packages of household lye used to make soap. Each year, both the chemical's resemblance to sugar and its users' carelessness in storing the lye caused thousands of young children to suffer chemical burns; some were fatal.

The Act was widely complied with and required minimal enforcement. However, as new products increased, the number of unintentional ingestions increased, so that by the 1950s, physicians considered poisonings by common household chemicals and medicines the leading cause of injuries to children under 5 years of age (3). The U.S. Public Health Service (PHS) National Health Survey estimated that each year 500,000 unintentional ingestions of toxic and potentially toxic substances occurred among young children; many pediatricians and public health officials estimated the figure at one million (1). Death certificates from states attributed almost 500 fatalities per year among children under 5 years of age to ingestion of drugs and household products (1). Therefore, the American Academy of Pediatrics' Committee on Accident Prevention recommended the establishment of poison control centers. The first center opened in Chicago, Illinois, in 1953.

In 1957, under the auspices of PHS, the National Clearinghouse for Poison Control Centers was established to collect data from poison control centers and provide them with diagnostic and therapeutic information on the many household products involved in childhood poisonings. In 1958, the American Association of Poison Control Centers was created to provide a professional membership society that offered guidance to its members and produced and disseminated poisoning-prevention materials.

Creation of NPPW. In the 1950s, a Missouri pharmacist, Homer A. George, became concerned about conflicting or nonexistent antidotes for some medicines and chemicals sold in his practice. He perceived a need for greater public awareness of means to prevent childhood poisonings. In 1958, he convinced his town's mayor to proclaim a Poison Prevention Week, then persuaded Missouri's governor to proclaim a statewide Poison Prevention Week. Eventually, Homer George convinced his congressional representative to introduce national legislation. With assistance from the American College of Apothecaries, the American Pharmaceutical Association, and PHS, the enabling legislation was guided through the 86th Congress and signed into law by President John F. Kennedy on September 16, 1961. To coordinate the first NPPW, the American Pharmaceutical Association and PHS sponsored a meeting in Washington, D.C., that was attended by 21 professional, industrial, and service organizations and federal agencies. That meeting established what is now called the Poison Prevention Week Council (PPWC). The first NPPW was observed March 18-24, 1962. EFFECTS OF NPPW

By 1966, almost every state had some poisoning-prevention activity, including distribution of poisoning-prevention publications, governors' proclamations, and public service announcements. In 1970, Congress passed the Poison Prevention Packaging Act, which required child-resistant packaging for many products. While poisoning deaths had begun declining during the 1960s, this Act had a major effect on poisonings (4). By 1973, poisoning deaths among children under 5 years of age had declined 50% since the first NPPW. This was attributed in large part to increased public awareness of poisoning-prevention measures (1) and to the Poison Prevention Packaging Act. In 1986, 33 years after the opening of the first U.S. poison control center, there are over 300 such centers nationwide.

Over the past 25 years, the PPWC has dealt with issues that included:

1. First Aid Measures. The PPWC recommends that a poison

control center, hospital, or physician be called as soon as possible after ingestion.

2. Different Statistics. Although there are several sources of data about childhood poisonings (5), mortality data collected by the National Center for Health Statistics have been considered the most reliable, because all states are required to report deaths to NCHS.

3. Adult Poisonings. While NPPW focuses on children, the elderly are also at risk of being poisoned.

Editorial Note

Editorial Note: NPPW is sponsored by the PPWC, a coalition of 34 national organizations* representing industry, consumer groups, health professionals, government, and the media. PPWC members are continuously involved in projects to reduce unintentional poisonings among young children (4-6).

This year, as many as 130,000 children under 5 years of age will ingest poisons. The PPWC and the U.S. Consumer Product Safety Commission (CPSC) recommend the following precautions to reduce the risk:

1. Household products and medicines should be kept out of reach and out of sight of children, preferably in a locked cabinet or closet. When leaving the room even briefly, containers of such products should be moved to a safe place.

2. Medicines should be stored separately from other household products and kept in their original containers--never in cups or soft-drink bottles.

3. All products should be properly labeled, and the label should be read before use.

4. A light should be turned on when giving or taking medicine.

5. Since children tend to imitate adults, adults should avoid taking medications in their presence. Medicine should not be drunk from the bottle.

6. Medicines should be referred to by their correct names. They are not candies.

7. Medicine cabinets should be cleaned out periodically. Old medicines should be discarded by flushing them down the drain, rinsing the container with water, and discarding it.

8. Household substances in child-resistant packaging should be used. Prescription medicines should be contained in safety packaging. Safety features should be carefully resecured after using. To avoid poisonings among elderly persons, PPWC and CPSC recommend

the following:

1. Always read the label and follow instructions when taking medicine.

2. Turn on a light at night when taking medicine.

3. Never mix medicines and alcohol, and never take more than the prescribed amount of medicine.

4. Do not "borrow" a friend's medicine or take old medicines.

5. Inform the physician what other medicines are being taken to avoid the risk of adverse drug interactions. Additional information on NPPW is available from the Secretary,

PPWC, P.O. Box 1543, Washington, D.C. 20013; telephone (301) 492-6580. Additional information on poisoning prevention is available from CPSC's toll-free hotline, (800) 638-2772. Reported by Poison Prevention Week Council, Consumer Product Safety Commission, Washington, D.C.; Office of the Director, Epidemiology Program Office, CDC.

References

1. Poison Prevention Week Council. 1985 annual report. A history of National Poison Prevention Week. Washington, D.C.: Poison Prevention Week Council, 1985.

2. Division of Vital Statistics, National Center for Health Statistics. Unpublished data, 1983.

3. American Academy of Pediatrics. Unpublished data, 1950.

4. CDC. Unintentional poisoning among young children--United States. MMWR 1983;32:117-8.

5. CDC. Update: childhood poisonings--United States. MMWR 1985; 34:117-8.

6. CDC. Poisoning among young children--United States. MMWR 1984;33:129-31. *Members of the PPWC are: American Academy of Clinical Toxicology; American Academy of Pediatrics; American Association of Poison Control Centers; American Association of Retired Persons; American College of Emergency Physicians; American Dental Association; American Hospital Association; American Medical Association; American Nurses' Association; American Petroleum Institute; American Pharmaceutical Association; American Public Health Association; American Red Cross; American Society of Hospital Pharmacists; Boy Scouts of America; Chemical Specialties Manufacturers Association, Inc.; Closure Manufacturers Association; Cosmetic, Toiletry, and Fragrance Association, Inc.; Council For Responsible Nutrition; Council on Family Health; Girl Scouts of the United States of America; National Agricultural Chemicals Association; National Association of Broadcasters; National Association of Chain Drug Stores; National Association of Retail Druggists; National Paint and Coatings Association; National Safety Council; Pharmaceutical Manufacturers

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