An examination of fatal child poisonings in the United States using the National Violent Death Reporting System (NVDRS), 2012-2017

Background Fatal drug overdoses are predominantly attributed to opioids. Women of childbearing age are among those at greatest risk, underscoring the need to understand the overlapping risk of fatal poisoning in children. Methods A retrospective analysis of fatal poisonings among decedents aged 0-9 years captured in the National Violent Death Reporting System (NVDRS) from 2012 to 2017 was employed. Poisonings were identified using International Classification of Diseases, Tenth Revision (ICD-10) codes for poisonings (T36-T50, Y10-Y19), toxic effects of substances (T51-T65), and assault (X85-X90). The frequency and types of drugs involved in poisonings were derived from toxicological analysis. Logistic regression was used to model the odds of fatal poisoning by decedent and perpetrator characteristics. Qualitative content analysis was used to contextualize the patterns of fatal poisonings. Findings 1850 violent deaths were identified; 7% (n = 122) were poisoning-related, and 50% of these were attributed to opioids. Next, benzodiazepines (8%), amphetamines (7%), and antidepressants (5%) were most prevalent. Among poisoning-related deaths, 25% involved homicide-suicide. No differences in deaths were observed according to child race/ethnicity, and the risk of fatal poisoning decreased 6% with each year of child age. Following qualitative analysis, three unique categories of fatal poisoning emerged: "intentional administration without documented benign intent", "intentional administration with benign intent", and "unclear administration". Conclusion The high proportion of fatal poisonings in children attributed to opioids in this study suggests a need for universal dissemination and training of naloxone in households comprised of children living with parents experiencing, or in recovery for substance misuse. Findings also indicate a needed emphasis on safe storage practices and education to parents about the risk of prescription drug toxicity in children.