Recent increases in numbers and risk of fatalities in young children ingesting iron preparations

Iron preparations are the most frequent cause of pediatric ingestion fatalities. The purpose of this study was to quantify the impression of an increase in iron deaths in young children and to postulate on the reasons. Using the data provided by the American Association of Poison Control Centers, overall annual mortality rate from iron preparations and among children <6 y was calculated and changes in incidence were recorded. Between 1983 and 1991, there was a 2 to 3-fold increase in the numbers of reported ingestions of iron preparations by toddlers. In the general population the annual mortality rate/100 exposures to iron preparations increased from 0.05 during 1983-1990 to 0.116 in 1991 (p<0.01). A similar trend was noted in children <6 y with a rate of 0.004 in 1983-1990 compared with 0.12 in 1991 (p<0.01). Hence, the increase in mortality was beyond what would be predicted from the increased number of ingestions noted. It is likely that increased awareness of pregnancy-induced anemia results in abundant use of iron pills. These pills have the appearance of candies, which should be changed immediately by legislation. During this period, the volume of iron preparations prescribed increased only marginally (16%), suggesting that over-the-counter use of iron pills increased substantially. In addition to warning labels and child-resistant packaging, an aggressive educational plan directed at the general population and physicians should be instituted immediately.