Drugging Kids a Form of Abuse

By Todd Neale, Staff Writer, MedPage Today
Published: July 22, 2010
Reviewed by Robert Jasmer, MD; Associate Clinical Professor of Medicine, University of California, San Francisco and
Dorothy Caputo, MA, RN, BC-ADM, CDE, Nurse Planner 

Giving children pharmaceuticals for nontherapeutic reasons may be an under-recognized form of abuse, a retrospective study showed.

Data from U.S. poison control centers revealed an average of 160 cases of "malicious" use of pharmaceuticals in children younger than 7 annually over a nine-year period, Shan Yin, MD, MPH, of Rocky Mountain Poison and Drug Center in Denver, reported online in the Journal of Pediatrics.

The most commonly used drugs were analgesics, stimulants/street drugs, sedatives/hypnotics/antipsychotics, and cough and cold preparations.

About half of the cases (51.1%) involved a sedating agent.

Moderate or major outcomes -- or death -- occurred in 13.8% of cases.

Mark Riddle, MD, a psychiatrist at Johns Hopkins Hospital, said in an e-mail that it can be difficult to differentiate between accidental and malicious misuse of a drug, and that looking at a pattern of previous behaviors might help decide.

"A malicious act directed at a child is unlikely to be a stand-alone event," said Riddle, who noted that mental illness or substance abuse in a parent may impair his or her judgment.

Although the study could not determine the reasons for the inappropriate use of drugs in children, Yin speculated in his paper that parents might be trying to get a baby to stop crying, calm a child after being physically abused, or take a break from caring for a child.

Aside from sedation, he added, other reasons might include homicide, punishment, Munchausen by proxy, or amusement.

Regardless of the reason, according to Paul Miller, PhD, a psychologist at Arizona State University, "parents first need to be directly informed about the consequences of misusing such agents for their children."

"Evidence of malicious drugging should be considered child abuse," he said in an e-mail. "This may well be hard to determine, but if there is evidence that the behavior is actually malicious, children need to be protected from their parents just the same as if the parents were physically attacking them."

According to Yin, the nontherapeutic use of pharmaceuticals does not fit well in the four traditional categories of child maltreatment -- physical abuse, sexual abuse, emotional abuse, and neglect.

But on the basis of reports of Munchausen by proxy syndrome via poisoning, malicious use of over-the-counter cough and cold medicines, and sexual abuse of children facilitated by drugs, it is reasonable to consider such an act a form of child abuse, he wrote in his paper.

To quantify the problem, Yin reviewed information reported to the U.S. National Poison Data System regarding all exposures to pharmaceuticals and alcohol coded as "malicious" -- meaning someone intentionally meant harm -- from 2000 to 2008.

Over that time, there were 1,439 cases, ranging from 124 to 189 per year. There was a steady increase over time (P=0.006).

Eleven categories of pharmaceuticals or alcohol accounted for 82.3% of the cases -- analgesics, stimulants/street drugs, sedatives/hypnotics/antipsychotics, cough and cold preparations, unknown, ethanol, topical preparations, gastrointestinal preparations, antihistamines, antidepressants, and cardiovascular drugs.

About one in every 10 (9.7%) of cases involved more than one substance.

Among those cases with outcome data, 13.8% resulted in moderate or major outcomes or death; 18 children died, 17 of whom were given sedating agents such as antihistamines and opioids.

The occurrence of death or major outcomes was associated with exposure to multiple agents (OR 3.0, 95% CI 1.6 to 6.0), exposure to a sedating agent (OR 3.6, 95% CI 1.7 to 7.7), and age younger than 3 (OR 1.9, 95% CI 1.02 to 3.6).

But even though the majority of children did not have serious immediate consequences from the exposures, there could be long-term effects, according to Alan Kazdin, PhD, a psychologist at Yale University.

"The impact of abuse of drugs in this way is likely to have cascading effects on the developing biology of children and even potentially long-term effects on morbidity and mortality," he said in an e-mail.

Yin acknowledged some limitations of his study, including the possibility that some cases were mistakenly coded as malicious; the lack of information on the exact circumstances of each case; the reliance on voluntary and self-reported data, which may underestimate the problem; and the lack of data confirming exposures with drug levels except for the fatalities.

Yin reported that he had no conflicts of interest.

This article was developed in collaboration with ABC News.

Primary source: Journal of Pediatrics
Source reference:
Yin S "Malicious use of pharmaceuticals in children" J Pediatr 2010; DOI: 10.1016/j.jpeds.2010.05.040.