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| A sample size package of Tide Pods free & gentle. Image by Me (CC BY-NC-ND) |
Today's article is from Fox news, and there is also a very similar article published in the NY Times (Detergent Pods Pose Risk to Children, Study Finds). Both of these articles share the findings of a new study released today in the journal of Pediatrics. The basic message is one that has been on the news several times in the last two years or so: the new colorful and convenient laundry pods are very dangerous to small children. I want to take a closer look at the statistics presented so that we can better understand how big a risk these are to children. Are laundry pods a major concern or is the media fueling needless paranoia and creating a new battle field in the "mommy wars"?
The Fox article briefly introduces those of us who've been living under a rock to laundry pods (such as those by Tide) before going on to say that researchers at Nationwide Children’s Hospital in Columbus, Ohio found that poison control was called over 17,000 times about laundry pod ingestion in two years. They say several children were hospitalized and that one died. Based on these dangers Fox says the study authors recommend switching back to traditional liquid or powdered laundry soap or being very very careful when getting pods out to use. They do point out that after washing there is no difference in the safety of clothing washed in pods or traditional detergents; the danger is in the pods allowing children to access a large dose of undiluted detergent.
The NY Times article contains a few additional details and a scary sounding statistic, it says that two children have died, 750 were admitted to the hospital, and 6000 were seen by the ER. The NY times estimates that laundry pods have a new parent calling poison control every hour! It also includes the story of one mother who had to take her 18 month old to the ER; she fumbled her pod while starting the wash and when it hit the floor the toddler stole and ate it before she could take it away. Both articles state that there remains some confusion about some of the symptoms of laundry pod poisoning (which include drowsiness or altered mental state, breathing problems, and even cardiac arrest in addition to the more expected vomiting or eye irritation), and that these may be related to the chemicals used to package the pods or to the detergent concentration.
So what did the authors of this paper in Pediatrics find out about laundry pod poisoning?
Because laundry pods are a new consumer item in the US with the potential to be a dangerous poison, the researchers wanted to study the occurrence of pediatric laundry pod exposure and the effects thereof. To do this, researchers collected data from Poison Control. Poison Control in the US not only helps people by advising them what to do in cases of potential poisoning, they also collect information about each case that can be used by researchers. In most cases poison control collects information about the age, sex, and race of the poisoned individual; the poison; the amount to which the individual was exposed; and the route of exposure (skin, eyes, inhaled, or swallowed). They also collect information about any followup medical care the individual receives (Is the person taken to the hospital? Are they admitted? Etc.).
For this study researchers requested information about all calls to poison control made in 2012 and 2013 where the poisoned individual was 6 or younger and exposed to a laundry pod (any brand). This resulted in 17,230 calls; 6267 in 2012 and 10963 in 2013. Of these calls, nearly two thirds were about a 1 or 2 year old toddler, and nearly all (98.9%) were exposed at home. The most common type of exposure was ingestion (79.7%). Information regarding how the child got the pod was only recorded about 5% of the time. In half of those cases the child got access to a pod when the package had been opened by an adult for use; the other half were the result of pods not stored away from a child's reach.
Slightly more than half (53.5%) of cases were handled "on-site", meaning that the child was not taken to a hospital or doctors office. One third (35.4%) of the exposed children were treated and released from the hospital or doctors office, 2.4% were admitted to non-critical care, and 2% were admitted to critical care. About two thirds of all children that received medical care were in route when poison control was called, the other third were taken on the advice of poison control.
In most cases the location of the symptoms correlated to the type of exposure. The most common symptoms of laundry pod ingestion were tummy troubles; these included vomiting (56%), nausea (4.9%), diarrhea (2.2%), or pain in the mouth (3.5%), throat (2.5%), or abdomen (1.1%). The next most common symptoms of laundry pod ingestion were coughing/choking (14.6%) and drowsiness or lethargy (7.8%). For eye exposure, eye irritation/pain (78.4%) and redness (50.6%) were most common while vomiting, coughing, or drowsiness were rare (each <1%). Skin exposure nearly exclusively resulted in skin irritations such as flushing (39.2%), pain (30.4%), and rash (21.6%); only two children with skin-only exposure reported non-local symptoms (vomiting, coughing, and eye irritation). Aspiration/inhalation was the least common route of exposure (about 0.3%) but it had some of the most worrying effects. These effects included those localized to the respiratory system: coughing/choking (66.1%), difficulty breathing (16.9%), wheezing (11.9%), hyperventilation (10.2%), and pain in the mouth (3.4%) or throat (6.8%). As well as vomiting (81.4%), drowsiness (22%), and rapid pulse (15.3%). Rapid pulse was also noted in 0.8% of children who had eaten a laundry pod. Two children died, but their route of exposure is not described.
Based on these findings the researchers conclude that laundry pods represent a risk to the health of small children. They suggest that families with children under 4 should not use laundry pods. Barring that, the risk of exposure is best addressed by improvements to product packaging and labeling, as well as product reformulation. This last recommendation is based on the researchers' finding that negative effects are more common from laundry pod exposure compared to traditional laundry soap exposure. The researchers acknowledge that the study relies on voluntary reports to poison control, and so the number of cases of laundry pod exposure is likely under reported. This limits the study in two ways, it underestimates the rate of exposure and it may over estimate the negative effects of exposure (as people who never call poison control are more likely to have children who did not show symptoms from exposure).
What are my conclusions?
To better understand how the threat of laundry pod poisoning stacks up, let's talk about some other statistics. In 2012 poison control was called on behalf of 1,402,937 children (1,102,307 of those under age 6). There were an estimated 73.7 million children in the US in 2012 (24.1 million of those kids were under age 6). That means that 1.2/24.1 million or 4.5% of children needed poison control in 2012 and 6,267/1,102,307 or 0.6% of all child poisoning in 2012 were caused by laundry pods (up to about 1% in 2013). That mean 0.003% of all kids under 6 in 2012 were poisoned by a laundry pod.
Consumer Reports states that laundry pods make up 6% of the laundry soap market. So let's say 6% of the 24.1 million kids are in homes that use laundry pods, that's 1.4 million kids. Of those, six to ten thousand were exposed each year, or 0.4% to 0.77% of at-risk kids are exposed to a laundry pod (as measured by calls to poison control). Of those, only about half required medical care. From this perspective those pods don't look so dangerous any more, but maybe we should compare the risks of laundry pods to other things in a child's environment.
Poison control's own annual report shows that roughly 600 children per month in 2012 were poisoned by non-pod laundry detergent. That's about 7200 kids. With non-pod laundry soap retaining 94% of the market, 22.7 million kids were at risk. That means that 0.03% of at-risk kids are exposed. There is a more than 10-fold increase in poisoning risk with the pods!
If we continue to think about child poisonings, many of the calls to poison control on behalf of children involve medication dosing errors (measurement error being the most common). Of those that involve the child getting into something, the most common are cosmetics (make up, shampoo, etc), analgesics (prescription and over-the-counter pain medicines), and household cleaners (including laundry pods). Analgesic and other medication poisonings are the most likely to be fatal. But calculating the relative risk here gets nearly impossible, so let's not.
Instead I give these statistics for comparison: in 2012 405 children under 6 were killed in car accidents, 41,826 children under 6 were injured, and from Sept. 2012 to March 2013 105 kids died from the flu. This means that about 200 times as many children died from a car crash compared to a laundry pod, 6.2 times as many children died in a car crash compared to any type of poisoning (65 pediatric poisoning fatalities in 2012), and 8 times as many children were injured by a car crash vs a laundry pod (82% or 5,164/6,267 of laundry pod exposed children had some symptoms).
Based on these numbers, I think that it is prudent to use non-pod laundry detergent when your child is a toddler (1-4) or at least buy the free and gentle, which don't look so much like candy. I also think you should worry more about driving your kid around than your laundry pods once reasonable precautions have been taken. For the two news stories, I give Fox a B+, this information is accurate and not over-hyped; I also like that they provide the number for poison control. However, they could stand to improve their citation. They provide the name of the second author and his institution, but not the name of the journal or first author. For the NY Times I give them a B-. They loose points for their scary statistic (1 child/hour sounds very scary without proper context), but provided more specifics and a better citation with a (broken) link to the article, the name of the second author (apparently the one that likes to talk to the media!), the journal, and the publication date.
References (lots of government databases today)
Valdez, Amanda L., et al. "Pediatric Exposure to Laundry Detergent Pods." Pediatrics published online November 10, 2014.
Mowry, James B., et al.
"2012 Annual Report of the American Association of Poison Control
Centers' National Poison Data System (NPDS): 30th Annual Report." Clinical toxicology 51.10 (2013): 949-1229.
"Number of Children (in Millions) Ages 0-17 in the United States by Age, 1950-2013 and projected 2014-2050" Childstats.gov. http://www.childstats.gov/americaschildren/tables/pop1.asp. Accessed Nov 11, 2014.
"Laundry detergent pods remain a health hazard" Consumer Reports. March 2013. http://www.consumerreports.org/cro/2013/03/laundry-detergent-pods-remain-a-health-hazard/index.htm. Accessed Nov 11, 2014
"Fatality Analysis Reporting System Web-based Encyclopedia" National Highway Safety Administration. http://www.nhtsa.gov/FARS. Accessed Nov 11, 2014/
"Web-based Injury Statistics Query and Reporting System" Centers for Disease Control. http://www.cdc.gov/injury/wisqars/. Accessed Nov 11, 2014.
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