Increasing child opioid overdose cases

Increasing child opioid overdose cases | Image Credit: © Antonio Rodriguez - © Antonio Rodriguez - stock.adobe.com.

According to the abstract “Characteristics of Children with Opioid Poisoning Consulted by a Child Protection Service,” presented at the 2024 American Academy of Pediatrics (AAP) National Conference & Exhibition, the opioid crisis has increasingly been poisoning children over the last decade, with a 4-fold increase observed from 2019 to 2023.¹

“As parents and other adults increasingly misuse opioids, it’s becoming more and more possible for those drugs to end up in children’s hand,” said Maria Quidgley-Martin, MD, pediatric emergency medicine attending and clinical assistant professor of emergency medicine at the University of Florida. Quidgley-Martin is also the lead author of the study that examined the demographic and medical records of 69 children who were assessed by Suspected Child Abuse and Neglect teams in the Philadelphia, Pennsylvania area.¹

“Children are most often coming across these drugs in familiar settings such as their home or the home of a relative,” Quidgley-Martin said in a press release from The AAP.¹

Below, read study details and findings presented at the 2024 AAP National Conference & Exhibition, taking place from September 27 through October 1, 2024 from Orlando, Florida.¹

Background

With increasing opioid exposures, particularly fentanyl that have resulted in fatal poisonings, the opioid crisis in the United States continues to be a concern for children. Adult opioid misuse is also linked to increased cases of child abuse and neglect, leading to involvement from the child welfare system.²

There is a lack of literature describing the demographic, clinical, and social characteristics, as well as the acute medical outcomes of children evaluated for opioid poisoning in the context of child maltreatment. The study investigators sought to address this gap by detailing these features among children who were consulted by the child protection team at a quaternary urban children's hospital.²

Study details and results

A retrospective cohort study was conducted at a large urban children's hospital, analyzing children who received a consultation from the Suspected Child Abuse and Neglect (SCAN) team because of opioid exposure between June 2012 and December 2023. Data were collected from medical records within an existing patient registry and de-identified before being entered into a REDCap database. The dataset included demographic, clinical, and social information. Descriptive statistics were used to characterize the population, and comparisons were made based on age and fentanyl exposure.²

A total of 69 SCAN consultations for opioid ingestions were analyzed, revealing a 4-fold increase in such cases from 2019 to 2023. Most of the affected patients (72%) were under 2 years of age, and there was an 11-fold increase in non-Hispanic Black children affected during this period. Fentanyl was identified as the most frequently involved opioid, with the majority of exposures (87%) having occurred in the child’s home or a relative's residence.²

The most common presenting symptoms were altered mental status, abnormal breathing, and seizures. Of the patients, 11 arrived at the hospital in cardiac arrest, with nine of these being under the age of 2 years. Respiratory arrest or depression was present in 71% of the cases upon presentation. Emergency medical services provided pre-hospital care for 59% of the children, and 61% were transferred from general emergency departments. Naloxone was administered to 71% of the patients, with higher odds in children under the age of 2 years (OR 3.2, 95% CI [1.04-9.8], P =0.04).²

Fifty-eight percent of the children were admitted to the intensive care unit (ICU), with those under 2 years having higher odds of ICU admission (OR 3.33, 95% CI [1.1-10], P = 0.03).²

Four children, all under the age of two, died from fentanyl poisoning. Over half (52%) of the families had prior involvement with Child Protective Services (CPS), with significantly higher odds in children under 2 years (OR 4.57, 95% CI [1.42-14.7], p=0.01). A family history of opioid abuse was reported in 65% of cases, and nearly half of the children were discharged to out-of-home placements.²

Conclusion

The sharp increase in SCAN consults for opioid ingestions, primarily involving fentanyl, underscores the urgent need to address opioid exposure among children. The study reveals that young children, particularly those under the age of two, and non-Hispanic Black children are disproportionately affected. Most ingestions occurred in familiar settings, and a significant number of cases required pre-hospital care and ICU admission.²

Furthermore, the findings highlight the critical role of child protective services, as many of the families involved had a history of CPS interaction. These results can inform targeted education, advocacy, and policy initiatives to mitigate the impact of the opioid crisis on children, including preventing opioid access in homes and improving the support systems for vulnerable families.²

“As a pediatric emergency medicine doctor, I have seen children injured and killed by fentanyl way too often,” said Quidgley-Martin. “We need to speak about this more and work together to protect our children.”¹

References:

1. Opioid poisoning in children increasing alongside adult misuse. American Academy of Pediatrics. Press release. September 27, 2024. Accessed September 29, 2024.

2. Quidgley-Martin M. Characteristics of Children with Opioid Poisoning Consulted by a Child Protection Service. Abstract. Presented at: 2024 American Academy of Pediatrics National Conference & Exhibition. September 27-October 1, 2024, in Orlando, Florida.