title: Efficacy of flow restrictors in limiting access of liquid medications by young children.
abstract: OBJECTIVE
  To assess whether adding flow restrictors (FRs) to liquid medicine bottles can provide additional protection against unsupervised medication ingestions by young children, even when the child-resistant closure is not fully secured.
  
  
  METHODS
  In April and May 2012, we conducted a block randomized trial with a convenience sample of 110 3- and 4-year-old children from 5 local preschools. Participants attempted to remove test liquid from an uncapped bottle with an FR and a control bottle without an FR (with either no cap or an incompletely closed cap).
  
  
  RESULTS
  All but 1 (96%; 25 of 26) of the open control bottles and 82% (68 of 83) of the incompletely closed control bottles were emptied within 2 minutes. Only 6% (7 of 110) of the bottles with FRs were emptied during the 10-minute testing period, none before 6 minutes. Overall, children removed less liquid from the bottles with FRs than from the open or incompletely closed control bottles without FRs (both P < .001). All children assigned open control bottles and 90% of those assigned incompletely closed control bottles removed ≥ 25 mL of liquid. In contrast, 11% of children removed ≥ 25 mL of liquid from uncapped bottles with FRs. Older children (aged 54-59 months) were more successful than younger children at removing ≥ 25 mL of liquid (P = .002) from bottles with FRs.
  
  
  CONCLUSIONS
  Our findings suggest that adding FRs to liquid medicine bottles limits the accessibility of their contents to young children and could complement the safety provided by current child-resistant packaging.
authors.affiliation: Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA.
authors.forename: Maribeth C
authors.initials: MC
authors.lastname: Lovegrove
authors.forename: Stephanie
authors.initials: S
authors.lastname: Hon
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Geller
authors.forename: Kathleen O
authors.initials: KO
authors.lastname: Rose
authors.forename: Lee M
authors.initials: LM
authors.lastname: Hampton
authors.forename: Jill
authors.initials: J
authors.lastname: Bradley
authors.forename: Daniel S
authors.initials: DS
authors.lastname: Budnitz
mesh_terms: D002648:Child; D002675:Child, Preschool; D003257:Consumer Product Safety; D004349:Drug Packaging; D004867:Equipment Design; D005260:Female; D006801:Humans; D008297:Male; D061214:Patient Safety; D004364:Pharmaceutical Preparations / Q000008:administration & dosage*; D011041:Poisoning / Q000517:prevention & control*
chemical_list: D004364:Pharmaceutical Preparations
keywords: CDC; Centers for Disease Control and Prevention; ED; Emergency department; FR; Flow restrictor; OTC; Over-the-counter; PPPA; Poison Prevention Packaging Act
references.citation: Pediatrics. 2011 Jun;127(6):e1597-9
references.pmid: 21555494
references.citation: Vet Hum Toxicol. 1996 Oct;38(5):380-3
references.pmid: 8888549
references.citation: Ann Emerg Med. 2009 Apr;53(4):419-24
references.pmid: 18774623
references.citation: Arch Pediatr Adolesc Med. 2010 Feb;164(2):181-6
references.pmid: 20124148
references.citation: Clin Toxicol (Phila). 2006;44(3):205-23
references.pmid: 16749537
references.citation: Am J Prev Med. 2009 Sep;37(3):181-7
references.pmid: 19666156
references.citation: J Paediatr Child Health. 2003 May-Jun;39(4):264-9
references.pmid: 12755931
references.citation: J Paediatr Child Health. 2001 Jun;37(3):262-5
references.pmid: 11468041
references.citation: Pediatrics. 2010 Dec;126(6):1100-7
references.pmid: 21098150
references.citation: Am J Prev Med. 2011 Jun;40(6):585-92
references.pmid: 21565648
references.citation: Ann Pharmacother. 2008 Jan;42(1):46-52
references.pmid: 18056832
references.citation: JAMA. 1996 Jun 5;275(21):1661-5
references.pmid: 8637140
references.citation: Clin Toxicol (Phila). 2007 Sep;45(6):662-77
references.pmid: 17849242
references.citation: Clin Toxicol (Phila). 2011 Dec;49(10):910-41
references.pmid: 22165864
references.citation: J Pediatr. 2012 Feb;160(2):265-270.e1
references.pmid: 21920539
references.citation: Emerg Med Clin North Am. 2004 Nov;22(4):1019-50
references.pmid: 15474780
references.citation: Pediatrics. 1971 Oct;48(4):613-28
references.pmid: 5114749
references.citation: Hum Toxicol. 1987 Jul;6(4):303-14
references.pmid: 3623576
references.citation: Am J Public Health. 1989 Jul;79(7):853-6
references.pmid: 2660604
references.citation: Clin Toxicol (Phila). 2006;44(1):1-18
references.pmid: 16496488