Antidote for Child Poisonings: A Bitter Pill : Health: To prevent accidents, some manufacturers are putting the vile-tasting agent denatonium benzoate in products.
Dr. Richard Thomas often hears the same mournful words from parents who call the Regional Poison Control Center at UC Irvine.
“The story typically starts with ‘I don’t know how he did it. He climbed up on the counter. . . , ' " says Thomas, whose office handles about 130 calls a day for information or emergency assistance.
Craig and Ann Newberg of Tampa, Fla., are typical of thousands of parents who, each year, find out how easily accidental poisonings can occur.
A furniture refinisher had mixed polish and other substances in a cup and set it on the floor. The Newberg’s daughter Elizabeth, 2, found the cup and drank two to three ounces of the liquid.
“It was in a cup she was used to drinking out of,” says Craig Newberg, whose daughter recovered after she was taken to an emergency room.
This spring a handful of manufacturers are introducing products that contain denatonium benzoate, the most bitter-tasting substance in the world. The agent tastes so vile that children almost always spit it out the second it enters their mouths.
The nontoxic bittering substance is added in such minute quantities that it doesn’t change product effectiveness, color or scent. But according to officials at Henley Chemicals in Montvale, N.J., distributors of Bitrex, one ounce of the bittering agent can foul the taste of 1,600 gallons of alcohol.
This is the first new strategy to prevent accidental poisonings since the invention of child-resistant closures in the early 1970s.
About 3,000 accidental poisonings in the United States were related to household products in 1987, the last year for which such data is available. Many occurred among children under age 6. (Medications and food were the predominant causes of the 700,000 accidental poisonings nationally that year.)
Rep. Charles E. Schumer (D-N.Y.), who has introduced legislation calling for wider use of bittering agents, says that 173 life-threatening exposures and 14 deaths resulted from accidental poisonings with household products in 1987.
U.S. manufacturers, however, have been reluctant to add bittering agents for several reasons: They believe consumers are not looking for added protective measures and fear that adding bittering agents might bring unwanted attention to a product’s toxicity potential.
In addition, many manufacturers contend that child-resistant closures are adequate to prevent poisonings. Although statistics show that such closures have caused a dramatic decline in poisoning deaths, they do not always provide enough protection. For example, closures can get sticky or gummy and then won’t lock properly, some experts say.
In a study by the American Assn. of Poison Control Centers, investigators studied the bottles and caps involved in dozens of child poisonings. They found that 65% of the caps didn’t work properly; the rest worked, but children still managed to open the bottles.
Now, after intense lobbying by a grass-roots consumer organization, Poison Prevention Project, and the threat of legislation in several states, a few manufacturers are adding bittering agents.
These include Eaton & Co., makers of a rodenticide, and Mac’s Oil & Chemical, which produces NAPA and Ig-Lo automotive products.
True Value Hardware Stores has announced it would introduce seven household products this month with a bittering agent, and Wal-Mart Stores Inc. has said it would sell a nail-polish remover that contains a bittering substance beginning this spring.
“We became aware of the product in the European markets. We evaluated it and decided to do it on the basis of it just being the right thing to do,” says John Dillon, marketing manager of Mac’s Oil & Chemicals Inc. of Lexington, Ky. (Some European manufacturers have added bittering agents for several years.)
“Kids being kids will get into just about anything. While all of our products have child-resistant caps, nothing is foolproof, and this additional measure is one we can take to ensure a child’s safety. If it prevents even one child from being harmed, it will be well worth the effort.”
Adding a bittering agent would cost only pennies, according to officials at Henley Chemicals. Several manufacturers that have added bittering agents have said they will not pass on the increase to consumers.
A bittering agent probably would have saved the 2-year-old New York child who downed sweet-tasting antifreeze in his parent’s garage, says Lynn Tylczak, the Albany, Ore., housewife who started a campaign to promote bittering agents about two years ago.
“This mother started crying on the phone to me,” says Tylczak, who has received about 30,000 calls or letters of support. “She said, ‘Two cents would have saved my son. All the money in the world can’t bring him back.’ ”
Tylczak agrees that the use of bittering agents is no panacea. But, she says, “where this stuff works, it’s extremely effective and extremely cost-effective. After two years, if anyone had a good reason not to do this, I would have heard about it by now.”
Still, many manufacturers have long resisted adding bittering agents, and even some poison-control experts have reserved judgment about their effectiveness.
Congress has ordered the Consumer Product Safety Commission to study the effectiveness of bittering agents, also called aversion agents, says commission spokesman Ken Giles. Until then, he says, the council cannot recommend use.
The commission has also instructed manufacturers not to swap child-resistant closures for bittering agents, believing child-resistant closures are far more effective. A law scheduled to go into effect in California on Jan. 1 would give the option of using child-resistant closures or a bittering agent to manufacturers of some toxic products made or sold in the state.
“We think the real message is: Use safety caps,” Giles says. “They save lives.”
Giles says that questions remaining about bittering agents include: Does the substance trigger a gag reflex that might cause a child to inhale the toxin into the lungs, where tissue damage is potentially much more serious than in the stomach? How long does the bittering agent remain effective? How does it react with other chemicals in the product?
But these questions are not likely to deter parents who want to take every precaution.
Says Craig Newberg, the Tampa father: “The use of bittering agents is a very good idea. They say it would taste so nasty that no one would drink it. Or if they did take a sip, they wouldn’t take much.”
Thomas, of the Regional Poison Control Center, says poisonings often occur because of three common errors:
* If a child has access to a container, even a few seconds is enough time for a poisoning.
* Parents underestimate the ability of a 2-year-old to reach or open a product.
* A toxic product is poured into another container and then mistaken for something harmless. Pine-based cleaning solutions, for example, have been mistaken by a 2-year-old for apple juice.
In one tragic case, a Mercer Island, Wash., boy, 17, accidentally drank a red-colored solution in a glass that he mistook for cranberry juice. The substance was a detergent. The youth suffered damage to his throat, esophagus and stomach.
The presence of a bittering agent would prevent someone from ingesting more than a sip of a toxin, experts say. A hospital study in Wales found that 20 of 23 children who drank orange juice with Bitrex stopped after one or two sips.
And in another study by the Procter & Gamble Co., young children were offered a soapy solution. Those who drank the solution with a bittering agent ingested less than half a teaspoon. But those who drank it without a bittering agent ingested over a teaspoon.
Children reacted with aversion to the solution with a bittering agent within four seconds of tasting it, compared to an average 18 seconds needed to respond negatively to the solution without it.
Procter & Gamble uses bittering agents in its Bold and Solo combination detergent and fabric softeners, says Marie Salvado, a company spokeswoman: “We found out that the smell (of those products) might be appealing to young children. Softener has a sweet smell.”
All other P&G; products, she says, contain an emetic, a substance that induces vomiting if ingested. Often used as protection against accidental poisonings, emetics are not thought as effective as bittering agents because emetics don’t prevent ingestion.
According to Tylczak, manufacturers have claimed that there is no consumer demand for products with a bittering agent. But she thinks that might be changing:
“I’m hoping it’s turning a corner. What is happening is the smaller chains are starting to say here is a way to differentiate our product. There are a zillion cleaners out there; this is a way to say this is also safer for your children. As a consumer, that appeals to me. I have yet to meet someone who would take a dangerous product over a safer one.”
And, she says, most manufacturers have resisted adding a bittering agent, despite its low cost, by claiming that it will give parents a false sense of security.
"(This) is the same inane argument they gave when child-resistant closures came out,” she says. “Besides, it’s the kids who have the false sense of security.”
BITREX COULD SHOW UP HERE
Products that contain the bittering agent Bitrex, produced by a Scottish manufacturer, might bear a seal that says “Bitter With Bitrex” or “Contains Bitrex.” Other products might simply list the generic name of the bittering agent, denatonium benzoate, in the ingredients list.
Consumers groups have recommended adding bittering agents to these types of products, but only a few manufacturers have added the substance so far: Cleaners Disinfectants Laundry detergents Polishes Air fresheners After shaves Cosmetics Hair colorings and conditioners Shampoos and hair sprays Nail polishes and removers Toilet waters Perfumes Ice/hot packs Medical wipes Nail-biting deterrents Thumb-sucking deterrents Rubbing alcohol Animal deterrents Herbicides Insecticides Pesticides Plant nutrient sticks Anti-freeze Car wash surfactants Car waxes and polishes Chrome polishes Windshield cleaning fluids Brake fluid Denatured alcohols
Source: Henley Chemicals Inc.