Day: December 19, 2016

What Medical Problems Do Laundry Pods Cause?

Patient Presentation
A 2-year-old female came to clinic for her 2 year health maintenance examination. Her mother said that she was a typical 2-year-old but was more adventurous. She seemed to be more active and would get into more things than her other 2 siblings. Recently her mother had found her trying to get into the laundry detergent. “Luckily I have safety locks on the cabinet but she was still trying to get into the container. I bought some of the new laundry pods because I thought they would be less messy, but I worry that she might have tried to eat them if I hadn’t found her. I’ve already put a second latch on the cabinet, ” her mother said.

The pertinent physical exam showed a healthy female with normal vital signs and growth parameters in the 25-50%. Her examination was normal. The diagnosis of a healthy female was made. “I’m really glad you already had a safety latch on the door and I know you try to keep a close eye on her. Laundry pods have become a bigger problem because the kids want to eat them. We actually recommend that parents of small children use regular liquid or powered detergent instead. So you could give the pods away or throw them out. If you keep them I would put the laundry pod detergent container high up in another cabinet if possible so the kids can’t get into them,” the pediatrician recommended. “I’ll write the poison control center number down for you to keep by your phone too just in case something happens.”

Discussion
Laundry detergent capsules are small, single-use pod, liquidtab or sachets with concentrated cleaning product encased in a water dissolvable membrane. They are brightly colored and promote use by being conveniently single-use. They are used mainly for laundry and dishwashers, and look similar to candy or toys which encourages ingestion by children. They were first used in Europe in 2001, and then were marketed in the U.S. in 2010. Not long afterwards, there was an increase in Poison Control Center calls regarding exposure to the products particularly by small children. An analysis from 2012-2013 found the number of exposures increased 645%. Exposure was approximately equal for both genders, and highest in the 1- and 2-yea- old age groups. Almost all cases were in children < 6 years old.

The pods contain anionic and non-anionic detergents and cationic surfactant. Some products also contact alkaline substances. All products contain irritants. It is not really known at this time why laundry pods have more toxic effects than liquid detergent but it does not appear to be simply a chemical concentration issue. Specific chemicals and alkalinity of the products are possible causes.

A review of common toxidromes can be found here.

Learning Point
Patients have primarily 3 types of health problems because of laundry pod exposure (data is from the 2014 study listed below, and is similar to other studies):

  • Ingestion – most common exposure at ~80%, types of clinical effects include emesis, nausea, oral or throat irritation, diarrhea and abdominal pain
  • Multiple routes ~10%
  • Ocular ~7% effects include pain/irritation, red eye/conjunctivitis, lacrimation, abrasion, burns and photophobia
  • Dermal ~1% effects include erythema, edema, irritation/pain, and rash

The most common clinical problems for all types of laundry pod exposures were emesis (48%), coughing/choking (13.3%), ocular irritation (10.9%), lethargy/drowsiness (7.0%) and red eye/conjunctivitis (6.7%).

Most children exposed to laundry pods were not treated in a health care facility (53.5%), 35.4% were treated and released from a health care facility, 2.4% were admitted to a critical care unit, and 2% were admitted to a non-critical care unit. Most children fortunately had a minor effect (50.3%), 17.6% had no effect, 0.6% had a major effect. Other children were not followed for various reasons (31.5%). Major effects include coma, seizure, pulmonary edema and respiratory arrest. Two children died. Endotracheal intubation was required by 102 children.

Although companies have made changes to their packaging including making containers opaque to be less attractive and being harder to open, it is recommended that households with small children use liquid or powdered cleaning products and not laundry pods. As with any household cleaner and other similar products, keeping them out of reach, in locked cabinets is the best way to decrease unintentional exposure with the products.

Questions for Further Discussion
1. Describe your treatment/management strategy if you had a child with a laundry pod exposure come to your practice?
2. What anticipatory guidance do you routinely provide to 2 year old children?
3. What anticipatory guidance do you routinely provide regarding poisoning?

Related Cases

To Learn More
To view pediatric review articles on this topic from the past year check PubMed.

Evidence-based medicine information on this topic can be found at SearchingPediatrics.com, the National Guideline Clearinghouse and the Cochrane Database of Systematic Reviews.

Information prescriptions for patients can be found at MedlinePlus for this topic: Poisoning.

To view current news articles on this topic check Google News.

To view images related to this topic check Google Images.

To view videos related to this topic check YouTube Videos.

American Association of Poison Control Centers. AAPCS Position Statement on Single-Load Liquid Laundry Packets. Available from the Internet at: https://aapcc.s3.amazonaws.com/files/library/AAPCC_Laundry_Packet_Position_Statement.pdf (cited 10/25/16)

Valdez AL, Casavant MJ, Spiller HA, Chounthirath T, Xiang H, Smith GA. Pediatric exposure to laundry detergent pods. Pediatrics. 2014 Dec;134(6):1127-35.

Fontane E. Ingestion of Concentrated Laundry Detergent Pods. J Emerg Med. 2015 Jul;49(1):e37-8.

Sjogren PP, Skarda DE, Park AH. Upper aerodigestive injuries from detergent ingestion in children. Laryngoscope. 2016 Jul 28.

Author
Donna M. D’Alessandro, MD
Professor of Pediatrics, University of Iowa Children’s Hospital