Child-resistant caps are an important safety feature on the bottles of medications or other household substances (e.g. toilet bowl cleaner). The IPC recommends that they are used on all bottles in homes with children because they can reduce the incidence of poisoning.  What is critically important to remember, though, is that these caps are child-resistant, not child-proof.  Check out these two real cases that were reported to the IPC in just a 1 month period:

• A 10 month old child was given a bottle of over the counter Tylenol tablets to shake while his diaper was being changed.  The cap flew off and tablets dumped out on to the baby’s face. He was thought to have ingested 1 or 2 tablets.  Luckily this amount was not toxic for this child.

• The IPC received a call from a hospital regarding a toddler who was brought to the ER by her family when they couldn’t wake her up from a nap.  Upon questioning the family, it was discovered that the child had been given a closed bottle of prescription medication to shake and play with as a rattle.  The bottle was a typical prescription bottle with a child-resistant cap but the toddler was still able to remove the cap, and she ingested some tablets.  The child was comatose and admitted to the ICU, but recovered after about 24 hours.

Pill bottles used as rattles are unfortunately a too-common occurrence reported to the IPC.  Parents or grandparents often believe that the caps are kid-kryptonite and so there is no harm in letting them play with a pill bottle filled with potentially dangerous medications as long as it has a safety cap.   They are often surprised (and horrified) when the child is able to open the bottle, sometimes faster than the parents can themselves!

The use of child-resistant packaging is actually required by law—the Poison Prevention Packaging Act, which was first enacted in 1970.  Child-resistant packaging is specifically defined as, “packaging that is designed to be significantly difficult for children under 5 years of age to open…within a reasonable time…it does not mean all children will not be able to open within a reasonable amount of time.” (italics mine)  In other words, the caps can slow kids down, but will not completely prevent children from opening the bottle.   After all, the caps need to be opened by adults within a reasonable amount of time.

These caps are deemed to be officially ‘child-resistant’ by gathering groups of 50 kids, giving them the closed bottles and literally timing them to see how long it takes for a certain percentage of kids to open the bottles.  They also give the same closed bottles to adults and seniors to ensure they can access medication themselves without too much trouble. Safety caps try to strike a balance between being difficult for kids to open, but not so hard that adults cannot.  That perfect cap does not exist, hence caps that are child-resistant (not child-proof).

The moral of the story is, NEVER give a child a child-resistant pill bottle to play with or shake as a rattle (ever)!  Keep pill bottles out of sight and reach of children even if they have safety caps, and even if they are being supervised. Kids are so fast, it can only take a few seconds for them to get hurt!  The IPC received almost 33,000 calls on kids age 5 and under.  Check out our other pediatric poison prevention information here.