Ten days before Christmas 2008, an 18-month-old Queensland toddler suffered horrific injuries when he swallowed highly caustic dishwasher detergent. For just a brief moment Harrison had wandered out of his mum's sight and grabbed a bottle of Morning Fresh Ultra Shine with Baking Soda from a cupboard under the sink. The detergent burnt away his epiglottis - the valve-like structure at the back of the throat that stops food and drink getting into the windpipe - and left the toddler with a legacy of medical problems for the rest of his life.
"I have five kids and had no idea the product was so caustic," Harrison's mother, Lisa Clark said.
They'd like to see all types of dishwasher detergent sold with effective child-resistant closures (like on medicine bottles), packaging more tightly controlled and the formulations changed to make all dishwasher detergents less corrosive.
Sadly, child poisoning cases involving household chemicals are far from unusual.
According to Kidsafe (the Child Accident Prevention Foundation of Australia):
- about 50 children are admitted to hospital each week because of poisoning
- each year between five and 10 children die from poisoning
- One in three childhood poisonings are associated with medicines
- household chemicals are the other main cause.
Only Queensland and Victoria have special units that monitor presentations to emergency departments, but the numbers recorded there of child poisonings associated with dishwasher detergent are appallingly high.
The Queensland Injury Surveillance Unit at the Mater Hospital (QISU) brought Harrison's tragic injuries to our attention. It collects data from 15 different emergency departments. In the six-year period to the end of 2004, QISU recorded 76 cases where children had swallowed dishwasher detergent (an average of 13 per year); the Victorian Emergency Minimum Dataset (which records data from 28 hospitals) identified 207 cases over eight years to mid 2004 (an average of 26 per year). And in New Zealand our sister organisation reported in March 2005 that since June 2002, 615 incidents had been reported of children swallowing dishwasher detergent powder, including five over the previous five months with severe burns to the mouth, throat and airways.
According to Kidsafe Australia, a general problem in more than half of all child poisonings is the fact that:
- the container wasn't properly closed or
- not stored in a cupboard or enclosed space
- that the substance wasn't in a child-resistant container was an even more common factor.
Two clicks to close
Child-resistant closures (CRCs) are designed to restrict access to substances that could be dangerous to children. They should make it difficult for a youngster to open the container, but not too tricky for an adult to reseal it, otherwise it's likely it won't always be resealed properly after use.
As far as dishwasher detergent bottles are concerned, not all their CRCs are designed the same way, and they're generally easier to open than, say, a medicine bottle. You generally have to squeeze and turn the cap to open the bottle, but with some, to reseal it you must turn the cap till it's clicked into place twice.
Unfortunately this instruction was nowhere stated on the bottle when Harrison swallowed the detergent in December 2004. Even more disturbingly, when we bought the bottles pictured below in April 2005, four months later, the same bottle he had grabbed was still being sold without any instructions on how to close it securely. Many of the staff here at CHOICE were unaware of the 'two clicks to close' mechanism - would you have known?
While child-resistant closures have reduced the number of child poisonings over the years, the large number of reported incidents involving children and dishwasher detergent shows two things: that people aren't aware of the potential dangers, and that some closures are simply not good enough.
In Queensland, the tragic incident late 2004 prompted the establishment of a working party, with representatives from Kidsafe Queensland, QISU, the Poisons Information Centre and the Department of Fair Trading, Product Safety and the Queensland Health Environment and Poisons Unit, to take a closer look at the issue and discuss how packaging could be improved.
When we talked to manufacturers in April 2005, they finally seem to have been prompted into long overdue action, redesigning their products' packaging. Cussons told us from late May/early June 2005 its MORNING FRESH dishwasher powder would have a 'Clic-Loc' CRC that wouldn't need to be clicked twice, just closed tightly like a medicine bottle. Cussons also advised it would put a label - "2 clicks to close" - on the current bottle closure so people can distinguish between the two types.
Reckitt Benckiser's Finish powder packaging is also currently undergoing change, including a new bottle closure due mid-year 2005. However, its Kwit powder bottle won't change design "in the short term" but will feature the new Finish closure "in the medium term". And if you currently buy Castle dishwasher detergent in the 2 kg bottle, its closure will also be changed to the one currently on the 1 kg bottle.
And of course you can even still buy dishwasher detergent in simple cardboard boxes that aren't child-resistant at all.
Using dishwasher detergent safely
- Always close the container properly - test that the cap is locked in place.
- Store the detergent out of reach of young children, on a high shelf or in a locked cupboard, and put it back there as soon as you've finished using it.
- Put detergent in the dishwasher just before the wash, and if there's any residue, clean it out afterwards - children have been known to scrape the leftover goop out of the dispenser and eat it.
- Ask grandparents, nannies and others who look after your children to follow your detergent rules - at your home and theirs, if the kids are likely to visit.
Some detergents are based on enzymes and oxygen bleach, which are less alkaline (and therefore less caustic) than the 'alkaline salts' you'll find on the label of others. Finish, Kwit, Castle and many detergent tablets are examples. They have a lower pH and are likely to cause less severe injuries when swallowed. Products based on alkaline salts must carry the warning BURNS SKIN AND THROAT when they have a pH of more than 11.5. Enzyme-based products, on the other hand, are labelled IRRITANT. Don't get complacent with them, though - they can still cause harm.
While all these products comply with legislative requirements for labelling, we think the closing mechanism needs to be explained on the bottle (two clicks to secure) and the cautions should stand out more prominently (in red, or in a box) on highly alkaline products such as Morning Fresh Ultra Shine with Baking Soda, left, which can do much more harm when swallowed than less alkaline products such as the other detergents pictured (see Using dishwasher detergent safely, above).
If you think your child has swallowed a corrosive, burning poison (such as dishwasher detergent, acid, caustic oven cleaner, swimming pool chemicals and some disinfectants), seek urgent medical help. Signs of poisoning include red lips, blisters, possible breathlessness and coughing, swelling inside the mouth and severe pain. Don't induce vomiting and give nothing to eat or drink. Wash any burning substance off the mouth and face with water.