Iron supplement warnings issued Children mistake pills for candy

The bright green pills looked like candy and tasted sweet to 4-year-old Timothy Snyder. But the pills were adult iron supplements, which can poison or kill children.

The Baltimore boy was hospitalized for three days last year after the incident. He suffered no long-term effects, but the scare he gave his family was used yesterday as a warning to other parents.


"Seeing him with all those tubes and monitors, I thought he was going to die," Kathy Snyder, Timothy's mother, said at a news conference at Johns Hopkins Children's Center.

Yesterday's event featured consumer advocates from Maryland Public Interest Research Group, pediatricians, and Maryland Attorney General J. Joseph Curran Jr.


On Aug. 17, Mr. Curran and attorneys general in 33 other states and territories petitioned the Food and Drug Administration, urging stricter regulations on the labeling and packaging of iron supplements.

The petition recommends warning labels, child-resistant blister packets for iron pills or caplets of 30 milligrams or more, and an end to the manufacture of brightly colored, sugar-coated pills.

"These pills look exactly like licorice, green mints or red candy you might want [to eat]," Mr. Curran said, gesturing to several brands of iron pills piled on a table.

"Doctors estimate that just five pills containing 60 milligrams of iron can be toxic to a 22-pound child, and 10 pills can be fatal," he said.

Adult iron supplements are the leading cause of childhood poisoning deaths in the United States. Excessive amounts of iron can result in gastrointestinal and liver damage, shock, coma, cardiovascular collapse and death.

"From 1986 to 1992, there were nearly 50,000 reports to poison centers across the United States of ingestions of adult iron supplements by children under 6 years of age," said Wendy Klein-Schwartz, director of the Maryland Poison Center.

Over the past seven years, 43 children aged 9 months to 3 years have died from iron overdose in the United States, she added.

Iron pills -- widely regarded as harmless -- "are a perfect prescription for disaster" in the household, said Dr. Julius Goepp, assistant director of the Pediatric Emergency Department at Johns Hopkins Hospital.


Iron is often prescribed for pregnant women, but when they stop taking it, that leaves a substantial number of pills on the shelf that a small child could get into, he said. Dosages are particularly high in prenatal prescriptions.

"In the past three years, there have been 20 admissions to the Children's Center and 17 visits to the Pediatric Emergency Room for iron overdose," he said.

Parents have an obligation to store pills where children can't get to them, but manufacturers also have an obligation to market their products safely, Dr. Goepp said.

The attorneys general are still waiting for a response from the FDA, Mr. Curran said. But "drug manufacturers understand our concern and have begun using the labels on their own," he said. "That's a step in the right direction."

The nonprescription drug industry put a voluntary program in place at the end of September, which calls for child-resistant packaging and an end to the sweet coatings.

"In the last few weeks we have initiated a consumer education program encouraging adults to be more careful about storing their medicines," said Frank H. Rathbun, a spokesman for the Nonprescription Drug Manufacturers Association.