Study Links Over‑the‑Counter Painkillers and Allergy Medicines to Surge in Self‑Harm Poisonings Among Preteens

A national analysis of poison control records found a steep rise in suspected self‑harm poisonings among children ages 6 to 12 over the past two decades, driven largely by common over‑the‑counter pain relievers and allergy medicines, researchers reported.

Using U.S. Poison Control Center data from 2000 through 2023, investigators reported that suspected self‑harm exposures in this age group rose by more than 300 percent in 2009–2021 compared with 2000–2008, with the most acute increases among preteens. For children aged 11 and 12, rates of suspected self‑harm poisoning climbed by nearly 400 percent. The study, published in Pediatrics, found that although self‑harm events represent a smaller fraction of overall pediatric medication exposures, they account for a disproportionate share of severe medical outcomes.

Across the 23‑year period, poison centers logged more than 1.5 million substance exposures for children aged 6 to 12. Of those, roughly 72,400 were reported as suspected self‑harm or suicidal intent. Girls accounted for about 83 percent of suspected self‑harm exposures in the preteen group. Overall there were 95 deaths tied to exposures in this age range during the study period; 25 of those deaths were associated with intentional incidents.

Pain relievers such as acetaminophen (Tylenol) and ibuprofen (Advil) and allergy medicines including antihistamines were the two most common substance categories cited in suspected self‑harm exposures. The study and pediatric experts highlighted the role of easy household access to these medications — which are taken by an estimated 100 million Americans each year — in enabling overdose attempts.

"The most significant category was pain relievers, over‑the‑counter Tylenol, Advil, things like that," said Dr. Jason Lewis of the Children's Hospital of Philadelphia. "People, parents, have a false sense of security that it's safe and cannot be used in a harmful way."

Children who ingested medications in suspected self‑harm events were markedly more likely to require hospital care than those with accidental ingestions. The analysis found they were more than 14 times as likely to be hospitalized and about eight times as likely to have a serious medical outcome. The study drew attention to the particular toxicity risks these common medicines pose to children: for an average 12‑year‑old, serious harm can occur after roughly 12 tablets of 500 mg acetaminophen, more than eighty 200 mg tablets of ibuprofen, or about a dozen 25 mg diphenhydramine (Benadryl) tablets, depending on weight and other factors.

Clinically, acetaminophen overdose primarily causes acute liver injury and, in severe cases, liver failure leading to bleeding and brain swelling. Nonsteroidal anti‑inflammatory drug (NSAID) overdose can precipitate metabolic acidosis, acute kidney injury, seizures and multi‑system collapse. Antihistamine overdoses can depress the central nervous system, causing respiratory depression, coma, seizures and dangerous heart rhythm disturbances.

The researchers also documented a significant rise in accidental medication errors over the study period, up about 79 percent since 2000. Early increases were driven by cough and cold medicines and analgesics, with a later 131 percent jump in antihistamine mistakes.

The upward trend in preteen self‑harm poisonings comes amid broader and sustained increases in youth suicide and suicidal behavior. The Centers for Disease Control and Prevention has reported that suicide is the second‑leading cause of death for Americans ages 10 to 24 and that suicide rates and attempts rose in recent years. CDC data cited by the researchers indicate that suicide deaths among 10‑ to 24‑year‑olds increased 62 percent from 2007 to 2021, and that the suicide rate for children ages 5 to 11 grew by more than 50 percent from 2010 to 2020. A national survey published in 2023 found one in 10 U.S. high school students attempted suicide in 2021.

The study's authors and other child health experts cited multiple factors that may underlie rising suicidal behavior among youths, including increased depression linked to social media use, academic pressure, family instability, anxiety about global events and greater public awareness and detection of mental health problems. They noted that the trend has been particularly pronounced among preteen girls and that suicide increases have been observed in very young children in other recent research.

The investigators said the pattern of overdose exposures peaked around 2021 and showed a slight decline afterward, a change they suggested might reflect a delayed effect of the COVID‑19 pandemic and the large public‑health response that included expanded suicide prevention efforts. They cautioned, however, that the causes of the increase are complex and multifactorial and that continued surveillance is necessary.

The paper calls for national‑level analyses focused on substance‑related exposures and suspected self‑harm in the 6‑ to 12‑year‑old population, arguing that research to date has concentrated primarily on children under 6 and on adolescents. The authors said a more granular understanding of the problem could help shape prevention strategies such as safer storage of household medications, public education for caregivers, and targeted mental‑health services for younger children.

Clinicians and poison center officials recommend that caregivers treat over‑the‑counter medications as potentially dangerous, store them out of reach and sight, and seek immediate medical or emergency psychiatric assistance if a child expresses suicidal thoughts or is believed to have ingested a toxic amount of medication. The study and accompanying commentary underscore the intersection of medication safety and youth mental health in efforts to prevent serious injury and death among children.