Detergent pods and children: a health hazard on the rise.

Dear Editor,

Laundry detergent pods are an increasingly popular household cleaning product. During a washing cycle, laundry detergent pods are immersed in water which result in the disintegration of the outer shell and release of detergent. Concerningly, laundry detergent pods may prematurely release their contents if they come into contact with moisture, such as inside a child’s mouth, or if sufficient pressure is applied to burst them open, including being bitten or squeezed by a young child.

Several exposure routes exist in the context of detergents and children, including ingestion, skin contact, and ocular exposure. Ingestion of detergent may lead to numerous systemic features including dyspnea, vomiting, diarrhea, and central nervous system depression [1]. Severe reactions may lead to pneumonitis, pharyngeal swelling, and upper airway inflammation requiring intensive care. Skin contact may result in rashes, blisters, and burns. The face is most commonly involved, followed by the hands and fingers [1].

Conjunctivitis is the most commonly described ocular feature of exposure followed by corneal abrasions or epithelial defects [2]. While healing is often quite rapid with corneal abrasions, significant morbidity may occur, with reports of delayed healing greater than two weeks. In 2015, it was estimated that one-quarter of all chemical ocular injuries in the United States were associated with laundry detergent pods [3].

At our tertiary ophthalmology center in Ontario, Canada, we unfortunately see ten to fifteen cases a year of children with such presentations. Furthermore, anecdotally speaking, we have seen an increase in cases over the past year during the COVID-19 crisis. We suspect that children are spending more time indoors and have increased opportunities to handle laundry detergent pods within their households.

Public health efforts have been made to encourage the manufacturers of laundry detergent pods to limit the exposure potential of their products to children. Enhanced warning icons, opaque packages, and child-proof lids have been implemented by some manufacturers. However, it is unclear whether the rates of adverse exposures to laundry detergent pods after such interventions have decreased at a population level [1]. This is exacerbated by the fact that off brand and generic laundry detergent pods often do not engage in child-proof packaging and manufacturing.

In conclusion, laundry detergent pods are a commonly used household cleaning item associated with significant risk. There is clearly a need for a renewed effort to reduce the morbidity associated with laundry detergent pods. More needs to be done from a manufacturing and marketing perspective to reduce the pediatric morbidity associated with exposure to these potentially harmful products.