Comment from David Vearrier, MD

As a board-certified medical toxicologist, I support the proposed rule. While the use of child-resistant packaging is important in preventing childhood poisoning, it is not uniformly effective. Child-resistant packaging fails when a child is able to defeat the packaging mechanism or when adults fail to close the container properly and re-engage the protective mechanism after use. The American Association of Poison Control Centers National Poison Data System (NPDS) 27th Annual Report (2009) reported 1,601 lamp oil exposures in children aged 5 years or younger, which included 1 death. Children with lamp oil aspiration events suffer significant morbidity that may require extended pediatric intensive care unit stays and invasive life-saving maneuvers including endotracheal intubation with positive pressure ventilation and extracorporeal membrane oxygenation (ECMO). Additionally, children who survive the acute poisoning may be at a long-term risk for more frequent lower respiratory tract infections, delayed pneumatocele formation, and, less commonly, pulmonary fibrosis or bronchiectasis. To young children, lamp oil resembles juice or other non-juice sweet flavored drinks, giving them incentive to attempt to defeat the child-resistant packaging. The use of non-see through packaging would remove this incentive and, in conjunction with the already mandated child-resistant packaging, reduce the likelihood a child will open the container and suffer a subsequent aspiration event. While I am not knowledgeable about the costs of the production of plastic containers, it does not seem that the proposed rule would impose an undue hardship on manufacturers.