Trends in pediatric household cleaning product exposures before and during the COVID-19 pandemic: a national poison data system analysis (2016–2023)

BACKGROUND: Unintentional exposures to household cleaning products remain a common cause of pediatric poison center calls in the United States, particularly among children under six. Most exposures involve toddlers and rarely result in severe outcomes. The impact of the COVID-19 pandemic on exposure patterns has not been well characterized. This study evaluates trends in pediatric exposures from 2016 to 2023, with a focus on changes in 2020. METHODS: We conducted a retrospective analysis of unintentional exposures to household cleaning products reported to the National Poison Data System from 2016 to 2023 among children aged 0-5 years. Product types were grouped into 14 chemical categories. Descriptive statistics summarized exposure patterns, and interrupted time series analysis using segmented Poisson regression evaluated immediate and post-2020 changes in annual exposure trends associated with the COVID-19 pandemic. RESULTS: A total of 633,317 unique exposures met inclusion criteria. Most involved children younger than 3 years (84.1%) and occurred at home (97.2%), with 87.7% managed on site. Significant clinical effects occurred in 2.7% of exposures with known outcomes. Soap and bleach products were the most frequent exposures, while alkali-based cleaners accounted for the highest number of moderate or more severe medical outcomes. Interrupted time series analysis demonstrated that several chemical classes experienced significant increases in exposures in 2020, most notably pine oil cleaners, bleach, soaps, and cationic cleaners. CONCLUSIONS: Pediatric exposures to household cleaning products remain common but showed an overall declining trend from 2016 to 2023, largely driven by decreases observed in alcohols/glycols, alkali, bleach, laundry, dishwasher, and soap products. Transient increases in exposures occurred during the COVID-19 pandemic, particularly for soaps, bleach, cationic cleaners, and pine oil products. Although severe outcomes were uncommon, alkali-based products posed the greatest risk.