Iron Poisoning in Children Climbs : Accidents: Southland leads state in cases of youngsters dying after swallowing iron supplements, but officials don’t know why.

ORANGE —  California leads the nation in childhood deaths due to accidental poisoning from iron supplements, and most of those deaths have occurred in Southern California, state and UCI Medical Center officials said Thursday.

In the past, poison deaths in children under age 6 were most often caused by over-the-counter pain relievers, said David Harden, an analyst at UC Irvine Medical Center’s poison-control center. But in recent years, iron-supplement pills have taken over as the leading cause of childhood poisoning deaths.

From 1983 to 1990, 16 children in the United States died from iron poisoning, according to Amy Arcus, a specialist in preventive medicine for the state Department of Health Services’ emergency preparedness and injury control section.

“Then in 1991, in that one year alone, there were 11 deaths,” Arcus said. “It jumped dramatically.”

Five of those deaths occurred in California.

Because of the alarming increase, Arcus said, the state has begun gathering information about iron poisonings to find some reason for the change.

Initial data indicates that the children are dying after swallowing sugar-coated vitamin and mineral tablets containing iron, Arcus said. The pills are most often those prescribed as a dietary supplement for pregnant women.

In most of the local poisonings, the children were able to open the bottles of pills and swallow 30 or more tablets. Eight to 10 iron supplement pills are sometimes enough to kill an infant under a year old, Arcus said.

Although no nationwide figures are available after 1991, childhood deaths from iron poisonings have continued to rise in California, where at least eight children under 6 years old died in 1992 after taking too many iron pills. Arcus said they still are collecting data for 1992.

What has puzzled poison-prevention officials, Harden said, is that the number of children who accidentally take the iron supplements does not seem to have increased. In 1989, for example, the UCI Medical Center poison-control center handled 452 reported cases of iron poisonings in Orange, Riverside, San Bernardino, Inyo and Mono counties. Yet none of those children died.

No children died from iron poisonings in 1990, either, in the five-county region.

But of the 492 reported iron poisonings in the region in 1991, three children under age 6 died. In 1992, six children in the five-county region died of iron poisoning.

“The sheer numbers of exposures to iron products doesn’t seem to change much,” Harden said. “What stands out over several years is the number of kids who are dying.”

Children seem to be attracted to the pills because they often resemble colorful candies, Arcus said. The tablets usually have a sugar coating to make them palatable and so they slide down the throat easily.

Besides the mysterious sudden increase in deaths in the past two years, investigators also are unsure why Southern California seems to have a larger problem, Arcus said.

Of the eight children who died in 1992 from iron poisonings, four were in Los Angeles County, two were from San Bernardino County and one was from Riverside County, she said.

Of those, six were Latino children. But Arcus said language difficulties don’t seem to be a major factor. Some of those children had English-speaking parents or were with English-speaking care-givers when they died, she said.

“We’ve been trying to put together a common tie, but there’s just not enough evidence,” she said.

Arcus and Harden offered advice for parents with iron supplements in their homes:

* Always make sure the child-resistant cap is attached securely to the bottle.

* Keep it locked and out of a child’s reach.

* Never take the pills in front of children.

They advised parents to call 911 or a poison-control center immediately if they suspect their child has taken iron supplement. Symptoms of poisoning may not show up until a child already has been severely injured by the corrosive action of the iron, Arcus said.

Symptoms include stomach pain, vomiting, diarrhea and sleepiness, usually within 30 minutes to two hours after taking the iron.