HealthDay News — Adding flow restrictors to liquid medication bottles safely prevents young children from quickly emptying the bottles’ contents, researchers found.

Just 6% of bottles with flow restrictors (seven of 110) were emptied during a 10-minute test period, and none were emptied within the first six minutes, Daniel Budnitz, MD, of the CDC’s division of healthcare quality promotion in Atlanta and colleagues reported in The Journal of Pediatrics.

In contrast, most bottles without a flow restrictor could be emptied within two minutes (96%), the researchers found.

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Mandatory use of child-resistant packaging has greatly reduced the number of pediatric deaths due to unsupervised medication ingestion, but poison control centers still receive about 500,000 calls related to the issue each year, many involving children aged younger than 5 years.

This may be attributable to not closing the medication bottles properly after use, which is necessary to reengage the child-resistant packaging. So Budnitz and colleagues enrolled 110 children aged 3 to 4 years to see whether adding flow restrictors could reduce the proportion of preschool-aged children who are able to access liquid contents of medication bottles, the amount of content accessed, and the time it took to empty the bottles.

Pairs of children were asked to “get everything out” of bottles filled with a test liquid. Children in the flow restrictor group were given a bottle without a child resistant cap, but with a flow restrictor. Controls were given bottles without flow restrictors that did not have a cap or had an improperly closed cap.

The content of liquid medication containers was emptied from 96% of open bottles (25 of 26) and 82% of the incompletely closed bottles (68 of 83) within two minutes. No bottles with flow restrictors were emptied earlier than 6 minutes, and only 7% of restricted bottles were emptied within 10 minutes.

Participants were able to empty 25 mL or greater of liquid from 90% of incompletely closed and 100% of open control bottles “almost always within the five-minute test period.” Whereas only 11% of children in the flow restrictor group were able to empty this volume, and only one within the first five minutes of testing.

Older children were better able to remove 25 mL or greater of liquid from bottles with flow restrictors than younger children, the researchers found. Ten of 12 children in the 54- to 59-month age group were able to remove that volume from flow-restricted containers.

Among methods used to remove liquid from flow-restricted bottles, the majority of children used the dosing syringe (93%), followed by pouring, shaking or squeezing the bottle (60%). One child used teeth to remove the flow-restrictor cap and was able to empty the bottle.

Four children attempted to drink from bottles with flow restrictors. However, the researchers noted that many may have been discouraged from attempting to drink from the bottle because adults were watching.

“Our findings suggest that adding flow restrictors to liquid medicine bottles limits the accessibility of their contents to young children and could complement the safety provided by current child-resistant packaging,” the researchers wrote.

Study limitations include lack of generalizability to all fluid restrictor designs, medication formulations and fluid viscosity, and the researchers did not evaluate adult ease of use for flow-restricted bottles.


  1. Budnitz DS et al. J Pediatr 2013; doi:10.1016/j.jpeds.2013.05.045.