Impact of Social Media Challenges on Pediatric Single-Use Detergent Sacs and Diphenhydramine Ingestions Reported to United States Poison Control Centers
Background: Social media platforms are popular among children and often feature challenges that become viral. Notably, the Tide Pod？ and Benadryl？ challenges encouraged viewers to ingest these substances for their visual appeal and hallucinogenic effects, respectively. This study aimed to assess the clinical impact and outcomes of single-use detergent sacs (SUDS) and diphenhydramine challenges on pediatric ingestions reported to United States (U.S.) Poison Control Centers (PCCs). Methods: We conducted a retrospective review of pediatric exposures reported to U.S. PCCs using data from the National Poison Data System (NPDS). The study included intentional single-substance ingestions of both brand-name and generic forms of SUDS and diphenhydramine among children ≤ 19 years. We compared the number of calls, clinical effects, disposition, and management strategies for SUDS (pre: 01/01/17 to 12/31/17 vs. post: 01/01/18 to 12/31/18) and diphenhydramine (pre: 08/01/19 to 07/31/20 vs. post: 08/01/20 to 07/31/21) ingestions 12 months before and after the introduction of the respective social media challenges. Differences in proportions were compared using the Chi-square test. Results: During the study period, 469 ingestions of SUDS and 5,702 ingestions of diphenhydramine were reported. Post-challenge periods saw an increase in both SUDS (pre: 82 vs. post: 387; 372% increase) and diphenhydramine ingestions (pre: 2,672 vs. post: 3,030; 13% increase). While there were no significant changes in moderate or major clinical outcomes, hospitalizations increased post-challenge for both SUDS [pre: 4 (4.9%) vs. post: 33 (8.5%); p = 0.25] and diphenhydramine [pre: n = 904 (33.8%) vs. post: 1,190 (39.3%); p < 0.001]. Conclusion: Pediatric ingestions reported to U.S. PCCs and hospitalizations increased coinciding with the introduction of Tide Pod？ and Benadryl？ challenges. While causality cannot be definitively established, it is essential for pediatricians and parents to be aware of these challenges and educate vulnerable children about the harmful effects of participation in such challenges.
References
[1]
Cho, H., Li, P., Ngien, A., Tan, M.G., Chen, A. and Nekmat, E. (2023) The Bright and Dark Sides of Social Media Use during COVID-19 Lockdown: Contrasting Social Media Effects through Social Liability vs. Social Support. Computers in Human Behavior, 146, Article 107795. https://doi.org/10.1016/j.chb.2023.107795
[2]
Anderson, M., Faverio, M. and Gottfried, J. (2023) Social Media and Technology 2023. https://www.pewresearch.org/internet/2023/12/11/teens-social-media-and-technology-2023/
[3]
Nedelman, M. (2018) Poison Control Calls ‘Spike’ Due to Online Laundry Pod Challenge. https://edition.cnn.com/2018/01/17/health/tide-laundry-pod-challenge-poison-control/index.html
[4]
Frey, A.S. (2018) Tide Pod Challenge: A Closer Look at the Toxicology. https://www.emra.org/emresident/article/laundry-pod-challenge
[5]
US Food and Drug Administration (2023) FDA Warns About Serious Problems with High Doses of the Allergy Medicine Diphenhydramine (Benadryl). https://www.fda.gov/drugs/drug-safety-and-availability/fda-warns-about-serious-problems-high-doses-allergy-medicine-diphenhydramine-benadryl
[6]
Elkhazeen, A., Poulos, C., Zhang, X., Cavanaugh, J. and Cain, M. (2022) A TikTok™ “Benadryl Challenge” Death—A Case Report and Review of the Literature. Journal of Forensic Sciences, 68, 339-342. https://doi.org/10.1111/1556-4029.15149
[7]
Washington Poison Center (2020) Washington Poison Center Warns Parents of Continued Dangers with the Benadryl™ Challenge. https://www.prnewswire.com/news-releases/washington-poison-center-warns-parents-of-continued-dangers-with-the-benadryl-challenge-301179080.html
[8]
American Association of Poison Control Centers (2014) National Poison Data System (NPDS) Coding Users’ Manual Version 3.1.
[9]
Mazhari, E. (2018) The Strange Story of How Tide Pod Eating Went Viral. https://www.forbes.com/sites/quora/2018/02/05/the-strange-story-of-how-tide-pod-eating-went-viral/?sh=43f3de2e4932
[10]
Marshall, R.D., Bailey, J., Lin, A., Sheridan, D.C., Hendrickson, R.G., Hughes, A., et al. (2024) Impact of Social Media “Challenges” on Poison Center Case Volume for Intentional Ingestions among School-Aged Children: An Observational Study. Clinical Toxicology, 62, 183-189. https://doi.org/10.1080/15563650.2024.2331064
[11]
Minhaj, F.S. and Leonard, J. (2021) Dangers of the TikTok Benadryl Challenge. Contemporary Pediatrics, 38, 20-21.
[12]
Bai, M., Miao, C., Zhang, Y., Xue, Y., Jia, F. and Du, L. (2022) COVID-19 and Mental Health Disorders in Children and Adolescents (Review). Psychiatry Research, 317, Article 114881. https://doi.org/10.1016/j.psychres.2022.114881
[13]
Darracq, M.A. and Thornton, S.L. (2022) A Different Challenge with Benadryl: Adolescent Diphenhydramine Ingestions Reported to National Poison Database System, 2007-2020. Clinical Toxicology, 60, 851-859. https://doi.org/10.1080/15563650.2022.2051536
[14]
Roversi, M., Martini, M., Musolino, A., Pisani, M., Zampini, G., Genuini, L., et al. (2023) Drug Self-Poisoning in Adolescents: A Report of 267 Cases. Toxicology Reports, 10, 680-685. https://doi.org/10.1016/j.toxrep.2023.05.012
