Chasing red herrings: Can visual distracters extend the time children take to open child resistant vials?

BACKGROUND: Unintentional exposure to medications is a noted problem in pediatric populations despite the prevalent use of child-resistant (CR) packaging and educational campaigns informing consumers about appropriate storage. OBJECTIVE: Conduct a proof-of concept study that evaluates how package designs that engage the attention of children in meaningless ways affect opening time and number of openings. STUDY DESIGN: Non-CR vials with or without distracters were provided to 108 children (24–51 months) in pairs. Each participant was handed a vial and instructed to “do whatever you want to with it.” Successful opening and time to opening were recorded. Data were analyzed using generalized linear mixed models. RESULTS: Older children were approximately four times more likely than younger children to successfully open a vial with a visual distracter (P = 0.049); when distracters were not present, no evidence for differences was apparent between age groups (P = 0.64). For successful openings of either age group, distracter presence significantly prolonged time to opening (P = 0.0375); vials containing distracters took nearly three times longer to open than those without. CONCLUSIONS: Existing CR designs almost exclusively rely on late stages of information processing (e.g. difficult to understand or open). Our results suggest that packaging designs that target early stage processing (i.e. perception) represent a potential paradigm for creating effective CR designs. It should be acknowledged that visual distracters, by their very nature, have the potential to act as "attractive nuisances" (i.e. if it were to be so effective that it drew children to the hazard). Further studies designed to specifically investigate this possibility are advised.