Decreasing the Size of Bottle Caps: Helping or Hurting Children?

Introduction: In the last two decades, plastic drink bottle cap size has reduced to decrease plastic waste. Our study aims to assess if decreasing bottle cap size was associated with more ingestions and injuries nationally.

Methods: The National Electronic Injury Surveillance System (NEISS) was queried for bottle cap ingestions in children 0-18 years old between 2002 and 2021. Age, race, sex of the patient were included for demographic information. Location where the ingestion took place and disposition of the patient were also analyzed. Data was excluded if narrative did not specify an ingestion of a cap of a drinking bottle.

Results: A total of 420 bottle cap ingestion injuries were identified, for a national estimate of 11,764 injuries. The mean age at time of ingestion was 9.9 +/- 5.3 years and the majority of the injuries occurred in males (N=307, 73.1%). 39.0% (N=164) were Caucasian, 19.5% (N=82) were Black or African American, and 6.9% (N=29) were Hispanic. 31.7% (N=133) of injuries occurred at home, while 2.6% (N=11) occurred at school. 78.3% (N=329) of patients were treated in the emergency department and released, 14.3% (N=60) were treated and admitted, 3.6% (N=15) were treated and transferred, and 1.4% (N=6) were held for observation. From 2002 (N=1) to 2021 (N=80), there has been a statistically significant increase in bottle cap ingestions (p < .001).

Conclusions: Plastic bottle cap ingestions have increased in children over the last 20 years, coincident with the change to smaller bottle caps.