Poison control centers in the United States receive over two million reports of exposures to toxins each year. More then 80% of these exposures are unintentional, and over 90% occur in the home.
Children under six years of age account for over 50% of accidental exposures to toxins. In 2003, 27 such children died from poisoning, and fourteen of these fatalities occurred after the ingestion of prescription medications. (Watson W, et al. Annual report of the American Association of Poison Control Centers Toxic Exposure Surveillance System. Am J Emerg Med 2005;23(5):589-666)
Although most childhood exposures to toxins resolve without significant complications, the ingestion of even a small amount of some substances can lead to serious consequences, including death. A child who is suspected of having taken a highly toxic substance should be evaluated quickly, because prolonged absorption or mechanism of action may delay the onset of symptoms until successful treatment becomes difficult or impossible.
Ipecac has not been shown to be beneficial, even when given within minutes of ingestion. It is not recommended for home use. (Poison treatment in the home. American Academy of Pediatrics Committee on Injury, Violence, and Poison Prevention. Pediatrics 2003;112(5):1182-1185)
Anyone who lives with or cares for children should periodically review poison prevention policies with other family or staff members. Awareness of commonly ingested items and familiarity with highly toxic substances are key components of poison prevention.
Commonly Ingested Substances in Young Children
- Cosmetics and personal care products
- Cleaning products
- Pain killers (both prescription and over-the-counter)
- Topical preparations (creams, lotions, etc.)
- Foreign bodies (coins, safety pins, beads, etc.)
- Cough and cold preparations
- Plants
- Pesticides (herbicides, insecticides, etc.)
- Vitamins (e.g., iron-containing prenatal and children’s supplements)
- Antihistamines
- Antimicrobials (antibiotics, antifungals, etc.)
- Office/arts/crafts supplies
- Gastrointestinal preparations (Pepto-Bismol, antacids, etc.)
Substances That Are Highly Toxic in Children
Nonpharmacologic
- Alcohols (beverages, antifreeze, windshield washer fluid)
- Caustics (drain and oven cleaners, toilet cleaners, perm relaxers)
- Food flavorings (methyl salicylate, or oil of wintergreen*)
- Hydrocarbons (kerosene, lamp oil, furniture polish, lighter fluids, mineral spirit paint thinners)
- Industrial chemicals (methylene chloride, gun bluing, soldering fluids and fluxes)
- Nail products (primers, artificial nail removers)
- Pesticides (lindane*, organophosphate insecticides, paraquat)
Pharmacologic (Medications)
- Antidepressants (tricyclics* [nortriptyline, amitriptyline, imipramine, etc.])
- Antipsychotics (phenothiazines*)
- Heart medications (beta-blockers*[propranolol, timolol, metoprolol, etc.]; calcium channel blockers* [nifedipine, Procardia, Cardizem, etc.]; Catapres* [clonidine]; quinidine*)
- Opioids (methadone*, oxycodone*, Lomotil* [diphenoxylate/atropine]; prescription cough syrups)
- Diabetes medications (Glucophage [metformin]; oral sulfonylureas*)
- Malaria medications (Aralen* [chloroquine]; quinine*)
- Topical agents (Americaine* [benzocaine]; lindane*; Podocon [podophyllin]; tea tree oil*; oil of wintergreen*)
- Lung medications (theophylline*)
- Tuberculosis medications (Nydrazid [isoniazid])
*Substances that may be fatal in small doses (1 to 2 tablets or teaspoons) in children weighing less than 20 pounds
(Adapted from McGregor T, et al. Evaluation and management of common childhood poisonings. Am Fam Phys 2009;79(5):397-403)
Adults are responsible for preventing childhood poisonings, and prevention is relatively straightforward: Children cannot ingest what they cannot reach. Locks, safety catches, cabinet door alarms, inaccessible shelves, warning stickers, and other practices for securing toxins should be scrupulously observed in households where children live or visit.
When accidents do occur—depending on the substance, route of exposure, dosage, and weight of the child—some exposures can be managed at home.
Everyone who oversees children should know the phone number for Poison Control (800-222-1222). When a child ingests a foreign substance, telephone consultation may help to determine if medical evaluation is warranted. However, in the event of known ingestion of a highly toxic substance, or if a child appears to be ill following exposure to any substance, transport to a medical facility should not be delayed while Poison Control is contacted.
