COMMON TYPES OF POISONING IN CHILDREN
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The Dangers of Poisoning in Children
Poisoning is one of the leading causes of injury-related deaths in children in the United States and is the third most common cause of injury-related deaths in teenagers. Around 1,595 children per 100,000 population have experienced poisoning at one point in time, around four times as much as compared to adults.
For the most part, poisoning in children is unintentional, and commonly occurs at home through ingestion of a substance. The most commonly implicated sources are adult medicines, personal care products and cleaning products. Analgesics such as acetaminophen (paracetamol) are the most common medicines that are ingested (accidentally for young children, intentionally for adolescents). For children under 6 years old, exposure to carbon monoxide and batteries are the most common causes of poisoning. Other ways that poisoning occurs are through inhalation, absorption through the skin, and contact with eyes.
The following paragraphs will provide more details on the various substances or sources of childhood poisoning, as well as the commonly encountered signs and symptoms in children.
Acetaminophen or Paracetamol
This is the most commonly ingested drug among children, usually taken for pain or fever. Very high doses may lead to nonspecific signs and symptoms during the first few hours, followed by vague abdominal pain, nausea, and vomiting. After one to two days, laboratory evaluation may show elevated levels of liver enzymes and a prolonged prothrombin time. If not diagnosed properly, left untreated or taken in severe amounts, acetaminophen poisoning can lead to liver and multiorgan failure.
Aspirin is well-absorbed in the body. Excess amounts can cause vomiting, ringing in the ears (called tinnitus), fast and deep breathing (called tachypnea and hyperpnea, respectively), a fast heart rate, and mental status changes, such as drowsiness. Metabolic disturbances in the body can occur, such as low blood glucose levels and acidosis.
Alcohol and Illicit Substances
Methanol is found in some solvents, paint removers, fuel, and windshield washer fluids. Symptoms may develop immediately after ingestion. These include nausea, vomiting, blurry vision and metabolic disturbances in the body. If this isn’t promptly treated, symptoms may become worse until the child becomes irreversibly blind.
Ethylene glycol is commonly seen in antifreeze products, coolants, paints, detergents, and some cosmetic products. When eaten, individuals can experience nausea, vomiting, drowsiness and possible lack of coordination, which can further lead to metabolic disturbances, kidney injury and cranial nerve palsies.
Some household products include strong acids and alkalis, called caustics. Examples include bleach, baking powder, metal polish, acetic acid (vinegar), and sulfuric acid. There can be severe injury and death (called necrosis) when body tissues come into contact with any of these substances. Children may experience pain, difficulty swallowing, drooling, vomiting or abdominal pain. They may also develop burns along their esophagus. In severe cases, blood circulation is affected, leading to shock.
In rural or farmland homes, children may be exposed to pesticides, which contain organophosphates and carbamates. These can cause diarrhea, constricted pupils (called miosis), wheezing and bronchospasm, decreased heart rate, vomiting and excessive production of tears and saliva.
Young children may play with toys containing small batteries that are loosely placed or easily dislodged. These button - or disk-shaped batteries, when eaten unknowingly, can remain trapped in small airways or tissues of the esophagus. These batteries contain alkaline fluid and electrical discharge, which can erode through the affected area, causing necrosis and voltage burns.
Initial symptoms include sore throat and coughing. They may develop fever, vomiting, difficulty or pain on swallowing, and loss of appetite. Complications include constriction of the esophagus (stenosis) or an unnatural communication between the esophagus and the trachea (fistula), which may need surgical repair.
Carbon monoxide is the most common poisonous gas in children. It is a byproduct of certain fuels that undergo combustion. It may be found in cars, old furnaces, heaters, and wood-burning stoves. Children exposed to carbon monoxide may develop headache, nausea, vomiting, confusion, an elevated heart rate and an increase in their respiratory rate. Exposure to high amounts may lead to seizures, decreased blood flow to the heart, coma, and even death.
Hydrocarbons are commonly found in gasoline (commonly used in cars), kerosene (used in furnaces and kerosene lamps) and paint removers. Ingestion of these substances can trigger coughing and gagging, which can cause the hydrocarbon to enter the lungs and airways by mistake, leading to aspiration pneumonitis. Hydrocarbons can also enter the body through inhalation or exposure to skin.
Affected individuals may experience cough and aspiration, respiratory distress, and fever. Inhaling hydrocarbons can additionally cause irregular heartbeats (dysrhythmias) or kidney problems (renal tubular acidosis).
There are many sources of lead at home - cables, plastics, batteries, cosmetics, old house paint, and even some medicines can have traces of this metal. Inappropriate ingestion of lead can lead to abdominal pain, vomiting, loss of appetite, recurrent constipation, headache, body weakness and lethargy. Without timely management, this can further progress to decreased hearing, hyperactivity and aggressiveness, seizures, or even coma.
It may be surprising that some common household plants can be poisonous. The following are some common household plants that may be dangerous to children.
Philodendrons (Philodendron) and Dumb canes (Dieffenbachia)
Dieffenbachia and Philodendron plants, when eaten, can cause vomiting and pain or irritation in the mouth, lips, or tongue.
Ingestion of parts of the oleander plant can cause nausea, vomiting, increased potassium levels in the body, and slow, irregular heartbeats.
Eating parts of the rhododendron plant can lead to vomiting, loose and watery stools, and a dangerously slow heart rate.
What to do?
If your child has swallowed a liquid substance, do not make them vomit. If they can follow directions, ask them to spit out any remaining substance in their mouth. If your child has had skin contact with a poisonous substance, rinse the affected area with lukewarm water for 15 minutes. Remove all of the child’s clothing and isolate these from any other materials at home. If the eyes are affected, flush the eyes with water (not cold nor hot) for 15 minutes. If the child has inhaled toxic fumes, immediately transfer them to a well-ventilated area with fresh air, or outside the building or home. If you suspect your child has swallowed a battery, bring them to the nearest emergency room for immediate care.
Do not give your child anything to eat or drink until given the go signal by a healthcare provider. If he or she is unconscious or not breathing, call for help and perform basic life support. When bringing the child to the hospital or healthcare facility, make sure to bring the suspected source of poisoning, including the packaging details. Make sure this is carefully and securely packaged, for everyone’s protection.
As the child is being examined, the healthcare provider will ask many questions to determine the best medical management for the child. Important details that they may require include the suspected substance involved, the dose or amount ingested (an estimate would do), the type of preparation (was it a liquid, a capsule, or a tablet?), and the type of route (was it inhaled, eaten, or in contact with the eyes or skin?). Other details include the time it occurred, any unusual symptoms, and what safety measures were done or given before the child was brought in for examination.
How to prevent this?
The best way to manage accidents such as poisoning is to prevent them from happening in the first place.
1. Use proper storage options for dangerous objects, such as small batteries, coins and buttons. Place them in areas that children cannot reach and cannot easily open. Use smart locks when available.
2. Use the original packaging or bottles for household items. Do not transfer contents of any container to another one that is labelled for a different substance or material.
3. Be mindful of all medications at home. Throw away expired medicines. Keep them in their original packaging, away from young children.
4. When giving medications to a child, always double check the bottle or container before administering the medicine.
5. Store gas-powered appliances, stoves, furnaces, and coal out of reach of children.
6. When designing your home, make sure to educate yourself on the use and safety of your chosen household plants. Avoid plants that are known to be poisonous. At the very least, keep them in areas that children cannot reach, such as the top of a tall cabinet.
Childhood poisoning is a very serious consequence of complacency, especially at home. While most cases of pediatric poisonings are unintentional, these can definitely be prevented. Reading on the most common sources, knowing what signs and symptoms to watch out for, and mindfully implementing prevention measures at home can help reduce the chances of poisoning in children.
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- Types of Poisoning in Children. Hassenfeld Children’s Hospital at NYU Langone. Taken from: https://nyulangone.org/conditions/poisoning-in-children/types
- Alhaboob, A.A. (2021). Sociodemographic Characteristics and Risk Factors for Childhood Poisoning Reported by Parents at a Tertiary Care Teaching Hospital. Cureus. 2021 Feb; 13(2): e13313.
- Berta, G.N., et al. (2020). Childhood acute poisoning in the Italian North-West area: a six-year retrospective study. Ital J Pediatr. 2020; 46: 83.
- Toce, M.S. & Burns, M.M. (2017). The Poisoned Pediatric Patient. Pediatrics in Review May 2017, 38 (5) 207-220; DOI: https://doi.org/10.1542/pir.2016-0130
- Poison Prevention & Treatment Tips (2021). American Academy of Pediatrics. Taken from: https://www.healthychildren.org/English/safety-prevention/all-around/Pages/Poison-Prevention.aspx
- McGregor, T., Parkar, M., & Rao, S. (2009). Evaluation and Management of Common Childhood Poisonings. Am Fam Physician. 2009 Mar 1;79(5):397-403.
- Kliegman, R.M. et al. (2020). Chapter 77 Poisoning. Nelson Textbook of Pediatrics 21st edition. Elsevier.
- Kimball, S.J., Park, A.H. & Rollins, M.D. (2010). A Review of Esophageal Disc Battery Ingestions and a Protocol for Management. Arch Otolaryngol Head Neck Surg. 2010;136(9):866-871. doi:10.1001/archoto.2010.146
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