Caustic substances include acids (60-80% vinegar, acid detergents, battery acid, fiberglass hardener) and alkali with a pH ≥ 12 (lye, dishwasher detergent, ammonia, sodium hydroxide).
Alkali with a pH > 12.5 and acids with a pH < 2 are especially caustic.
Washing the mouth and drinking fluid is an adequate first aid.
In general children without symptoms can be followed up at home, but those with symptoms should be referred to a hospital.
First aid at home
Wash the mouth and pharynx with water as soon as possible.
Give fluid (water, milk) to dilute the corrosive substance.
Do not induce vomiting.
First aid in primary care
Asymptomatic children can be sent home for follow-up. The parents are advised to contact the doctor if symptoms develop (see below).
Dysphagia (the child does not want to drink or eat), drooling, vomiting, or respiratory distress are indications for immediate referral to a hospital.
Also refer to a hospital all children who have ingested lye, an unknown corrosive substance, a detergent for dishwashing machines in institutional use (pH >12.5) or a strong acid (pH < 2).
Laboratory tests, radiographic examinations, corticosteroids 1 or antibiotics are not indicated.
Treatment in the hospital
If the child has dysphagia, drooling, vomiting, or respiratory distress, follow-up in a hospital or, if necessary, on an intensive care unit is indicated.
Haematemesis, difficulty breathing and simultaneous occurrence of more than 3 symptoms suggest a more serious corrosive lesion 2.
The child can take fluid and food freely if there is no vomiting or dysphagia preventing drinking and eating (in the latter case intravenous fluids should be administered).
No routine diagnostic investigations such as oesophagoscopy, laboratory tests or radiographs are indicated. Oesophagoscopy is performed no earlier than after 24-36 hours on children who have had salivation and pain on swallowing for 12-24 hours.
Endotracheal intubation may be indicated because of respiratory distress.
References
Pelclová D, Navrátil T. Pelclová D, Navrátil T. Do corticosteroids prevent oesophageal stricture after corrosive ingestion? Toxicol Rev 2005;24(2):125-9 [PubMed]
Lamireau T, Rebouissoux L, Denis D et al. Accidental caustic ingestion in children: is endoscopy always mandatory? J Pediatr Gastroenterol Nutr 2001;33(1):81-4. [PubMed]