Poisoning in Children

Essentials

• Substances that are dangerous even in small amounts include petroleum products/hydrocarbon in the respiratory tract, substances used as alcohol substitutes, highly corrosive substances and some adult medicines.
• A poisoning event with a happy ending will offer an opportunity to advise the parents about future preventive measures. All dangerous household substances must be stored out of the reach of children. Keeping medicated charcoal at home will hasten the onset of treatment by at least 15-30 minutes, which may prove to be significant as far as symptom development and prognosis are concerned.

Prevalence

• The normal development of a child includes a phase when he/she will put everything in the mouth. Suspected cases of poisoning are therefore common, whereas dangerous situations are rare.
• From school age onwards, poisonings in children resemble those seen in adults and are often associated with experimentation and use of intoxicating substances. Suicide attempts are also possible.

Measures at the scene of poisoning

1. Minimise acute danger - empty the mouth, take the poisonous substance away from the child
2. Immediate first aid - check airway and circulation
3. Establish what caused the poisoning - composition, name, chemical properties
4. Estimate the amount of poison - has the child swallowed anything, estimate the minimum and maximum amount
5. Poisoning first aid - prevention of the absorption of the poison
6. If the symptoms are severe, seek immediate medical assistance
7. If possible, take the poison and its container to show to the medical personnel.

Risk assessment

• Establish what the substance is and how much the child may have ingested.
• Certain illnesses (pica, developmental anomalies) may make the child more likely to ingest significant amounts of abnormal substances.
• During the course of play children may feed each other medicines or plants in greater volumes than they would voluntarily consume.
• Information about the toxicity of certain substances, and measures to take, are available at national poisons information centres, see above.
• Only a very few substances such as aspirated hydrocarbon, or a corrosive or an irritant in the mouth or eye, cause symptoms to appear almost immediately.

First aid when a toxicologically significant poisoning is suspected

• If the poison has been taken by mouth, the first line treatment consists of administering activated charcoal in order to reduce the absorption of the poison.
  • The dose of activated charcoal in children is 1(-2) g/kg (in adults 50-100 g)
  • Activated charcoal is not effective in binding certain substances, such as iron and products containing alcohol. In such a case, gastric lavage should be performed or emesis should be induced with ipecacuanha mixture (in some countries only under special licence). The choice of treatment depends on the ingested substance and which method is considered more appropriate as far as speed and safety are concerned.
  • Activated charcoal binds the poison immediately and will therefore reduce the absorption significantly more effectively than ipecacuanha mixture, but its effect will decline if treatment is delayed.
• The sooner the measures to reduce the absorption are employed after the ingestion the more effective they are. A delay of only 30 minutes can be crucial. It is therefore usually better to give the activated charcoal as soon as possible after the incident rather than try to get the child to a hospital for the administration of charcoal.
• If the ingested substance is corrosive or a petroleum product, charcoal should not be given nor emesis induced.
• Any poison on the skin or in the eyes should be rinsed off with copious amounts of water.