Pediatric-Specific Poisoning, Ingestions, and Prevention
Why children differ
Children explore by mouth, have higher minute ventilation and surface-area-to-mass ratios, and lower glycogen reserves, so hypoglycemia and hypothermia appear early. Their smaller mass makes a tiny absolute dose clinically significant. The classic "one pill can kill" list includes clonidine and imidazolines (tetrahydrozoline eye drops), sulfonylureas, opioids including methadone and buprenorphine, tricyclics, calcium channel blockers, chloroquine, camphor, and methyl salicylate. Elemental iron and button batteries are quintessential pediatric hazards.
Special ingestions
- Button battery in the esophagus: honey and sucralfate may be given while arranging emergent endoscopic removal within two hours; do not induce vomiting.
- Multiple magnets: endoscopic removal before they traverse the pylorus to prevent fistula and perforation.
- Hydrocarbons: aspiration pneumonitis; no emesis, no charcoal.
- Caustics: no emesis, no lavage; early endoscopy.
- Acetaminophen is still the most common serious pediatric overdose; the Rumack-Matthew nomogram applies to acute single ingestion.
Prevention
Child-resistant packaging under the Poison Prevention Packaging Act, safe storage, return of unused opioids, and poison center utilization all reduce morbidity. Syrup of ipecac is obsolete and should not be recommended. Weight-based dosing errors are a major source of iatrogenic poisoning.
Traps
Applying adult dose thresholds to children; assuming a negative history means no ingestion; forgetting that sustained-release and transdermal products (clonidine patches, fentanyl patches) cause delayed, prolonged toxicity; and missing non-accidental poisoning.
Rule of thumb: for a toddler, any ingestion of a cardiotoxic or centrally acting tablet should prompt poison-center consultation and a period of monitored observation regardless of symptoms.