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The Informed Parent

Accidental Substance Ingestion

by Shanna R. Cox, M.D., F.A.A.P.
Published on Nov. 20, 2006

As we approach the holiday season families look forward to visiting each other, traveling near and far and succumbing to the holiday flurry of activities. During this time there exists a special risk for little ones getting into things they shouldn't. While certainly this is an all year phenomena, the hectic schedule of the holiday season and often altered normal daily routine can lead to accidental substance ingestion or poisoning. Across the United States emergency rooms see greater than fifty thousand children a year who have inadvertently ingested a medication or substance not intended for them. This is to the exclusion of alcohol and narcotic ingestions.

Looking across the literature available through the Centers for Disease Control studies shows that children four years and under are at the greatest risk for accidental substance ingestion. This is not surprising given the continuous curiosity that characterizes toddlers and their desire to model adults. Of those children who are actually brought to the ER, many have ingested a family member's prescribed medication or taken too many of an easily available over-the-counter medication. Safety laws that have required child resistant tops on medications have helped. But they are essentially useless when a person transfers medication to a pill-carrying case, the bottom of a purse, or any other readily accessible container. While this may help the adult patient's compliance with the medication it may well prove fatal for a child.

Many common adult medications have serious side effects for children. The simple explanation for this is the weight difference between the adult and the child. Further complications exist if the particular medication is used for a serious systemic disease most likely not present in a child. Cardiac and neurological medications are oftentimes implicated in the approximate thirty percent of children that require intensive care after presenting to the emergency room following an accidental substance ingestion. The effects of these medications have a wide range of immediate and late consequences that physicians must look for and be aware of. Therefore, it is important that the physician have all the information possible regarding the type and quantity of substance ingested, and the time period that elapsed between ingestion and presentation to emergency care.

When children are present medications should be kept in a locked cabinet that is difficult to access. It is not appropriate to keep medications in a purse or diaper bag that can be easily manipulated, even by an infant. When families are outside their own environment they should make a conscious effort of reminding their hosts that medications must truly be out of reach. The majority of accidental ingestions happen in the home of the child or the child's relative.

The Center for Disease Control recommends that medications be left in their labeled container. In the event of an ingestion family and medical personnel may immediately assess the risk profile of that particular drug and have a better understanding of what dosage was taken. Families should post the poison control number in clear view in their households. All members should have a low threshold in seeking medical attention after a child has potentially been poisoned.

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