Poisoning in Children and Adolescents
Alan D. Woolf MD, MPH1
1 The Program in Clinical Pharmacology & Toxicology in the Division of Ambulatory Pediatrics, Children's Hospital; Department of Pediatrics, Harvard Medical School; The Massachusetts Poison Control System, Boston, MA.
Definition
A poisoning can be defined as the exposure of the victim to an agent that, by transference of chemical or radiant energy, can cause symptoms and signs of organ dysfunction leading to injury or death.
Epidemiology
Childhood poisonings continue to challenge the diagnostic and treatment skills of the pediatrician. Of more than 1.7 million poisoning exposures reported to 72 poison centers in the United States in 1990, 60.8% involved children less than 6 years of age (Table 1). Fortunately, young children account for fewer than 4% of poisoning-related fatalities. Generally, childhood poisonings involve products in use and occur when a parent is distracted. The profile of a toddler at high risk for repeated poisonings is one who is active, is inquisitive, and has oral behaviors. Frequently, these children are described as negativistic; a power struggle between parents and child over putting forbidden objects in the mouth may be evident. Parents of these children may be socially isolated, burdened with physical or psychiatric problems, and hampered by insecurities regarding their own competence as parents.
Clinical Aspects
TOXIN INFORMATION
The history and physical examination are of paramount importance in reaching the correct diagnosis of the poisoned child. The pediatrician must find out what toxin(s) might be implicated in the poisoning: the exact ingredients and their concentrations.
