Poisoning in children

Poisoning in children is usually accidental and rarely causes toxicity; however, if poisoning is suspected in a child, always seek advice from a clinical toxicologist or poisons information centre—telephone 13 11 26. If a child has ingested a poison, advise to rinse their mouth immediately to remove remaining tablet fragments or liquid.

Agents with a high risk of toxicity in children are:

• opioids
• iron supplements
• button batteries—diagnosis requires a very high index of suspicion because early symptoms are often nonspecific (eg pain, vomiting, loss of appetite), young children cannot provide a reliable history and these exposures are rarely witnessed.

Most household products have a low risk of toxicity when small amounts are ingested by children. Accidental or unintentional ingestion of paracetamol rarely results in toxic concentrations in children.

Deliberate self-poisoning in children has a similar risk of harm as in adults.

To aid in the risk assessment of poisoning, estimate the amount of drug or toxin a child has ingested as accurately as possible. If in doubt, overestimate the amount to allow a safety margin. Small, sugar-coated or chewable tablets are more likely to be ingested in multiples than large or unpalatable medicines.

To estimate the amount of a liquid formulation ingested:

• measure the remaining volume in the container
• subtract the remaining volume from the original volume of the container to estimate the amount ingested
• if known, also subtract the volume used before the ingestion
• do not subtract the volume spilt because it is difficult to estimate.

Paediatric toxic doses and treatment recommendations are included in each monograph.

In young children who present with poisoning, an assessment must be made about their safety, including their social situation and risk of nonaccidental injury or repeat poisoning.