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Phone calls to poison centers regarding childhood exposures to xenobiotics are more frequent than those regarding any other age group. Because of this and the frequent role of poisoning as a cause of pediatric injury, pediatricians have been active for many years in helping to establish and promote the study of medical toxicology, as well as in establishing and supporting the use of regional poison centers. Although the basic approaches to the medical management of toxicologic problems outlined in Chaps. 3 and 4 are generally applicable to both children and adults, issues such as child abuse by poisoning are of particular concern. This chapter provides a perspective on the application of generally accepted toxicologic principles for children.
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To analyze the problem of pediatric poisoning, it is necessary to understand the magnitude of the problem. When assessing the impact of a particular type of injury such as poisoning, epidemiologists examine multiple parameters, such as exposure, morbidity, mortality, and cost, to measure the effect of the injury; however, these parameters are difficult to measure accurately. An important source for information on the extent and effects of poisoning exposures in the United States is the American Association of Poison Control Centers (AAPCC). Every year, the AAPCC compiles standardized data collected from poison centers throughout the United States; the 2012 annual review includes information submitted by 57 poison centers. In the following discussion, comments on AAPCC data refer to cumulative information from the previous five published reports covering the years 2007 to 2011 (Chap. 136).
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Each year, the AAPCC reports approximately 1.2 million potentially toxic exposures in children and adolescents from birth to 19 years, which account for 66% of all reported exposures. In fact, children younger than age 6 years account for 53% of all reported exposures. Of the reported exposures in children and adolescents, children younger than age 6 years account for 79%, children between 6 and 12 years of age account for 10%, and adolescents between 13 and 19 years of age account for 11%. Girls represent 47% of the reported poisoning exposures in young children and 54% of the reported exposures among adolescents.
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Among the AAPCC reported xenobiotic exposures in children younger than age 6 years, 99% are labeled unintentional. In contrast, only 44% of the reported adolescent exposures are unintentional; 50% of exposures in adolescents are labeled intentional, mostly resulting from substance use or suicide attempts. The high frequency of intentional poisoning in adolescents has been reported by others.34,183,184 The remaining 6% of adolescent exposures include adverse drug events and other miscellaneous or unknown causes. Differences in the reasons for exposure between young children and adolescents account for differences in the outcomes of these exposures.
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Approximately 125,000 xenobiotic exposures each year are classified by the AAPCC as therapeutic errors, accounting for approximately 6% of exposures ...