Poisoning remains a significant but preventable cause of pediatric injury. Phone calls to poison control centers regarding pediatric exposures are more frequent than those regarding any other age group. Pediatricians have been leaders for 60 years in helping to establish and promote the study of medical toxicology, supporting the use of regional poison control centers and promoting the principles of poison prevention. 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, some issues such as child abuse by poisoning are of particular concern. This chapter provides a perspective on the application of generally accepted toxicologic principles to children.
To understand the magnitude of pediatric poisoning and its impact, epidemiologists examine multiple parameters, such as exposure, morbidity, mortality, and cost; however, these parameters are often difficult to measure accurately. An important source of information on the extent and effects of poisoning exposures in the United States is the American Association of Poison Control Centers’ (AAPCC’s) National Poison Data System. Every year, the AAPCC compiles standardized data collected from poison control centers throughout the United States; the 2015 annual review includes information submitted by 55 regional poison control centers. In the following discussion, comments on AAPCC data refer to cumulative information from the previous 5 published reports covering the years 2011 to 2015 (Chap. 130).
Each year, the AAPCC reports approximately 1.1 million potentially toxic exposures in young children from birth to 6 years of age that account for almost half (48%) of all reported exposures in the AAPCC database. Pediatric exposures involving all children and adolescents younger than 19 years account for 61% of all reported exposures. Of the reported pediatric exposures in children and adolescents, young children (younger than 6 years) account for 78%, school-age children (between 6 and 12 years) account for 10%, and adolescents (between 13 and 19 years of age) account for 12%. Females represent 43% of the reported poisoning exposures in young children and 58% of the reported exposures among adolescents.
Among the AAPCC-reported xenobiotic exposures in young children, 99% are coded as unintentional. There is some controversy regarding the use of the term unintentional with respect to childhood poisoning. A toddler quite purposefully intends to ingest a substance but does not intend to injure or harm him- or herself. Unsupervised is a term preferred by some epidemiologists to better describe the etiology of these exposures.110 In contrast, 39% of reported adolescent exposures are coded as unintentional, and 56% of adolescent exposures are coded as intentional. This shift in intentionality is due to an increased frequency of adolescent intentional substance use, abuse, and suicidal exposures. This high frequency of intentional poisoning in adolescents has been reported by others.36,141,183
Table 31–1 shows the leading causes of ...