CHAPTER 1-2: SPECIAL CONSIDERATIONS IN PEDIATRIC PATIENTS

INTRODUCTION

The majority of calls to poison control centers involve children younger than 5 years. Fortunately, children account for a minority of serious poisonings requiring emergency hospital treatment. Most common childhood ingestions involve nontoxic substances or nontoxic doses of potentially toxic drugs or products. Table I–43 lists important causes of serious or fatal childhood poisoning, which include iron supplements; tricyclic antidepressants; cardiovascular medications such as digitalis (Digoxin and other Cardiac Glycosides), beta receptor antagonists, or calcium antagonists; methyl salicylate (Salicylates); and hydrocarbons.

1. High-risk populations. Two age groups are commonly involved in pediatric poisonings: children between 1 and 5 years and adolescents.

   1. Ingestions in toddlers and young children usually result from oral and tactile exploration. Unintentional exposures in children younger than 6 months or between the ages of 5 and adolescence are relatively rare. In young infants, consider the possibility of intentional administration by an older child or adult. In school-aged children, suspect abuse or neglect.

   2. In adolescents and young adults, overdoses often are the result of suicidal or other self-harm intent, but may also occur in the settings of drug abuse, bullying, underlying mental health conditions, or experimentation. Common underlying reasons for adolescent suicide attempts include pregnancy; sexual, physical, or mental abuse; school failure; conflict with peers; conflict with homosexual orientation; a sudden or severe loss; and alcoholism or illicit drug use. Any adolescent with intentional poisoning must undergo psychiatric evaluation and follow-up.

2. Poisoning prevention. Young children with unintentional exposures are at higher risk for subsequent exposures compared to the general population. After an incident, prevention strategies must be reviewed. If the family does not understand or comply with the advice, or if a child presents with a subsequent poisoning, consider a home evaluation for child-proofing by a public health nurse, child protective services official, or other health care professional.

   1. Enhance child safety in the home, day care setting, and any households the child commonly visits (eg, grandparents and other relatives). Store all medicines, chemicals, and cleaning products out of the reach of children or in locked cabinets. All products should remain in their original containers, and must never be stored in food or drink containers, or in the same cabinets as food. Children commonly find medications and other products on bedside tables, kitchen counters, and in visitors' purses or backpacks.

   2. Use child-resistant containers to store prescription and nonprescription medications. It should be understood that child-resistant containers are not child-proof; they only lessen the time it takes a determined child to get into the container. Children should never be allowed to play with medication containers.

   3. Medication errors are a preventable cause of severe injury or death in children, especially those younger than 1 year. These errors are commonly associated with concentrated drugs in small volumes (<1-mL intended dosages); 10-fold dosing errors secondary to mislabeling or misinterpreted directions; unintentional repeated dosing secondary to multiple caregivers administering the same medication; and unintentional use ...