THE MANAGEMENT OF ACCIDENTAL CHILDHOOD POISONING

Abstract

Accidental childhood poisoning is still a common problem for the physician who provides primary care. At least 2,000,000 childhood ingestions per year come to the attention of the health professions in the United States in the wake of billions of containers of toxic substances, with thousands of variations in names and contents. Imperfect prevention programs fail to protect all young children, particularly those between the ages of 1 and 4 years who tend to include oral sampling of these products in their developmental experiences. Fortunately, although the samplings are frequent, the amounts ingested are usually of low toxicity, and the actual numbers of deaths and permanent injuries are relatively small. In addition, the patterns of ingestions tend to be repetitious and are useful in devising specific programs for management. The following series of articles deals with general approaches to the problem of accidental childhood poisoning and focuses on specific problems that require more precise attention. 1. The unknown poison can create a dilemma for parent, child, and the physician. However, by paying close attention to clues provided by a careful history combined with a physical examination and simple laboratory and clinical tests, the physician can both correctly diagnose and treat most ingestions in a rational and effective manner. 2. The management of acute poisoning with activated charcoal is a valuable technique that continues to be ignored by many physicians—yet it is a very effective method for reducing the absorption of many poisons. 3. Aspirin is still the No. 1 substance involved accidental childhood poisoning, although during the period from 1966 to 1973 the percentage of aspirin ingestions by children under 5 years of age reported to the National Clearinghouse for Poison Control Centers decreased from 25.8% to 6.5% of the total reported accidental poisonings—a 75% decrease in the past nine years, principally from ingestions of baby aspirin.