Source: White SR, Yadao CM. Characterization of methylphenidate exposures reported to a regional poison control center. Arch Pediatr Adolesc Med. 2000;154:1199–1203.A retrospective review of all methylphenidate ingestions reported to the Children’s Hospital of Michigan regional poison control center from January 1, 1993, to December 31, 1994, analyzed the severity of symptoms, risk for ingestion, and outcome in 289 patients of which 251 were children. Reports of multiple ingestions and ingestion of sustained release preparations were excluded. Ingestions were classified as accidental, therapeutic, intentional, or for reason unknown. Most therapeutic errors occurred in children age 6 to 11 years. Intentional or reason unknown ingestions were 3 times as likely (75%) to result in symptoms as those that were accidental (23%) or resulted from a dosing error (22%). Symptoms developed in 72 (29%) children, most often between ages of 0 to 5 years (33%). Isolated signs or symptoms (tachycardia, agitation, lethargy, insomnia, and rash) were more common than multiple manifestations (abdominal pain, emesis, or hypertension combined with isolated symptoms). Lower dose ingestions were more likely to be associated with no to minimal symptoms. Gastric decontamination (syrup of ipecac and charcoal) was not helpful in the management of these patients. The age curve of patients reporting any toxic ingestion is bimodal with peaks at 0–5 years and 14–18 years, whereas for methylphenidate ingestions the age curve was trimodal with an additional peak at age 6–9 years, a group where therapeutic error was the most common reason.The most interesting information in this paper is the relative rarity of serious side effects from methylphenidate ingestion. However, the greater incidence of symptomatic ingestions in the 0- to 5-year-old age group is of concern since this is the age group in which methylphenidate usage is growing rapidly.1,2 Intentional (suicidal) poisoning or recreational abuse of this drug has the potential for a more serious or fatal outcome.3 Most of the “therapeutic errors” were related to extra doses given by caretakers and were, therefore, theoretically preventable: for example, 2 caretakers administering the recommended dose twice because one was unaware that the other had given it. The authors offer an information sheet for parents to minimize such occurrences.There is little to “ADD” to this retrospective review of Ritalin toxicity except to note that despite its relative safety, children should not be treated with Ritalin unless they meet the AAP Guidelines for the diagnosis of ADHD.4