History

It will be important to obtain a history from the care giver responsible for the child at the time of the ingestion. This needs to be combined with a systematic examination of the child with the aim of determining if a significant ingestion has occurred, of what substance, and what further investigation or management is required to allow an assessment of risk to be made.

What was ingested?

Ask for empty packets, unconsumed pills, berries, leaves or their descriptions. Aim to establish what potential toxins are contained within these.

What was the maximum possible amount ingested?

Weigh the child and calculate this on a mg/kg basis for medications or establish how many berries, leaves etc may have been eaten.  Where more than one child or sibling is involved assume each has consumed the maximum amount in a worst case scenario.

What other toxins may have been available?

Enquire as to what prescription medications family members have within the household or what other household products were also present. This information is particularly important in suspected poisoning by an unknown substance. Consider plant or fungi ingestion in any acutely unwell child who has been outside.

When did the ingestion occur?

Aim to establish the time of ingestion (this may be a time frame of variable duration).

What symptoms have developed since then?

Ask specifically about coughing, choking, vomiting, diarrhoea, and reduced level of consciousness.

Could this be a deliberate ingestion?

Take all deliberate self-poisonings seriously.  They will need a formal age-appropriate psychiatric assessment prior to discharge.

In general the vast majority of substances ingested are of insufficient volume to cause problems to even the smallest of child however there are a few important exceptions with regard to children less than 10kg in weight, often referred to as the “one pill can kill” list:

One pill can kill [6]

• Tricyclic antidepressants (dothiepin)
• Chloroquine and hydroxychloroquine
• Calcium channel blockers (diltiazem, verapamil)
• Opioids (oxycodone, methadone, morphine sulphate controlled release)
• Amphetamines (amphetamine, MDMA)
• Propranolol
• Theophylline
• Sulphonylureas (glicazide, glibenclamide)

Other toxic substances

• Camphor (present in VixVapoRub and Tiger Balm)
• Methylsalicylate (present in Oil of Winter Green)
• Toxic alcohols (methanol, ethylene glycol)
• Iron supplements
• Essential oils

Low risk ingestations

A number of common household substances and drugs can confidently be described as low toxicity and parents can be reassured. However, this does not mean that the circumstances of the ingestion should not be assessed. Full details can be found on Toxbase and a poster is available from NPIS. Common substances include the penicillins, oral contraception pill, silica gel (desiccating bags), glow sticks, slugs, snails and garden worms.