The presentation of a child to the emergency department (ED) by concerned parents after ingestion of a potential toxin is a frequent occurrence. About 40,000 ED attendances each year in England and Wales are as a result of suspected poisoning in children and about half of these children are admitted for treatment or observation [1]. Approximately 13% referrals were made to on call consultants in National Poisons Information Service regarding Paediatric toxicology [2].

The majority of paediatric ingestions involve accidental unintentional exposure to small doses of non-toxic or minimally toxic substances in children between the ages of one and five, and it can often be difficult to establish whether or not an actual ingestion has occurred. More than 80% of these ingestions occur in the home.


The incidence of paediatric poisoning is partly determined by availability. Drugs appear second in frequency only to household products in the majority of episodes in children under the age of 5. In England and Wales 40% of cases of poisoning in children under the age of 15 relate to ingestion of pharmaceutical preparations. The most commonly ingested of these include iron, tricyclic antidepressants, benzodiazepines, paracetamol and oral contraceptive pills.

In the majority of accidental poisonings in children all that is required is parental reassurance, after a brief period of observation. Less than 1% of paediatric poisonings are clinically serious and death is rare [3]. In England and Wales, the most common cause of death from poisoning in children is in relation to carbon monoxide, but this will not be discussed further in this module.

Child protection

Although thankfully rare, the emergency physician must always consider the potential of child protection or safeguarding concerns for any paediatric toxicological presentation. Concerning features in the history and examination are discussed and key management points relating to paediatric poisons are demonstrated.

Child resistant containers

In general the mortality in paediatric poisoning cases appear to be steadily declining.  This may be as a result of child-resistant containers (CRCs), first introduced in the UK in 1972 for junior preparations of aspirin and paracetamol and 1976 for adult versions, increased poison prevention efforts and safer pharmaceutical agents being prescribed to the general population, particularly anti-convulsants and anti-depressants. It should be remembered however, a significant proportion of children under the age of 5 are able to open the CRCs and these only have the potential to be an effective deterrent if the tablet in question is stored in them and not left loose.

Learning bite

In August 2012 the Medicines and Healthcare Products Regulatory Agency (MHRA) introduced the Human Medicines Regulation that stated only those medications containing aspirin, paracetamol and greater than 24mg of elemental iron must be legally placed on the market in packaging that has been shown to be child resistant [4]. These drugs were chosen based on prevalence within the home and numbers of recorded toxic ingestions.  It is now felt that although CRCs have a role to play in the prevention of accidental poisoning in children priority should be given to safe and appropriate storage of medicines.

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