Paediatric toxicology in the ED will encompass 4 distinct groups of patients:

Accidental poisoning

This is by far the most frequently occurring presentation in children and generally affects those under the age of 5. Boys of the age of 2 are the commonest group to be involved. This module focuses predominantly on this group. This often occurs when there is inadequate supervision of the child and psychosocial stress within a family (e.g. a new baby, maternal depression or substance misuse) can be an important factor, as well as personality traits of the child such as hyperactivity.

Deliberate self-poisoning

This is not covered in detail in this module but generally involves teenagers and reflects adult patterns of self-poisoning. Encompassed within this will be those teenagers and young adults that experiment with alcohol and recreational drugs. These teenagers will require assessment by age-appropriate psychiatric and social teams.

Iatrogenic poisoning

Differences in size, body surface area, and immaturity of metabolic pathways are just a few of the differences between children and adults that make prescribing for children more hazardous. Drug calculations always need to be double-checked.

Deliberate poisoning

Fabricated or induced illness by proxy (moving away from the term Munchausen’s by proxy) is rare, but must be considered in children presenting to medical services with an unclear constellation of symptoms in a situation where the doctors may, or may not, have social concerns for that child. A number of substances have been used including common salt, emetics and purgatives.

Learning bite

Any toxicology presentation in a child or teenager requires investigation beyond the consequence of the exposure due to safeguarding, social and mental health issues.

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