Unintentional Intoxications in Children under 4 Years Old: A Current Reality?

Background: Young children are particularly susceptible to intoxications due to the natural need of environmental exploration and inability to measure risks. Despite several preventing efforts, intoxications remain a significant cause of admission to the pediatric emergency department (PED).

Objectives: Characterize childhood intoxication cases in the PED and develop prevention strategies.

Methods: Retrospective analysis of clinical cases of children under 4 years old attending to the PED during 10 years.

Results: Between 2008-2017, 383 children with unintentional intoxications attended the PED and accounted for 0,1% of all emergency visits during the study period. The median age was 2.1 years (±1.0 years); 54.3% (n=208) were female. Ingestion of drugs were involved in 52.5% (n=201) and antihistamines were the most frequent drug class. Domestic products were the second intoxication agent (36%, n=138) followed by carbon monoxide (5.7%, n=22), poisons (4.4%, n=17) and illicit drugs (0.8%, n=3). Forty percent (40.7%, n=156) of the intoxications occurred in the afternoon, 68.1% (n=261) during weekdays. 99.7% (n=382) intoxications occurred at home. A total of 50.4% (n=193) of patients were admitted less than 1 hour after exposure to the toxic agent and only 15.1% were transported to the hospital through the National Emergency Service. Most children were asymptomatic (n=224). In symptomatic patients, gastrointestinal manifestations were the most frequent (58.4%, n=93). The National Poisoning and Intoxication Center was contacted in 82.2% (n=315) of the cases. Gastrointestinal decontamination was performed in 30.3%. Four children underwent hospitalization for more than 36 hours. There were no admissions to the intensive care unit or mortality.

Conclusions: The number of children with unintentional intoxication did not change significantly over the last 10 years. Ingestion of drugs that belong to family members accounts for approximately half of the cases. It remains important to ensure prevention strategies in the community.