The first sign of accidental poisoning is often material evidence, such as an empty medicine bottle or tablet box, or an open carton of detergent capsules. Is it possible the contents have been consumed by a nearby child?
Or maybe it is the absence of evidence. Where the hell is that button battery out of the back of their toy?
What’s the first thing to do?
Don’t panic, but if the child is showing symptoms, such as being very short of breath, coughing and in obvious distress, call the emergency services right away, says Dr Edel Duggan, director of the National Poison Information Centre (NPIC).
If the poisonous matter is still in their mouth, make them spit it out. Then check inside their mouth and remove any remaining bits. While you might think it would be best to make them vomit immediately, in the hope they bring up any substance that has gone into their stomach, don’t do that. If it is something corrosive and has caused damage going down, it could cause more damage coming back up.
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“The danger is, especially if they are in any way drowsy, it could go into the lungs and cause damage in the lungs,” she warns.
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If the child is not showing any symptoms and you’re not exactly sure how much, if any, of a poisonous substance has been consumed, ring the NPIC’s Public Poisons Information Line (01 809 2166), which operates seven days a week between 8am and 10pm. A healthcare professional there will triage your child over the phone. They will advise if you need to seek urgent medical attention for your child, from a GP or emergency department, depending on what has been taken, the amount and the symptoms.
What sort of information do I need to provide?
Most important is an ingredient list from the label of the product and then an estimate of the amount that could have been consumed. You also need to know the weight of your child as this is key in determining the danger of a dose.
“We probably calculate the worst-case scenario,” says Dr Duggan. “Certain things we would say you definitely have to go into the emergency department” – the child might need blood tests or a tracing of the heart.
“Or if it is really just to get them checked out from a symptom point of view, we may say go to the GP. The GP can ring us up too.” Healthcare professions can ring the centre on 01 837 9964 at any time – 24 hours a day, every day of the year.
I have found my toddler with an open, almost empty bottle of liquid paracetamol . . .
Unintended or excess paracetamol consumption is the household scenario that the poison information centre is most often contacted about. A child may have got their hands on it or sometimes a well-meaning parent has spooned it out, not realising the other parent had just done that. Obviously this common, over-the-counter children’s medication is fine in appropriate amounts but if you suspect an overdose, you do need to seek medical advice.
“It can cause liver problems – and the child may have no symptoms,” says Dr Duggan. “If they have taken something like Calpol, give us a phone call because we will calculate the dose based on the child’s weight.” If it is estimated to be an overdose, the child needs a blood test to check the paracetamol level in the blood.
“If it is above a certain level, then there would be an antidote.” You have a couple of hours to get the child into the hospital for this test but don’t wait for symptoms because, if you do, it will then be too late for the antidote to be effective.
Does the NPIC get many calls from parents?
Just over half of the 10,281 inquiries it handled in 2022 came from members of the public, according to its latest annual report. The majority of poisoning queries related to children aged 14 and younger, with more than 40 per cent of cases being aged between one and four years old.
More than 90 per cent of all human poisonings occur in the home. Of all the cases that the NPIC dealt with in 2022, more than half involved drugs – including medications and drugs of abuse. But 17 per cent were common household products such as fabric detergents and multipurpose cleaners; 14 per cent were chemicals including alcohols, corrosive substances, essential oils and hydrocarbons.
Surely there is no need to worry about detergent sachets any longer because they come in child-proof containers?
Actually those containers are not “child-proof” – despite how much difficulty you might have in opening them. They are simply “child-resistant” and this acts as a delay mechanism, says Dr Duggan. It may give you enough time to catch your toddler in the act “before they actually figure out how to open it”. Keeping such household products right out of children’s reach is the only way to avoid accidental poisonings or damaging skin contact. If a chemical, such as a detergent, has splashed onto a child’s skin or in their eyes, wash the skin or eyes with tap water for 15 minutes.
The NPIC has queried with industry, she says, why detergent capsules have to be so brightly coloured and appear like sweets to children but little notice seems to have been taken of its concerns. “The proof is on the shelves unfortunately,” she concedes.
Are there other hazards in my home that I may have overlooked?
If you are a fan of reed diffusers, you should be aware that there has been an increasing incidence of accidental poisoning among children with these. The NPIC has been so concerned it contacted the Health Safety Authority about the trend.
In many cases, the NPIC did not know what it was dealing with if asked for advice. It could not tell what ingredients were in the chemical mixtures as the label on the reed diffuser did not have a Unique Formula Identifier (UFI), as required under EU regulation. Where the substances are unknown, the NPIC has to recommend a child goes into hospital just in case.
The Health and Safety Authority embarked on an inspection campaign to ensure reed diffusers with hazardous ingredients are adequately labelled. More than 85 per cent of the products inspected were non-compliant. Of course, these attractively scented products should be kept out of the reach of children but, if you are buying one, at least make sure there is a UFI on the label.
Batteries are a clear danger but I hear there has been a safety focus on these too?
We don’t get a huge number of calls relating to these, says Duggan – about 86 in 2022. “But it is one thing that has caused deaths in children and deaths from poisoning is very rare in kids.” There were no deaths of this kind in Ireland in 2022.
If a battery gets lodged in the pipe from the mouth to the stomach, it can cause serious trouble. Button batteries are ones that are probably most likely to be swallowed. Between 2016 and 2021, at least 27 children died in the US after swallowing button batteries, according to the US Consumer Product Safety Commission.
“It can get stuck on the way down and one of your major blood vessels coming out of the heart is behind that pipe going down into the stomach,” says Dr Duggan. Here it can cause irritation and damage the blood vessel, leading to death.
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Chemicals released from a battery can also cause burning of an airway, so if a battery goes into the trachea (windpipe) it is very worrying, particularly in small children. While it could pass safely through an older child, this might take a week or two and a monitoring X-ray or two would be needed to check its progress.
Once you start seeing these possible poisoning risks, they seem to multiply . . .
At this time of year, make sure anti-freeze or de-icer containers are not within reach inside your car. These can cause liver problems if ingested.
“There is an antidote for it but the child can become very sick if it is not recognised.”
Anything else I might not have thought of?
Perhaps how clueless visitors to your house can be about how easily medications they have in their bag can fall into the wrong, small hands. Eating just one tablet for blood pressure or a heart condition can cause a child to go into a toxic range. If grandparents, say, are staying overnight, ask them to make sure they put any pills up high, rather than leaving them in a bag that your child may rummage through.
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Finally, if you have house plants, make sure you know the name of each one is just in case a small child has a munch. The people at the NPIC will need that information to, hopefully, put your mind at rest and save you an unnecessary trip to hospital.
How do I spot if my child has . . .
- Coeliac disease
- Heat exhaustion
- Diabetes
- Asthma
- Anxiety disorder
- Dyslexia
- ADHD
- Eating disorder
- Being bullied
- Meningitis
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