Scott Webb (Host): Though most accidental poisonings in our kids are not fatal, it's best if we try to prevent our kiddos from getting their hands on dangerous items and medications. My guest is here today to talk about the prevalence of poisoning in kids, when to be worried, and how we can best prevent poisonings. I'm Scott Webb, and joining me today is Dr. Emily Nolte. She's a pediatrician with Carle. 

Doctor, so nice to have you here today. We're going to talk about poison prevention. So let's start there. Let's go through the epidemiology of poisoning, if you will. How many poisonings in kids are there per year? Are they fatalities? What are the most common causes? You know, all that sort of thing.

Emily Nolte, MD: So when I'm thinking about poisoning, you know, poisoning to me can mean a lot of different things. But today I wanted to focus on accidental ingestions, especially among younger kids. And so poisonings are actually quite common in this country, but they are preventable. Annually there's about 1 million poisonings that are reported to the American Association of Poison Control Centers.

And that's specifically in kids under six. In reality though, this might be an underestimation since, there are many instances that are likely to go unreported. I think it's also important to know that the vast majority of poison exposures actually occur in the home. So that's definitely something to look out for.

Thankfully, fatalities from poisonings are actually quite rare. For example, there was some data I found that in 2020, there were 21 fatalities in children under six, which of course is 21 too many, but also out of a million, you know, percentage wise is not terribly high. So that's a good thing. 

The most common cause for a serious injury from poisoning is really going to be a burn in the esophagus. And I would say the most common cause of death that we see from poisoning, especially among young children, is actually with opioid medications.

Host: Okay. Yeah. So as you're saying, usually these are accidental ingestions, right? Usually at home, younger kids, that sort of thing. So good baseline there. And I wanted to follow up and ask you like, when should we start to be worried about this type of thing? Like I can remember when my kids were really little, we had all those things on the cabinets, you know, so they couldn't get into the cabinets, that kind of thing. But just in general for parents, when should we be worried, and what should we do to maybe put that worry aside, that kind of thing,

Emily Nolte, MD: I do want to think about this kind of in terms of the developmental milestones that we commonly see for kids. Of course, kids can develop at their own pace. But, really starting around, you know, four months or so, sometimes even earlier, babies as we know, are really putting everything in their mouth.

So I think that's really the first age point to start thinking about this. Another important milestone is that around eight months old is when babies start crawling. So they're going to naturally start exploring their environment. They may be able to start to maneuver through the home, open cabinets, things like that.

You definitely want to be more cautious at that age. Of course walking typically starts around 12 months of life, so you might notice that they can grab things from places that were previously out of reach, like countertops and tables. And then, you know, once we get into the toddler years, so around two and a half years or so is when their fine motor skills are really becoming a lot better. So like a, a two and a half year old can typically open a screw top. So definitely when we're thinking of medicines, that's definitely something to be aware of. And, you know, even the concept of, of danger isn't typically understood until the preschool years. And even then, of course, whether they listen to us telling them that there's a something dangerous going on or not, is a whole different issue. So.

Host: Yeah, sort of taking me down memory lane, which is essentially, I asked you about the age and it's like, yeah. So pretty much, you know, once they're born, that's when we can start to worry. Of course. And you know, I have, my kids are 17 and 21 now, and I'm still worried. I'm just worried about different things.

Of course. Uh, so maybe you could give us some specific examples or you know, things that we should worry about specifically. You said most of the time this is in the home. So what are some of the areas of our home, some examples you can give us.

Emily Nolte, MD: The most commonly ingested substances for kids under the age of six are actually cosmetics and personal care products, and then cleaning products as well. So some specific household products to be aware of, that I think have gotten a little more attention lately. But like dishwasher and laundry detergent pods are really important to know about.

 They come in these bright colors, they're in little capsules. Kids might mistake them for candy or something interesting to play with. But of course the chemicals are, are inside them, can be quite dangerous. A couple other, specific examples I'd just like to point out are, button batteries which are found in a lot of different electronic products. Can be very, harmful.

Magnets are also something to be aware of. Of course we think about medicines as well, is something that kids are frequently getting into. As I mentioned before, you know, opioid medications are going to be one of the most common causes of death from poisoning. But some other medicines that I think we should just be aware of that has a high hazard factor, meaning they can be especially toxic if they're ingested even in small amounts, can include things like iron supplements, antidepressants, some cardiovascular medications, and aspirin as well.

Host: Hmm. Yeah, I see what you mean about the, uh, the laundry pods. When should we be concerned? Right? So if, if our child has ingested something, and hopefully we know what it is, but either way, like when should we be concerned? When should we call 9-1-1? That sort of thing.

Emily Nolte, MD: You know, and really the types of symptoms that kids may show can vary greatly based on what exactly it was that they ingested. General symptoms that seem to apply to many different substances can include, you know, sleepiness, being irritable, belly pain, vomiting.

Definitely if you ever see changes in their pupil sizes, which can especially be important for certain medicines, can be quite serious. Of course, if they, if at any point you notice they're having trouble breathing or they're so tired that you can't wake them up, then you should call 9-1-1 or get to the closest ER. But otherwise, if you feel like you're in a, a relatively safe space and don't have to do that, you can always call the poison control center. Many cases of poisoning can be managed at home as long as you've consulted with the Poison Control Center. And they're a, a toll free number. The number is relatively easy to remember.

It's 1-800-222-1222. I often tell parents, you know, either memorize this, put it in your phone, and give them a call and kind of see what they say. They have a lot of different resources for many different medicine substances. Really anything that kids can ingest. One thing that I feel like we used to hear about kind of in the past was, to force kids to vomit. But we've actually learned that in a lot of situations that can actually be more harmful than helpful. So we actually don't recommend doing that unless of course, you've been specifically instructed to do so.

Host: Sure. Yeah, it is interesting. You know, the things I've done podcasts on nosebleeds and the recommendations for how to stop a nosebleed are different than my grandma taught me, you know, and taught all of our grandmas may have taught us. Right, back in the day it was like, well, if you swallowed something you shouldn't have absolutely just go ahead and force yourself to throw that back up. So, uh, it's great to have your expertise. Great to understand the modern sort of frontline treatment things we should do as parents, and we all worry about these things, but hopefully listeners worry just a little bit less because they've heard you today. So thank you so much.

Emily Nolte, MD: Uh, no. Thank you so much for having me. It was great talking with you.

Host: For more information and to get connected with one of our providers, please visit carle.org. And that wraps up this episode of Expert Insights with the Carle Foundation Hospital. I'm Scott Webb. Stay well.