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Drugs Highly Toxic To Toddlers.

Anyone who knows a toddler knows that every passing month can produce a new developmental milestone. Their increasing ability to get around by themselves allows them to explore their environment to a degree for which parents are often totally unprepared.

Many one to two year olds are just learning to walk. In addition, their newly developed dexterity allows them to grasp objects which previously eluded them. Once they've latched onto the object, the next step in the exploration process is usually to put it in the mouth. Can it be any surprise to us, then, that accidental poisoning is a common medical emergency in this age group?

Each year, more than two million toxic exposures are reported to the American Association of Poison Control Centers and over half of them involve children under the age of six. Fortunately, this group accounts for fewer than five percent of all poisoning-related deaths.

Prescription and over-the-counter medications comprise over 40% of all toxic exposures reported to poison centers. Most of the time, a toddler thought to have ingested just one or two doses of a medication will be fine with little treatment beyond TLC. A few drugs, however, can be life-threatening, even in very small amounts.

Any list of toxic drugs should not be considered to be complete. It must be remembered that no two children necessarily suffer the same effects after ingesting the very same medication. Still, certain groups of medications have given physicians plenty of reason for concern.

Cardiovascular Culprits

The widespread prescription of heart medications to grandparents as well as parents make cardiovascular drugs common culprits for accidental exposure. For example, a group of medications known commonly as beta-blockers are used in the treatment of high blood pressure. Other uses for beta-blockers include correcting irregular heartbeats and preventing migraine headaches. Ingestion of as few as one or two tablets of Inderal, a commonly prescribed beta-blocker, is known to cause hypoglycemic seizures (seizures caused by low blood sugar levels) and coma in toddlers.

Another group of widely prescribed cardiovascular medications are calcium antagonists, such as Procardia and verapamil. These drugs and others similar to them increase the supply of blood and oxygen to the heart while reducing its workload. In direct contrast to the benefits these medications can provide when appropriate doses are administered to adults, deaths from overdose are reported every year, and for toddlers, the overdose can be just a couple of tablets.


Among the different classes of antidepressant drugs, tricyclic antidepressants are particularly hazardous to young children. Well known for their toxic effects on the heart after intentional overdose by adults, these drugs, such as imipramine and clomipramine, can cause very serious problems in young children who accidentally ingest small amounts. Typically toxic effects include serious heart rhythm disturbances and seizures.

Interestingly, although imipramine (Anafranil) is one of the tricyclic agents most commonly implicated in toddler poisonings, it is a fairly popular choice for the treatment of childhood enuresis, or bedwetting. However, dosage is of critical importance. The drug is available in the United States in a maximum dosage per pill of 150 mg for adults. Ingestion of just one 150 mg pill by a 22 pound toddler can be fatal.


Diphenoxylate can be very hazardous to toddlers, even with low dose ingestion. Lomotil, which is taken to relieve diarrhea, contains diphenoxylate. Just one tablet or teaspoon can cause symptoms in a toddler, and two tablets or teaspoons can be fatal.

Over-The-Counter Drugs

Several drugs present in various topical preparations can cause serious problems if ingested by toddlers.

One example is salicylates. While a toddler would have to ingest at least four extra-strength aspirin tablets to accumulate a lethal dose of salicylate, a highly concentrated form, called methyl salicylate, is found in many common commercial products. Food flavorings containing oil of wintergreen may be up to 98% methyl salicylate. One teaspoonful of oil of wintergreen is equivalent to fourteen extra-strength aspirin tablets. Methyl salicylate is also found in many topical arthritis remedies and muscle balms. The candy-like aroma of some of these agents may be particularly appealing to toddlers.

Another common ingredient in over-the counter products, such as inhalants used in chest colds, is camphor. Two popular camphor-containing products are Campho-Phenique, which is almost 10% camphor and Vicks Vaporub which is almost 5% camphor. Ingestion of less than two teaspoonfuls of Campho-Phenique can result in a range of adverse neurological effects and death.

Evaluating Poisoning in Toddlers

A careful history of the incident is probably the most important tool in evaluating the potentially poisoned toddler who is yet to display symptoms. Young children typically take with drugs that look appealing and are available. They are most often poisoned by one rather than multiple drugs. Parents, or other caregivers, often see the child ingest the medication. In these cases, they can usually identify the substance, the dose, and the time of ingestion. Even if the parents did not witness the ingestion, they may be able to create a list of potential toxins

The history and physical exam are often sufficient for physicians to diagnose most poisonings in toddlers. Sometimes tests such as blood chemistries, electrocardiograms, and toxicologic screens of the urine are required.

Most severe drug overdoses produce symptoms within four to six hours after ingestion. Once the toddler sees a doctor, treatment will depend on the specific symptoms.

Absorption of many ingested drugs can be prevented by the administration of activated charcoal. Contrary to popular belief, specific antidotes are only available for a minority of poisons.

So, although relatively small in number, some common medications can be fatal to a toddler with only one or two doses. In fact, they account for a large number of pediatric poisoning deaths. While there is no call for panic, parents and other caregivers must recognize the serious threat that these medications pose to young children.

Dr. Rosemary Iconis is an assistant professor at the City University of New York. She is a writer specializing in the areas of health and medicine. Her articles have appeared in many magazines and newspapers.
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Author:Iconis, Rosemary
Publication:Pediatrics for Parents
Date:Feb 1, 2001
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