BACKGROUND:Three sources used for poisoning surveillance-child fatality reviews (CFRs), poison centre (PC) calls and death certificates-employ disparate data methodologies. Our study objectives were to (1) characterise the number of fatalities captured by CFRs and PC data compared with death certificates by age and (2) compare demographic and substance characteristics of fatalities captured by the three sources. METHODS:We acquired CFR data from the National Fatality Review-Case Reporting System (NFR-CRS), PC calls from the National Poison Data System (NPDS) and death certificate data from Centers for Disease Control and Prevention's Wide-ranging Online Data for Epidemiologic Research (WONDER) on poisoning fatalities among children 0-17 years old between 2005 and 2020. RESULTS:A total of 6376 poisoning fatalities among children 0-17 years were reported to WONDER, 3460 to NFR-CRS and 1622 to NPDS. Using WONDER as the reference standard, NFR-CRS captured 71.1% of fatalities among infants, and 68.0% among children 1-4 years. NPDS captured 30.9% of fatalities among infants and 59.3% among children 1-4 years. Children≤4 years represented a greater proportion of fatalities in NFR-CRS (25.5%) and NPDS (37.0%) than WONDER (19.9%). NFR-CRS had a slightly higher proportion of fatalities involving Black or African American race (16.8%) compared with WONDER (14.4%). Opioids were the most common fatal substances associated with NFR-CRS and WONDER. CONCLUSIONS:Fatality counts, as well as demographic and substance characteristics of those fatalities, differ between poisoning databases used by investigators and health agencies. Reliable death classification can improve data quality. Optimising poisoning fatality capture is critical for informing effective prevention strategies.

Aims:Drowning is a leading cause of pediatric death in the United States, yet data characterizing these arrests is limited. Our study aimed to describe demographic and emergency medical services (EMS) response characteristics for drowning-related pediatric out-of-hospital cardiac arrests (pOHCAs). Methods:Using the 2023 National Emergency Medical Services Information System dataset, we conducted a cross-sectional study of EMS-attended 9-1-1 responses involving children 1 day-17 years old who experienced a drowning-related pOHCA. We used descriptive statistics and multivariable logistic regression (adjusted odds ratio; 95% confidence intervals) to identify factors associated with return of spontaneous circulation (ROSC). Results:Our study included 753 drowning-related pOHCAs. Most arrests were toddlers aged 1-4 years (57.8%), males (64.5%), at private residences (72.5%), and in urban settings (83.7%). EMS clinicians were commonly dispatched during the summer (46.7%) and between 12:00 and 17:59 (47.4%). Arrests were often unwitnessed (73.7%) and received bystander cardiopulmonary resuscitation (CPR) (81.3%). Fifty-four percent of adolescent arrests were unwitnessed compared to 80.5% among toddlers (P < 0.001). Most arrests (81.3%) received bystander CPR. Shockable rhythms were uncommon (4.6%). EMS-witnessed ROSC was obtained in 42.0% of arrests. In multivariable regression, adolescent age (3.25; 1.25-8.79), witnessed arrests (1.59; 1.03-2.45), and bystander CPR (2.83; 1.67-4.96) were associated with higher odds of ROSC. Conclusions:Most drowning-related pOHCAs involved young children, with age-based differences in scene characteristics and pre-EMS arrival factors. Adolescent arrests were more frequently witnessed and more likely to obtain ROSC. Opportunities exist to improve drowning prevention among children and enhance the chain of survival.

Background:Pediatric out-of-hospital cardiac arrests (pOHCA) are low frequency, high acuity events for Emergency Medical Services (EMS). The survival rate is low, with only 10% of children surviving, and few survivors having favorable neurologic outcomes. Optimal prehospital management of pOHCA includes rapid epinephrine administration, yet factors contributing to its administration are not well understood. Objective:Our study objective was to evaluate the frequency of epinephrine administration in pOHCA. Our secondary objective was to characterize the demographic and clinical characteristics associated with epinephrine administration in pediatric OHCA in the United States. Methods:In this retrospective, observational study, we analyzed data from the National Emergency Medical Services Information System (NEMSIS) dataset for the year 2021. We identified pediatric patients ages ≥1 day-old to <18 years-old from "9-1-1" activations that were treated by advanced life support (ALS) clinicians. OHCA events were identified by performance of cardiopulmonary resuscitation (CPR) or defibrillation. We used descriptive statistics to evaluate the frequency of epinephrine administration and assess demographic and clinical characteristics in this population. Multivariable logistic regression model was utilized to find characteristics associated with epinephrine administration. Results:In 2021, 8495 pOHCA events (median [IQR] age: 3.0 [0.3-13.0] years; 58.5% males) were managed by an ALS unit in the United States. Two out of every five (40.2%) pOHCA events did not receive epinephrine. Epinephrine use was more common in younger age groups (1 day-1 year OR, 1.25 [95% CI, 1.07-1.46]; 1-5 years OR, 1.19 [95% CI, 1.00-1.38]; 6-12 years OR, 1.59 [95% CI, 1.24-1.79]; referent: 13-17 years), urban population settings (OR, 2.06 [95% CI: 1.79-2.38]), incidents with scene time >10 min (OR, 1.41, [95% CI, 1.25-1.60]), advanced airway attempt(OR 8.33, [95% CI, 7.33-9.47]), and in those receiving defibrillation (OR 1.95, [95% CI, 1.61-2.37]). Odds of epinephrine administration were lower in public settings (OR 0.55, [95% CI, 0.47-0.65]) and in females (OR 0.83, [95% CI, 0.73-0.93]). Conclusion:Epinephrine is not given in 2 of every 5 pOHCA events. Longer scene time and additional resuscitation interventions were associated with epinephrine administration. The low rate of administration has implications for further research and reforms in the prehospital care of critically ill children.

IntroductionAs glucagon-like peptide-1 receptor agonist (GLP-1) use has increased among children, a better understanding of the related adverse effects in this population is needed.MethodsNational Poison Data System data from 2017 to 2024 were analyzed to compare characteristics and trends of exposures involving GLP-1s reported to United States (US) poison centers (PCs) among children 6-17 years old with those of adults.ResultsThere were 13,924 single-substance GLP-1 exposures reported to US PCs from 2017 to 2024. The rate of exposures per one million US population increased by 1,830.8% from 0.97 in 2017 to 18.79 in 2024, including a 4,805.0% increase among children 6-17 years old from 0.04 in 2017 to 1.97 in 2024, with the majority of the increase occurring after 2021. Most exposures (91.7%) were associated with no or mild effects, while moderate effects were observed in 8.0% and major effects occurred in 42 exposures; there were two deaths. Children 6-17 years old were more likely (RR: 2.66, 95% CI: 1.73-4.11) to be admitted than adults, and children 12-17 years old were more likely (RR: 1.68, 95% CI: 1.08-2.63) to experience a more serious medical outcome than adults. Children 6-17 years old with at least one clinical effect experienced vomiting (88.2%) more commonly than adults (61.3%) (RR: 1.44, 95% CI: 1.34-1.55). Additionally, exposures among children 6-17 years old were more likely to be attributable to intentional misuse (RR: 8.12, 95% CI: 6.47-10.17) than among adults.ConclusionsThis study provides national-level, real-world findings that may help inform clinical practice.

Ingestion of delta-8 tetrahydrocannabinol (Δ8THC) by young children is recognized as a public health concern and is commonly encountered by healthcare providers; however, a better understanding of Δ8THC toxicity in this age group is needed. The objective of this study is to investigate the relationship between body weight-based doses of ingested Δ8THC and clinical outcomes among children < 6 years old. Using data from the National Poison Data System, we analyzed single-substance Δ8THC ingestions reported to United States poison centers to investigate the dose-response relationship between Δ8THC dose and clinical outcomes, including severe and prolonged toxicity, followed by receiver operator characteristic (ROC) curve analyses. There were 232 cases (median age: 3.0 years, 51.7

Objectives: Fatal and nonfatal pediatric opioid poisonings have increased in recent years. Emergency medical services (EMS) clinicians are often the first to respond to an opioid poisoning and administer opioid reversal therapy. Currently, the epidemiology of prehospital naloxone use among children and adolescents is incompletely characterized. Thus, our study objective was to describe naloxone administrations reported by EMS clinicians during pediatric activations in the United States. Methods: We performed a cross-sectional study using the National Emergency Medical Services Information System (NEMSIS). Within NEMSIS, we identified emergency responses where children 1 day through 17 years old were documented by EMS to have received ≥1 dose of naloxone in 2022. We analyzed demographic and EMS characteristics and age-specific prevalence rates of activations where naloxone was reported. Results: In 2022, 6,215 activations involved naloxone administration to children. Most activations involved males (55.4%, 3,435 of 6,201) and occurred in urban settings (85.7%, 5,214 of 6,083). Naloxone administration prevalence per 10,000 activations was highest among the 13-17 year age group (57.5), followed by the 1 day to <1 year (17.9) age group. A dispatch complaint of an overdose or poisoning was documented in 28.9% (1,797 of 6,215) of activations and was more common among activations involving adolescents aged 13-17 years (31.5%, 1,555 of 4,937) than infants 1 day to <1 year (12.8%, 48 of 375). The first naloxone dose was documented to improve clinical status in 54.1% (3,136 of 5,793) of activations. Naloxone was documented to worsen clinical status in only 0.2% (11 of 5,793) of activations. Conclusions: In pediatric activations involving naloxone, less than one-third were dispatched as an overdose or poisoning but over half were documented to clinically improve after the first dose of naloxone. Naloxone was rarely documented to worsen clinical status. Our findings highlight the safety of prehospital naloxone use, as well as the importance of a high index of suspicion for opioid poisoning in the pediatric population. Opportunities exist to leverage linked data sources to develop interventions to improve prehospital opioid poisoning recognition and management.

INTRODUCTION:Glucagon-like peptide-1 receptor agonists (GLP-1RAs) are a class of medications for management of diabetes and obesity. The objective of this study is to characterize the epidemiology of GLP-1RA cases reported to US poison centers. METHODS:We analyzed cases involving a GLP-1RA reported to the National Poison Data System during 2017-2022. RESULTS:There were 5,713 single-substance exposure cases reported to US poison centers involving a GLP-1RA. Most cases were among females (71.3%) and attributable to therapeutic errors (79.9%). More than one-fifth (22.4%) of cases were evaluated in a healthcare facility, including 0.9% admitted to a critical care unit and 4.1% admitted to a non-critical care unit. Serious medical outcomes were described in 6.2% of cases, including one fatality. The rate of cases per one million US population increased from 1.16 in 2017 to 3.49 in 2021, followed by a rapid increase of 80.9% to 6.32 in 2022. Trends for rates of serious medical outcomes and admissions to a healthcare facility showed similar patterns with 129.9% and 95.8% increases, respectively, from 2021 to 2022. CONCLUSIONS:Most GLP-1RA cases reported to US poison centers were associated with no or minimal effects and did not require referral for medical treatment; however, a notable minority of individuals experienced a serious medical outcome or healthcare facility admission. The rate of reported cases increased during the study period, including an 80.9% increase from 2021 to 2022. Opportunities exist to improve provider and patient awareness of the adverse effects of these medications.

ImportanceMood disorders are prevalent among adolescents and young adults, and their onset often coincides with driving eligibility. The understanding of how mood disorders are associated with youth driving outcomes is limited.ObjectiveTo examine the association between the presence of a mood disorder and rates of licensing, crashes, violations, and suspensions among adolescents and young adults.Design, Setting, and ParticipantsThis cohort study was conducted among New Jersey residents who were born 1987 to 2000, age eligible to acquire a driver’s license from 2004 to 2017, and patients of the Children’s Hospital of Philadelphia network within 2 years of licensure eligibility at age 17 years. The presence of a current (ie, ≤2 years of driving eligibility) mood disorder was identified using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) or International Statistical Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) codes. Rates of licensure and driving outcomes among youths who were licensed were compared among 1879 youths with and 84 294 youths without a current mood disorder from 2004 to 2017. Data were analyzed from June 2022 to July 2023.Main Outcomes and MeasuresAcquisition of a driver’s license and first involvement as a driver in a police-reported crash and rates of other adverse driving outcomes were assessed. Survival analysis was used to estimate adjusted hazard ratios (aHRs) for licensing and driving outcomes. Adjusted rate ratios (aRRs) were estimated for driving outcomes 12 and 48 months after licensure.ResultsAmong 86 173 youths (median [IQR] age at the end of the study, 22.8 [19.7-26.5] years; 42 894 female [49.8%]), there were 1879 youths with and 84 294 youths without a mood disorder. A greater proportion of youths with mood disorders were female (1226 female [65.2%]) compared with those without mood disorders (41 668 female [49.4%]). At 48 months after licensure eligibility, 75.5% (95% CI, 73.3%-77.7%) and 83.8% (95% CI, 83.5%-84.1%) of youths with and without mood disorders, respectively, had acquired a license. Youths with mood disorders were 30% less likely to acquire a license than those without a mood disorder (aHR, 0.70 [95% CI, 0.66-0.74]). Licensed youths with mood disorders had higher overall crash rates than those without mood disorders over the first 48 months of driving (137.8 vs 104.8 crashes per 10 000 driver-months; aRR, 1.19 [95% CI, 1.08-1.31]); licensed youths with mood disorders also had higher rates of moving violations (aRR, 1.25 [95% CI, 1.13-1.38]) and license suspensions (aRR, 1.95 [95% CI, 1.53-2.49]).Conclusions and RelevanceThis study found that youths with mood disorders were less likely to be licensed and had higher rates of adverse driving outcomes than youths without mood disorders. These findings suggest that opportunities may exist to enhance driving mobility in this population and elucidate the mechanisms by which mood disorders are associated with crash risk.

IntroductionSince the passage of the Farm Bill in 2018, the availability of synthetic tetrahydrocannabinols has increased, including delta-8 tetrahydrocannabinol, delta-10 tetrahydrocannabinol, and tetrahydrocannabinol-O acetate. The objective of this study is to investigate the characteristics of delta-8 tetrahydrocannabinol, delta-10 tetrahydrocannabinol, and tetrahydrocannabinol-O acetate exposures reported to United States poison centers from 2021 to 2022.MethodsNational Poison Data System data were analyzed, including year, individual demographics, substance category and type, reason for exposure, highest level of health care received, and medical outcome. United States Census Bureau data were used to calculate population-based rates.ResultsThere were 5,022 reported cases involving delta-8 tetrahydrocannabinol, delta-10 tetrahydrocannabinol, and tetrahydrocannabinol-O acetate as the primary substance reported to United States poison centers from 1 January 2021 to 31 December 2022. The rate of exposure per 100,000 United States population increased by 89.1 percent from 0.55 in 2021 to 1.04 in 2022. Children less than 6 years old accounted for 30.1 percent of cases, with a mode at age 2 years (representing 8.9 percent of cases). Most cases involved delta-8 tetrahydrocannabinol (98.1 percent), were single-substance exposures (94.3 percent), or occurred in a residence (95.9 percent). Ingestions accounted for 94.2 percent of cases, including 95.1 percent among children less than 6 years old. The leading reason for exposure was unintentional-general (40.2 percent), followed by abuse (33.1 percent). The most common related clinical effects were mild central nervous system depression (25.0 percent), tachycardia (23.0 percent), and agitation (15.6 percent). More than one-third (38.4 percent) of cases experienced a serious medical outcome, and 10.3 percent were admitted to a noncritical care unit and 5.3 percent to a critical care unit.Discussion and limitationsThe National Poison Data System is limited by its passive surveillance design. Delta-8 tetrahydrocannabinol, delta-10 tetrahydrocannabinol, and tetrahydrocannabinol-O acetate have toxic effects, and reports to United States poison centers increased from 2021 to 2022. Unintentional ingestions by young children are of particular concern.ConclusionsOpportunities exist to improve regulation, with accompanying enforcement, of these products and to educate the public about their potential toxicity.

This study investigated exposures involving ∆8-tetrahydrocannabinol (∆8-THC) reported to US poison centers (PCs), including variation among states and regions. It evaluated whether the ∆8-THC exposure rate was lower among states with ∆8-THC regulations and states where cannabis (∆9-THC) use was legal. National Poison Data System data for ∆8-THC exposures in 2021–2022 were analyzed, including comparisons of state and regional population-based exposure rates. There were 4,925 exposures involving ∆8-THC as the primary substance reported to US PCs from January 1, 2021, to December 31, 2022, with 69.8

BACKGROUND AND OBJECTIVES:Fatal poisoning is a preventable cause of death among young children. Understanding factors surrounding these deaths will inform future prevention efforts. Our objective was to describe the characteristics of fatal pediatric poisonings using child death review data.METHODS:We acquired data from 40 states participating in the National Fatality Review-Case Reporting System on deaths attributed to poisonings among children aged ≤5 years from 2005 to 2018. We analyzed select demographic, supervisor, death investigation, and substance-related variables using descriptive statistics.RESULTS:During the study period, 731 poisoning-related fatalities were reported by child death reviews to the National Fatality Review-Case Reporting System. Over two-fifths (42.1%, 308 of 731) occurred among infants aged <1 year, and most fatalities (65.1%, 444 of 682) occurred in the child's home. One-sixth of children (97 of 581) had an open child protective services case at time of death. Nearly one-third (32.2%, 203 of 631) of children were supervised by an individual other than the biological parent. Opioids (47.3%, 346 of 731) were the most common substance contributing to death, followed by over-the-counter pain, cold, and allergy medications (14.8%, 108 of 731). Opioids accounted for 24.1% (7 of 29) of the substances contributing to deaths in 2005 compared with 52.2% (24 of 46) in 2018.CONCLUSIONS:Opioids were the most common substances contributing to fatal poisonings among young children. Over-the-counter medications continue to account for pediatric fatalities even after regulatory changes. These data highlight the importance of tailored prevention measures to further reduce fatal child poisonings.

BACKGROUND:Liquid laundry detergent packet exposures modestly declined in the mid-2010s among children less than 6 years of age due to public awareness and voluntary product safety standards. We aimed to assess longitudinal trends in the number and rate of liquid laundry detergent packet exposures in the United States by age. METHODS:Data from the National Poison Data System were analyzed to characterize liquid laundry detergent packet exposures between January 2014 and December 2022. RESULTS:From 2014-2022, there were 114,826 single and polysubstance exposures to liquid laundry detergent packets. Children less than 6 years of age (86.8 percent) were most commonly exposed. When evaluating multi-year trends, we found that the annual exposure rate per 1 million children less than 6 years old increased by 16.8 percent from 392.6 in 2018 to 458.7 in 2020. Subsequently, the annual exposure rate in children less than 6 years of age declined by 6.8 percent from 2020 to 2022 (427.4 exposures per 1 million). The annual rate of adolescent exposures increased by 85.4 percent from 2014 (4.1 exposures per 1 million) to 2017 (7.6 exposures per 1 million), with a subsequent increase of 155.3 percent from 2017 to 2018 (19.4 exposures per 1 million). Among adults, the annual exposure rate increased by 147.1 percent from 2014 (1.7 exposures per 1 million) to 2022 (4.2 exposures per 1 million). The number of more serious medical outcomes and hospital admissions among children less than 6 years of age declined by 44.3 percent and 68.6 percent, respectively, between 2014 and 2018. CONCLUSIONS:Despite declines in the number, rate, and severity of liquid laundry detergent packet exposures among children less than 6 years old, the exposure burden remains high. Additionally, exposures have increased among older children, adolescents, and adults. Renewed safety efforts are warranted to protect prior public health gains and further reduce exposures.

BACKGROUND:Pyogenic granulomas are acquired, benign growths of capillary blood vessels that are commonly seen in the pediatric population. Patients with these lesions often present to emergency departments and urgent care centers with persistent bleeding after minor trauma. Much of the published literature describing the management of pyogenic granulomas, however, is focused on outpatient or definitive therapies, and there is limited information on the management of acute bleeding. OBJECTIVE:We conducted a narrative review to present and evaluate strategies and therapies available to emergency physicians for managing actively bleeding pyogenic granulomas in acute care settings. DISCUSSION:Multiple options are available to emergency physicians to achieve hemostasis. Direct pressure with a nonadherent dressing remains first-line treatment. Additional therapeutic options, such as dressings impregnated with topical vasoconstrictors or hemostatic dressings or agents, can be used if bleeding persists. Certain approaches-silver nitrate, suture ligation, or electrocautery-may be available to some emergency physicians. These therapies, however, can compromise future histologic analysis of tissue for definitive diagnosis and have potential risks. CONCLUSION:Although there are multiple options to achieve hemostasis in cases of bleeding, some treatments may lead to suboptimal cosmesis or interfere with future management. Many bleeding pyogenic granulomas will become hemostatic with treatments available to emergency physicians. Surgical consultation may be warranted for pyogenic granulomas that are unresponsive to the therapies described in this review.

A previously healthy, term, 5-week-old girl initially presented to her primary care physician with a solitary, enlarging scalp nodule. The infant was otherwise well without additional signs or symptoms of illness. Over the next several weeks, the nodule continued to grow, and additional lesions appeared on her scalp. An ultrasound of the primary nodule revealed a hypoechoic structure favored to represent a serosanguinous fluid collection. After evaluation by general surgery and dermatology, she underwent a scalp biopsy of the largest lesion. While biopsy specimen results were pending, her parents noted that she was developing increased irritability, difficulty closing her right eye, and facial weakness. She was referred to the emergency department where a right-sided facial droop involving the brow and forehead was noted. The skin biopsy specimen results, along with subsequent laboratory studies and imaging, led to the final diagnosis.

Background Case studies and small series have demonstrated that beverage ethanol may pose a serious poisoning hazard to infants. Intoxicated infants may not present with the classic signs or symptoms of ethanol poisoning. The objective of this study was to describe the epidemiology of beverage ethanol exposures among infants reported to the United States poison control centers. Methods Data from the National Poison Data System were retrospectively analyzed for infants <12 months of age who were exposed to beverage ethanol from 2009-2018. Results Over the 10-year study period, 1,818 infant exposures to beverage ethanol were reported. Most exposures were single substance (95.2%), and the most common route of exposure was ingestion (n = 1,738). Infants 9-11 months were the most commonly exposed age group subset (45.3%). The annual number and rate of alcoholic beverage exposure increased by 37.5% and 42.9%, respectively, from 2009 to 2018. Of the 563 infants evaluated at a healthcare facility, 38% of exposures were hospitalized. Infants 0-5 months of age had higher odds of being admitted to a non-critical (OR: 2.35, 95% CI: 1.41-3.92) or critical care unit (OR: 2.39; 95% CI: 1.50-3.79) compared to infants 6-11 months of age. Infants 0-5 months of age were more likely to (OR: 4.65; 95% CI: 3.18-6.79) experience a serious outcome compared to infants ages 6-11 months. Five fatalities in infants <6 months old were documented. An in-depth case review identified improper storage and subsequent formula preparation with beverage ethanol as a common exposure mechanism. Conclusions Beverage ethanol exposures among infants are associated with hospitalization, serious clinical effects, and mortality. Infants may present with atypical signs and symptoms of intoxication, requiring a high index of suspicion. Opportunities exist to reduce exposures by addressing improper storage of beverage alcohols.

A primary goal of our medical education system is to produce physicians qualified to promote health, prevent and treat disease, and relieve suffering. Although some aspects of the practice of medicine can be learned in classrooms, from textbooks, or with simulators, other aspects can only be learned through the direct provision of patient care. Residency programs therefore offer essential educational experiences that support residents' acquisition of knowledge, skills, and professional judgment through the assumption of progressive responsibility under an appropriate level of supervision. Yet, ethical questions can arise when medical education is integrated with patient care. How should we balance the educational needs of residents and the social benefits of medical education against obligations to patients and families? In this article, we present the case of a child whose family requests that residents not be allowed to perform any procedures on their child and then ask experts (a pediatric residency program director, a pediatrics resident, and an ethicist) to comment.

The objective of this study was to characterize how pediatric primary care and emergency medicine health care providers and trainees engage in injury prevention counseling and assess perceptions toward injury prevention resources. We surveyed physicians, advanced practice providers, and trainees in the Emergency Department, Primary Care Network, and Pediatric Residency Program at Children’s Hospital of Philadelphia from September to November 2019. Of the 578 eligible participants, 208 (36.0%) completed the survey. When asked to rank the suitability of alternative personnel for providing counseling, 63.0% of the participants selected an injury prevention specialist as best suited. Seventy-six percent of the providers considered a tablet or mobile device used before a patient encounter to be a helpful resource. Variability existed in provider comfort, knowledge, and frequency of counseling by injury topic. Free-text responses cited time as a barrier to counseling. Opportunities exist to improve the provision of injury education through the utilization of novel resources and personnel.

Ethanol intoxication of infants and young children can be a challenging diagnosis in the pediatric emergency department, and features of the poisoning may differ in comparison with adolescents. The sources of ethanol exposures in this age are varied and include unintentional, malicious, and iatrogenic etiologies. Young children exposed to ethanol often present with mixed clinical signs and symptoms that may not fit the traditional ethanol or sedative-hypnotic toxidrome. Pediatric ethanol intoxications are often managed supportively, and recovery is usually rapid. The purpose of this review is to describe the sources of ethanol poisoning among children 6 years and younger, highlight presenting symptoms and pharmacokinetic considerations unique to this age group, and review management strategies. In addition, published cases of ethanol poisoning due to ingestion among young infants are compiled for presentation.

OBJECTIVES:To investigate exposures to liquid laundry detergent packets among children <6 years old in the United States and to evaluate the impact of the American Society for Testing and Materials voluntary product safety standard.METHODS:Data from the National Poison Data System involving exposures to liquid laundry detergent packets from 2012 to 2017 were analyzed.RESULTS:From January 2012 to December 2017, there were 72 947 single and polysubstance exposures to liquid laundry detergent packets. Most exposures (91.7%) were documented among children <6 years old. The annual number and rate of exposures for children <6 years old increased by 110.4% and 111.9%, respectively, from 2012 to 2015. From 2015 to 2017, the number and rate of exposures in this age group decreased by 18.0%. Among individuals ≥6 years old, the annual number and rate of exposures increased by 292.7% and 276.7%, respectively, from 2012 to 2017. Annual hospital admissions among children <6 years old increased by 63.4% from 2012 to 2015 and declined by 55.5% from 2015 to 2017. Serious outcomes among children <6 years old increased by 78.5% from 2012 to 2015 and declined by 32.9% from 2015 to 2017.CONCLUSIONS:The number, rate, and severity of liquid laundry detergent packet exposures have decreased modestly in recent years among children <6 years old, likely attributable, in part, to the voluntary product safety standard and public awareness efforts. Exposures among older children and adults are increasing. Opportunities exist to strengthen the current product safety standard to further reduce exposures.