Sally Weale: Children and the risk of accidental poisoning

Watching ER is frequently a harrowing experience, but among the most traumatic storylines in recent hospital TV drama must be the accidental poisoning of Dr Mark Green's baby daughter who swallowed ecstasy tablets brought into the home by his elder daughter Rachel. Last weekend, actors Sadie Frost and Jude Law endured their own real-life drama when their two-year-old daughter Iris found an ecstasy tablet on the floor at a children's party at Soho House, a private club in London's West End.

She was rushed to hospital on Saturday afternoon after her mother spotted the tablet in her mouth and managed to remove part of it before it was ingested. Iris had her stomach pumped and was given a brain scan, but was released from hospital the following day.

Anyone who has ever had a baby knows that up to a certain age they will put everything and anything in their mouth. The vast majority of rubbish that makes its way into their small intestine - whether it be a garden snail, or food remains that have been under the sofa since 1996 - will cause nothing more serious than an upset stomach. But every year, more than 30,000 children under the age of five go to hospital as a result of suspected accidental poisoning. Many cases will be false alarms, and the vast majority will not be serious, but a small number are fatal.

Over the past couple of years there has been a rash of reported cases of children as young as 19 months old being taken to hospital after swallowing ecstasy tablets in the mistaken belief that they were sweets. In July this year Jade Slack, aged 10, of Galgate, Lancaster, became the youngest person to die after taking the drug.

According to Alison Jones, consultant toxicologist with the National Poisons Information Service, there can be a wide variation in small children's responses to ecstasy. They can get very hot, which can lead to hyperthermic injuries to the liver, which means the liver almost cooks - some ecstasy casualties have had to have transplants as a result. The increase in body temperature can lead to muscle damage, which in turn can lead to kidney failure; and there can be haemorrhages and swelling to the brain, which is why Iris Law would have had an MRI scan. It can also result in rhythm disturbances to the heart and heatstroke.

But it is the cumulative effects of the drug being taken regularly, as it is in dance culture, that particularly concern the medical profession. Remarkably, says Jones, children accidentally swallowing one or two tablets may "tolerate it slightly better" than an adult taking the drug at a rave where they will get hot and may not drink enough fluids.

"A child [who had taken an ecstasy tablet] would feel potentially quite panicky, they might feel a racing in the heart, and they might feel a bit spacey - just not normal. If you get over the immediate effects, you are unlikely to suffer long-term injuries from taking one tablet," he says.

"We live in a world where loads of people have regular access to drugs," says Harry Shapiro of the drug information charity DrugScope. "The main issue that people have got to get their heads round is that in the same way they would do everything they could to stop their child getting hold of bleach, or playing with plugs, they have to take the same kind of care when it comes to all sorts of drugs.

"Most of the illicit drugs," he adds, "are powders, like heroin, cocaine and amphetamines, rather than pills, which makes it less likely that a child might swallow them."

Less likely, but not unheard of. In 1999 a three-year-old girl was taken to hospital in Newcastle upon Tyne after she swallowed cocaine which she thought was sherbert. She found the drug in a Tupperware container in a fridge in the back garden of her home, but fortunately did not suffer any serious side effects.

While illegal recreational drugs may make the headlines, scores of children end up in hospital after accidentally swallowing everything from prescription drugs to vitamin pills and household products - which can be even more dangerous. One of the biggest causes for concern at the moment is methadone, which is prescribed to heroin addicts. "Because it's brightly coloured, greeny-blue, and it tastes quite sweet, little ones are drawn to it," says Jones. Some parents even put it in their baby's bottle thinking it will help them sleep, but a child can overdose and some have died.

Other children have died after taking tricyclic anti-depressants, which are often attractive, brightly coloured tablets that look like sweets, but cause potentially fatal fits and cardiac arrest. "Even one or two tablets in a child under five could potentially kill," says Jones.

Iron tablets can also be particularly dangerous for children. In 1995 a two-year-old girl died after eating 80 of her mother's iron tablets thinking that they were sweets. Iron absorbed in large amounts damages the kidneys, liver, heart and brain. A post-mortem revealed that her blood contained nearly three times the fatal dose of iron. Mouthwash, similarly, is brightly coloured and tastes sweet, but contains alcohol and if a child swallows it can result in hypoglycaemia or glucose abnormalities, which can result in coma.

Many cases of suspected poisoning involve household products - kitchen cleaner or washing up liquid - which don't tend to be too serious. "Household products are getting pretty safe," says Jones; though there are exceptions. Dishwasher tablets leave corrosive burns in the mouth and throat. Other children have tragically died after drinking white spirits and sulphuric acid.

But the vast majority of inquiries to the NPIS involve nothing so horrifying, says Pat McElhatton, who specialises in the effects of drugs during pregnancy. Crayons, lipsticks, face creams, baby wipes, talcum powder and contraceptive pills seem to be common toddler and baby food, which alarms parents, but is unlikely to cause any serious injury. (In the majority of children, if they are fit and healthy, the Pill apparently does not cause a problem.)

Paracetamol, which is potentially dangerous for an adult if more than the stated dose is taken, interestingly does not have the same toxic effects on a child. But aspirin, anti-epileptic drugs, quinine, camphor and caustic soda can be very serious, depending on the quantity taken and on the weight and health of the child. "The majority of poisonings in children are relatively mild," says McElhatton. "We get very few fatalities."

Cold comfort to those whose children have died as a result of poisoning. In many cases a parent will have no control of the risk to their child, as in the case of Iris Law, whose parents could not have foreseen the danger. But in the home it is better to be safe than sorry, says Roger Vincent of the Royal Society for the Prevention of Accidents. "The key piece of advice we give is that any potentially dangerous substance needs to be kept well out of the reach of children or locked away. If people leave things around, whether it's matches or cleaning fluids, or chemicals for painting and decorating, there's always the potential for a child to do themselves harm."

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