By Dr. Tanaz Farzan Danialifar

What is a caustic ingestion?

Caustic substances are those that are capable of burning or eroding tissue by chemical effects. They can be either strongly acidic or strongly alkaline and they are in all of our homes. Common examples are household cleaning products (such as bleach, oven cleaner, and toilet bowl cleaner), laundry detergent, swimming pool products, cosmetic products like hair relaxer, and drain opener. When ingested these substances can cause injury to any part of the gastrointestinal tract including the mouth, throat, esophagus (food pipe), and the stomach as well as parts of the airway due to accidental inhalation.

What can happen after a caustic ingestion?

The type and severity of injury depends on the type, strength, and quantity of substance ingested. Generally, alkaline agents cause more severe injury, especially in the esophagus. Liquid cleaning products are generally less concentrated and due to bad taste children take smaller amounts. Concentrated and single use products like laundry “pods” are much more likely to cause severe injury. The effects can be immediate but in some situations delayed effects will be seen. In the gastrointestinal tract injury this can include mild burns, deeper burns resulting in scarring and long-term narrowing of the esophagus, and even perforations (tears) of the stomach or esophagus. Children with injury to the gastrointestinal tract will often experience pain or difficulty swallowing which can look like refusal to eat, drooling, or just fussiness. Some children may complain of chest or stomach pain, experience vomiting, or fevers.

How commonly do caustic ingestions and their complications happen?

In 2016 over 2 million accidental ingestions were reported by the American Association of Poison Control Centers. About 45% of these were in children under the age of 5 and more than half of those were children 2 and under. The most common ingestions were cosmetic/personal care products followed by household cleaning substances. In children 18-46% of ingestions may result in esophageal burns and injury. Stomach injury is less common.

What do I do if my child ingests a caustic substance?

Evaluation and management of caustic ingestion depends on the type and amount of substance ingested and the degree of symptoms the child is experiencing. If you suspect or know your child has ingested a substance that may be caustic first make sure the child has no problems breathing, if present seek immediate medical attention. If possible identify the exact type and brand of substance. Either keep the bottle or take a picture of the labels.

You can call Poison Control Centers of America (1-800-222-1222) 24 hours a day with this information and they will guide you on next steps. Medical evaluation may include a physical examination, x-ray imaging, and urgent endoscopy (camera evaluation of the inner lining of the intestinal tract). It is NOT recommend to induce vomiting after an ingestion as this will cause repeated contact of the caustic substance with delicate tissue.

  • How do I prevent caustic ingestions?
    At this point you may be panicking about all of the toxic products sitting in your home just waiting for your toddler to start playing with. Don’t worry; you don’t need to throw away every cleaning and cosmetic product. But there are some simple steps you can take to keep your children safe.
  • Keep all products in their original bottles/packaging. As discussed knowing the exact type of product is critical in determining the next steps. You can avoid unnecessary medical evaluation due to unknown ingestions
  • Keep all products in locked and if possible high cabinets. A home with young children can be difficult to navigate when full of childproofing. Consider putting locks on those cabinets with potentially harmful products. If locks are not a possibility keep potentially harmful products on the highest shelf.
  • Avoid purchasing gel packs, capsules, or pods. This type of single-use packaging contains the most concentrated forms of caustic products and the most likely to result in injury. Often due to the thicker consistency the can sit on tissues longer to cause more severe injury
  • Use child safety settings. Using products with child-proof lids or spray bottles with off position make it less likely that your child will actually ingest a substance they accidentally come in contact with.
  • Don’t leave children unattended around products. Ingestions can happen within just a few seconds. While it may not be possible to keep your children away when cleaning or working in the garage, don’t leave them unattended for even short periods of time. If you need to step away take either the products or the child with you.

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Tanaz Farzan Danialifar, MD is a board certified pediatric gastroenterologist practicing in Los Angeles, CA. She is the Medical Director of the Neurogastroenterology and Motility Program and Children’s Hospital Los Angeles and Assistant Professor of Pediatrics at Keck School of Medicine of USC. https://www.chla.org/profile/tanaz-farzan-danialifar-md

References
David D. Gummin, James B. Mowry, Daniel A. Spyker, Daniel E. Brooks, Michael O. Fraser & William Banner (2017) 2016 Annual Report of the American Association of Poison Control Centers’ National Poison Data System (NPDS): 34th Annual Report, Clinical Toxicology, 55:10, 1072-1254

Fishman, D (2018). Caustic esophageal injury in children. In AG Hooin (Ed.) UpToDate. Retrieved June 4, 2018 from https://www.uptodate.com/contents/caustic-esophageal-injury-in-children#H1.

Byrne WJ. Foreign bodies, bezoars, and caustic ingestion. Gastrointest Endosc Clin N Am 1994; 4:99.

Wasserman RL, Ginsburg CM. Caustic substance injuries. J Pediatr 1985; 107:169.

Nuutinen M, Uhari M, Karvali T, Kouvalainen K. Consequences of caustic ingestions in children. Acta Paediatr 1994; 83:1200.

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