Pediatric toxicology

Abstract

The preponderance of reported exposures to potentially toxic substances each year occurs in children. While many of these exposures are presumed accidental in nature, it is sometimes difficult to discern the cause and intent of a given event. Statistical evaluations generally demonstrate a low homicidal poisoning risk for children; however, such evaluations may not be complete in respect to investigation. Purposeful childhood poisoning is not a new phenomenon, with a number of significant historical events reported; in fact, at one time such acts may have been an accepted practice. The outcomes of accidental and deliberate poisoning in children may be distinct from that of adults based on a number of variables, including toxicokinetic and toxicodynamic differences. Many of these differences are developmentally based; for example, liver-enzyme biotransformation capabilities may be significantly different in young children compared to adults; additionally, blood-brain barrier development is not complete at birth. In general, the younger the child, the greater the likelihood of observable differences. With reference to postmortem forensic toxicological issues, every unexpected or unexplained child death should be presumed to be toxicological in nature. Of importance are a thorough scene examination, a complete autopsy to include unique sampling of fluids and tissues, and a toxicological examination that hones in on particular concerns for the pediatric population.