Pediatric IngestionAPPROACH

TOXICOLOGY AND BEHAVIORAL · 19 SECTIONS

⚲

415 items

☷ Legend

⚲

Resuscitation and Universal Approaches9▾

Chest and Cardiovascular12▾

Respiratory11▾

Abdominal and Gastrointestinal24▾

Renal and Urinary7▾

Neurologic11▾

Back and Neck8▾

Women's Health, Pregnancy, and GU11▾

Infectious Disease and Fever Syndromes11▾

Allergy and Dermatology7▾

Musculoskeletal and Extremities14▾

Trauma and Wounds14▾

ENT, Eye, Dental10▾

Endocrine, Metabolic, and Abnormal Labs9▾

Toxicology and Behavioral14▾

Undifferentiated Overdose Opioid Toxicity Opioid Withdrawal Alcohol Intoxication Alcohol Withdrawal Stimulant Toxicity Pediatric Ingestion Carbon Monoxide Exposure Inhalational Or Chemical Exposure Suicidal Ideation And Self Harm Risk Assessment Acute Psychosis And Mania Symptoms Anxiety And Panic Symptoms Capacity Assessment And Safe Disposition Behavioral Escalation And Restraint Considerations

Pediatrics16▾

Environmental and Exposure4▾

01History/hx37

Exposure details

›Ingestion narrative

›Substance identification

›Product name

›Active ingredient concentration

›Amount estimate

›Maximum possible amount

›Witnessed amount

›Time course

›Time of exposure

›Time of symptom onset

›Context

›Exploratory toddler ingestion

›Therapeutic error

›Intentional self harm concern in adolescent

Symptoms and trajectory

›Current symptoms

›Gastrointestinal

›Vomiting

›Abdominal pain

›Neurologic

›Somnolence

›Seizure

›Respiratory

›Coughing or choking episode

›Dyspnea

›Cardiovascular

›Palpitations

02Alarm Features/alarm27

Immediate resuscitation triggers

›High risk presentation

›Airway compromise

›Respiratory depression

›Hypoxia

›Shock

›Recurrent or ongoing seizure

›Severe agitation or delirium

High risk ingestion types

›Cannot miss exposures

›Button battery ingestion

›Magnet ingestion

›Caustic ingestion

›Hydrocarbon aspiration risk

›Sustained release or extended release drug

›Unknown opioid exposure

Vital sign danger thresholds

›Unstable physiology

›Age inappropriate hypotension

›Persistent tachycardia with poor perfusion

›Bradycardia with poor perfusion

›Hyperthermia

›Hypothermia

High risk exam findings

›Concerning exam

›Stridor

›Drooling

›Oropharyngeal burns

03Medications/meds19

Home and recent exposures

›Medication list

›Prescribed medications in the home

›OTC medications in the home

›Supplements and herbals

›Recent new prescriptions

High risk pediatric toxins

›Common high risk agents

›Acetaminophen

›Salicylates

›Opioids

›Clonidine

›Calcium channel blockers

›Beta blockers

›Sulfonylureas

›Tricyclic antidepressants

›Iron

Antidote relevant meds and interactions

›Contraindications and interaction traps

›Naloxone precipitated withdrawal risk in chronic opioid user

›Flumazenil seizure risk with chronic benzodiazepine use

›Flumazenil seizure risk with coingested proconvulsants

04Diet/diet8

Recent intake and fasting

›Nutritional status

›Time since last meal

›Prolonged vomiting

›Poor oral intake

Hypoglycemia risk context

›Glycemic vulnerability

›Infants and toddlers low glycogen reserve

›Diabetes medications exposure

›Sepsis like presentation

05Review of Systems/ros18

Toxidrome directed symptoms

›System review for toxidromes

›Anticholinergic

›Dry skin

›Urinary retention

›Cholinergic

›Diaphoresis

›Bronchorrhea

›Opioid

›Somnolence

›Hypoventilation

›Sympathomimetic

›Agitation

›Hyperthermia

Injury and complications

›Complication screen

›Aspiration symptoms

›Chest pain

›Hematemesis

›Severe headache

06Collateral History and Family History/chafh11

Source and reliability

›Collateral

›Witness identity

›Time since last seen well

›Medication inventory reliability

Family and household risk

›Household context

›Other children with access

›Recent caregiver medication changes

›Substance use in home

Relevant family history

›Predisposing conditions

›Long QT syndrome (I45.81)

›Seizure disorder (G40.909)

07Risk Factors/rf12

Patient specific vulnerability

›Higher risk physiology

›Infant age

›Low body mass

›Developmental delay with pica

Exposure circumstances

›Increased exposure risk

›Unlabeled containers

›Medication organizer access

›Transdermal patches accessible

Clinical risk domains

›High risk patterns

›Sustained release ingestion

›Polypharmacy household

›Language barrier affecting history reliability

08Differential Diagnosis/ddx52

Life threatening

›Life threatening causes

›Opioid toxicity (T40.2X1A)

›Miosis

›Hypoventilation

›Calcium channel blocker toxicity (T46.1X1A)

›Bradycardia

›Hyperglycemia

›Tricyclic antidepressant toxicity (T43.011A)

›Wide QRS

›Seizure

›Sulfonylurea exposure (T38.3X1A)

›Hypoglycemia

›Recurrent hypoglycemia

›Caustic ingestion (T54.3X1A)

›Drooling

›Stridor

›Button battery ingestion (T18.9XXA)

›Chest discomfort

›Drooling

Common

›Common causes

›Acetaminophen ingestion (T39.1X1A)

›Often asymptomatic early

›Delayed hepatic injury

›Cannabis edible exposure (T40.7X1A)

›Somnolence

›Ataxia

09Past Medical History/pmh13

Baseline status and comorbidities

›Relevant conditions

›Chronic lung disease

›Congenital heart disease

›Liver disease

›Renal disease

Prior events

›Prior similar episodes

›Previous ingestions

›Prior ICU admission

›Prior naloxone administration

Devices and procedures

›Devices

›Feeding tube

›Tracheostomy

›Ventricular shunt

10Physical Exam/exam34

Initial survey and toxidromes

›Primary survey and toxicity

›Airway patency

›Work of breathing

›Circulation and perfusion

›Mental status trend

Vitals interpretation

›Pattern recognition

›Bradycardia pattern

›Calcium channel blocker

›Beta blocker

›Tachycardia pattern

›Sympathomimetic

›Anticholinergic

›Temperature pattern

›Hyperthermia with rigidity

›Hypothermia with CNS depression

Focused system exam

›Key findings

›Pupils

›Miosis

›Mydriasis

›Skin

›Diaphoresis

›Dry skin

›Oral and airway

›Drooling

›Oropharyngeal burns

11Lab Studies/labs32

Core studies

›Baseline evaluation

›Point of care glucose

›VBG or ABG

›Electrolytes

›BUN and creatinine

›AST and ALT

Toxin specific labs

›High value levels

›Acetaminophen level

›Earliest reliable time 4 hours after ingestion

›Use with Rumack Matthew nomogram for single acute ingestion

›Salicylate level

›Serial levels for rising pattern

›Acid base status guides severity

›Ethanol level

›Hypoglycemia correlation

›Coingestion screen trigger

›Iron studies

›Serum iron peak 2 to 6 hours after ingestion

›Anion gap acidosis suggests severe poisoning

Interpretation thresholds

›Metabolic patterns

›Anion gap metabolic acidosis

›Toxic alcohols

›Salicylates

›Hyperglycemia

›Calcium channel blocker toxicity

12Imaging/img16

Scoring Systems

›Risk tools and nomograms

›Rumack Matthew nomogram

›Single acute acetaminophen ingestion

›Not valid for chronic supratherapeutic ingestion

›Anion gap and osmolar gap framework

›Osmolar gap elevated early in toxic alcohol exposure

›Anion gap rises with metabolism to acids

MRI

›MRI scenarios

›Neurologic injury concern after prolonged hypoxia

›Alternate diagnosis when ingestion uncertain

›CT scenarios

›CT head for persistent altered mental status with trauma concern

›CT chest for severe caustic complication concern local protocol dependent

Ultrasound

›POCUS adjuncts

›Lung ultrasound for aspiration pneumonitis

›IVC assessment for shock physiology adjunct only

13Special Tests/spec11

Bedside and procedural diagnostics

›Targeted diagnostics

›Pulse oximetry and capnography

›Capnography for hypoventilation detection

›Continuous monitoring during sedation risk

›Serial neurologic checks

›Trend mental status

›Detect recurrent sedation after naloxone

Radiography for foreign body ingestion

›X ray evaluation

›Button battery localization neck to pelvis

›Magnet ingestion localization

›Radiopaque drug packets rare pediatric scenario

14ECG/ecg16

Indications and high risk patterns

›ECG indications

›Unknown ingestion

›Any dysrhythmia

›Tricyclic antidepressant concern

›Calcium channel blocker concern

›Beta blocker concern

›ECG red flags

›QRS widening

›Sodium channel blockade pattern

›Seizure risk marker

›QT prolongation

›Torsades risk

›Electrolyte correction priority

›Bradycardia with AV block

›Calcium channel blocker toxicity

›Beta blocker toxicity

15Assessment/ax16

Problem representation

›Ingestion assessment

›Known agent ingestion

›Unknown agent ingestion

›Suspected toxidrome

Severity stratification

›Risk level

›Asymptomatic with reliable history and low risk agent

›Symptomatic or abnormal vitals

›High risk ingestion type

Key complications to exclude

›Immediate threats

›Airway compromise

›Hypoglycemia

›Dysrhythmia

›Seizure

Diagnostic uncertainty

›Alternate diagnoses

›Sepsis differential

›Head injury differential

16Plan/plan58

Differential Management

›!Acetaminophen toxicity→›!Caustic ingestion→›Foreign body ingestion→

First 5 minutes

›Immediate stabilization workflow

›Cardiorespiratory monitoring

›IV access criteria

›Symptomatic ingestion

›High risk agent ingestion

›Glucose check without delay

›Capnography for any CNS depression

Decontamination decision logic

›Decontamination options

›Activated charcoal

›Time window typically within 1 to 2 hours for many agents

›Consider later for sustained release agents with toxicology guidance

›Contraindications to activated charcoal

›Unprotected airway

›Caustic ingestion

›Hydrocarbon ingestion with aspiration risk

›Whole bowel irrigation

›Sustained release ingestion large burden with toxicology guidance

›Iron ingestion with radiopaque tablets and toxicity concern

Antidotes and targeted therapy

›Antidote protocols

›Naloxone for suspected opioid toxicity

›0.1 mg/kg IV or IN

17Disposition/dispo20

Level of care criteria

›ICU indications

›Recurrent seizures

›Persistent respiratory depression

›Shock requiring vasoactive support

›Dysrhythmia

›Inpatient admission indications

›Need for serial antidote therapy

›Rising toxin level trend

›Suspected caustic injury with symptoms

›Observation pathway

›Asymptomatic but high risk agent with delayed toxicity potential

›Post naloxone monitoring for recurrent opioid toxicity

›Discharge criteria

›Normal vitals for age over appropriate observation period

›Normal mental status at baseline

›No evolving symptoms

›Reliable caregiver and safe environment

Timing considerations

›Delayed toxicity windows

›Extended release drug observation longer with toxicology guidance

›Acetaminophen timing dictates level interpretation

18Discharge Instructions/di8

Copy discharge instructions

›Home plan

›Your child was evaluated for a possible ingestion

›Today the exam and monitoring were reassuring based on the substance and timing

›Keep all medications and chemicals locked and out of reach

›Do not give new medicines unless instructed

›Return now for trouble breathing, unusual sleepiness, seizures, repeated vomiting, chest pain, fainting, new confusion, or if you are worried

›Follow up with your primary care clinician within 1 to 2 days

›Poison control contact local protocol dependent

19References/r7

Guidelines and key resources

›Reference set

›American Academy of Pediatrics policy statements on prevention of poisoning and injury prevention most recent update local protocol dependent

›American Academy of Clinical Toxicology and European Association of Poisons Centres and Clinical Toxicologists position statements on gastrointestinal decontamination activated charcoal 1997 with updates and subsequent statements

›ACMT practice recommendations on acetaminophen poisoning and N acetylcysteine use updated statements and position papers local protocol dependent

›National Capital Poison Center button battery ingestion guideline and management recommendations most recent update local protocol dependent

›NASPGHAN magnet ingestion management guidance most recent update local protocol dependent

›Goldfrank’s Toxicologic Emergencies latest edition reference text local protocol dependent

Evidence & Review

Reviewed by SymptomDx Medical Team · Last reviewed February 24, 2026

SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.

Pediatric IngestionAPPROACH

TOXICOLOGY AND BEHAVIORAL · 19 SECTIONS

⚲

415 items

☷ Legend

⚲

Resuscitation and Universal Approaches9▾

Chest and Cardiovascular12▾

Respiratory11▾

Abdominal and Gastrointestinal24▾

Renal and Urinary7▾

Neurologic11▾

Back and Neck8▾

Women's Health, Pregnancy, and GU11▾

Infectious Disease and Fever Syndromes11▾

Allergy and Dermatology7▾

Musculoskeletal and Extremities14▾

Trauma and Wounds14▾

ENT, Eye, Dental10▾

Endocrine, Metabolic, and Abnormal Labs9▾

Toxicology and Behavioral14▾

Pediatrics16▾

Environmental and Exposure4▾

01History/hx37

Exposure details

›Ingestion narrative

›Substance identification

›Product name

›Active ingredient concentration

›Amount estimate

›Maximum possible amount

›Witnessed amount

›Time course

›Time of exposure

›Time of symptom onset

›Context

›Exploratory toddler ingestion

›Therapeutic error

›Intentional self harm concern in adolescent

Symptoms and trajectory

›Current symptoms

›Gastrointestinal

›Vomiting

›Abdominal pain

›Neurologic

›Somnolence

›Seizure

›Respiratory

›Coughing or choking episode

›Dyspnea

›Cardiovascular

›Palpitations

02Alarm Features/alarm27

Immediate resuscitation triggers

›High risk presentation

›Airway compromise

›Respiratory depression

›Hypoxia

›Shock

›Recurrent or ongoing seizure

›Severe agitation or delirium

High risk ingestion types

›Cannot miss exposures

›Button battery ingestion

›Magnet ingestion

›Caustic ingestion

›Hydrocarbon aspiration risk

›Sustained release or extended release drug

›Unknown opioid exposure

Vital sign danger thresholds

›Unstable physiology

›Age inappropriate hypotension

›Persistent tachycardia with poor perfusion

›Bradycardia with poor perfusion

›Hyperthermia

›Hypothermia

High risk exam findings

›Concerning exam

›Stridor

›Drooling

›Oropharyngeal burns

03Medications/meds19

Home and recent exposures

›Medication list

›Prescribed medications in the home

›OTC medications in the home

›Supplements and herbals

›Recent new prescriptions

High risk pediatric toxins

›Common high risk agents

›Acetaminophen

›Salicylates

›Opioids

›Clonidine

›Calcium channel blockers

›Beta blockers

›Sulfonylureas

›Tricyclic antidepressants

›Iron

Antidote relevant meds and interactions

›Contraindications and interaction traps

›Naloxone precipitated withdrawal risk in chronic opioid user

›Flumazenil seizure risk with chronic benzodiazepine use

›Flumazenil seizure risk with coingested proconvulsants

04Diet/diet8

Recent intake and fasting

›Nutritional status

›Time since last meal

›Prolonged vomiting

›Poor oral intake

Hypoglycemia risk context

›Glycemic vulnerability

›Infants and toddlers low glycogen reserve

›Diabetes medications exposure

›Sepsis like presentation

05Review of Systems/ros18

Toxidrome directed symptoms

›System review for toxidromes

›Anticholinergic

›Dry skin

›Urinary retention

›Cholinergic

›Diaphoresis

›Bronchorrhea

›Opioid

›Somnolence

›Hypoventilation

›Sympathomimetic

›Agitation

›Hyperthermia

Injury and complications

›Complication screen

›Aspiration symptoms

›Chest pain

›Hematemesis

›Severe headache

06Collateral History and Family History/chafh11

Source and reliability

›Collateral

›Witness identity

›Time since last seen well

›Medication inventory reliability

Family and household risk

›Household context

›Other children with access

›Recent caregiver medication changes

›Substance use in home

Relevant family history

›Predisposing conditions

›Long QT syndrome (I45.81)

›Seizure disorder (G40.909)

07Risk Factors/rf12

Patient specific vulnerability

›Higher risk physiology

›Infant age

›Low body mass

›Developmental delay with pica

Exposure circumstances

›Increased exposure risk

›Unlabeled containers

›Medication organizer access

›Transdermal patches accessible

Clinical risk domains

›High risk patterns

›Sustained release ingestion

›Polypharmacy household

›Language barrier affecting history reliability

08Differential Diagnosis/ddx52

Life threatening

›Life threatening causes

›Opioid toxicity (T40.2X1A)

›Miosis

›Hypoventilation

›Calcium channel blocker toxicity (T46.1X1A)

›Bradycardia

›Hyperglycemia

›Tricyclic antidepressant toxicity (T43.011A)

›Wide QRS

›Seizure

›Sulfonylurea exposure (T38.3X1A)

›Hypoglycemia

›Recurrent hypoglycemia

›Caustic ingestion (T54.3X1A)

›Drooling

›Stridor

›Button battery ingestion (T18.9XXA)

›Chest discomfort

›Drooling

Common

›Common causes

›Acetaminophen ingestion (T39.1X1A)

›Often asymptomatic early

›Delayed hepatic injury

›Cannabis edible exposure (T40.7X1A)

›Somnolence

›Ataxia

09Past Medical History/pmh13

Baseline status and comorbidities

›Relevant conditions

›Chronic lung disease

›Congenital heart disease

›Liver disease

›Renal disease

Prior events

›Prior similar episodes

›Previous ingestions

›Prior ICU admission

›Prior naloxone administration

Devices and procedures

›Devices

›Feeding tube

›Tracheostomy

›Ventricular shunt

10Physical Exam/exam34

Initial survey and toxidromes

›Primary survey and toxicity

›Airway patency

›Work of breathing

›Circulation and perfusion

›Mental status trend

Vitals interpretation

›Pattern recognition

›Bradycardia pattern

›Calcium channel blocker

›Beta blocker

›Tachycardia pattern

›Sympathomimetic

›Anticholinergic

›Temperature pattern

›Hyperthermia with rigidity

›Hypothermia with CNS depression

Focused system exam

›Key findings

›Pupils

›Miosis

›Mydriasis

›Skin

›Diaphoresis

›Dry skin

›Oral and airway

›Drooling

›Oropharyngeal burns

11Lab Studies/labs32

Core studies

›Baseline evaluation

›Point of care glucose

›VBG or ABG

›Electrolytes

›BUN and creatinine

›AST and ALT

Toxin specific labs

›High value levels

›Acetaminophen level

›Earliest reliable time 4 hours after ingestion

›Use with Rumack Matthew nomogram for single acute ingestion

›Salicylate level

›Serial levels for rising pattern

›Acid base status guides severity

›Ethanol level

›Hypoglycemia correlation

›Coingestion screen trigger

›Iron studies

›Serum iron peak 2 to 6 hours after ingestion

›Anion gap acidosis suggests severe poisoning

Interpretation thresholds

›Metabolic patterns

›Anion gap metabolic acidosis

›Toxic alcohols

›Salicylates

›Hyperglycemia

›Calcium channel blocker toxicity

12Imaging/img16

Scoring Systems

›Risk tools and nomograms

›Rumack Matthew nomogram

›Single acute acetaminophen ingestion

›Not valid for chronic supratherapeutic ingestion

›Anion gap and osmolar gap framework

›Osmolar gap elevated early in toxic alcohol exposure

›Anion gap rises with metabolism to acids

MRI

›MRI scenarios

›Neurologic injury concern after prolonged hypoxia

›Alternate diagnosis when ingestion uncertain

›CT scenarios

›CT head for persistent altered mental status with trauma concern

›CT chest for severe caustic complication concern local protocol dependent

Ultrasound

›POCUS adjuncts

›Lung ultrasound for aspiration pneumonitis

›IVC assessment for shock physiology adjunct only

13Special Tests/spec11

Bedside and procedural diagnostics

›Targeted diagnostics

›Pulse oximetry and capnography

›Capnography for hypoventilation detection

›Continuous monitoring during sedation risk

›Serial neurologic checks

›Trend mental status

›Detect recurrent sedation after naloxone

Radiography for foreign body ingestion

›X ray evaluation

›Button battery localization neck to pelvis

›Magnet ingestion localization

›Radiopaque drug packets rare pediatric scenario

14ECG/ecg16

Indications and high risk patterns

›ECG indications

›Unknown ingestion

›Any dysrhythmia

›Tricyclic antidepressant concern

›Calcium channel blocker concern

›Beta blocker concern

›ECG red flags

›QRS widening

›Sodium channel blockade pattern

›Seizure risk marker

›QT prolongation

›Torsades risk

›Electrolyte correction priority

›Bradycardia with AV block

›Calcium channel blocker toxicity

›Beta blocker toxicity

15Assessment/ax16

Problem representation

›Ingestion assessment

›Known agent ingestion

›Unknown agent ingestion

›Suspected toxidrome

Severity stratification

›Risk level

›Asymptomatic with reliable history and low risk agent

›Symptomatic or abnormal vitals

›High risk ingestion type

Key complications to exclude

›Immediate threats

›Airway compromise

›Hypoglycemia

›Dysrhythmia

›Seizure

Diagnostic uncertainty

›Alternate diagnoses

›Sepsis differential

›Head injury differential

16Plan/plan58

Differential Management

›!Acetaminophen toxicity→›!Caustic ingestion→›Foreign body ingestion→

First 5 minutes

›Immediate stabilization workflow

›Cardiorespiratory monitoring

›IV access criteria

›Symptomatic ingestion

›High risk agent ingestion

›Glucose check without delay

›Capnography for any CNS depression

Decontamination decision logic

›Decontamination options

›Activated charcoal

›Time window typically within 1 to 2 hours for many agents

›Consider later for sustained release agents with toxicology guidance

›Contraindications to activated charcoal

›Unprotected airway

›Caustic ingestion

›Hydrocarbon ingestion with aspiration risk

›Whole bowel irrigation

›Sustained release ingestion large burden with toxicology guidance

›Iron ingestion with radiopaque tablets and toxicity concern

Antidotes and targeted therapy

›Antidote protocols

›Naloxone for suspected opioid toxicity

›0.1 mg/kg IV or IN

17Disposition/dispo20

Level of care criteria

›ICU indications

›Recurrent seizures

›Persistent respiratory depression

›Shock requiring vasoactive support

›Dysrhythmia

›Inpatient admission indications

›Need for serial antidote therapy

›Rising toxin level trend

›Suspected caustic injury with symptoms

›Observation pathway

›Asymptomatic but high risk agent with delayed toxicity potential

›Post naloxone monitoring for recurrent opioid toxicity

›Discharge criteria

›Normal vitals for age over appropriate observation period

›Normal mental status at baseline

›No evolving symptoms

›Reliable caregiver and safe environment

Timing considerations

›Delayed toxicity windows

›Extended release drug observation longer with toxicology guidance

›Acetaminophen timing dictates level interpretation

18Discharge Instructions/di8

Copy discharge instructions

›Home plan

›Your child was evaluated for a possible ingestion

›Today the exam and monitoring were reassuring based on the substance and timing

›Keep all medications and chemicals locked and out of reach

›Do not give new medicines unless instructed

›Return now for trouble breathing, unusual sleepiness, seizures, repeated vomiting, chest pain, fainting, new confusion, or if you are worried

›Follow up with your primary care clinician within 1 to 2 days

›Poison control contact local protocol dependent

19References/r7

Guidelines and key resources

›Reference set

›American Academy of Pediatrics policy statements on prevention of poisoning and injury prevention most recent update local protocol dependent

›ACMT practice recommendations on acetaminophen poisoning and N acetylcysteine use updated statements and position papers local protocol dependent

›National Capital Poison Center button battery ingestion guideline and management recommendations most recent update local protocol dependent

›NASPGHAN magnet ingestion management guidance most recent update local protocol dependent

›Goldfrank’s Toxicologic Emergencies latest edition reference text local protocol dependent

Evidence & Review

Reviewed by SymptomDx Medical Team · Last reviewed February 24, 2026

SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.