Holiday Pediatric Ingestions
In the US, Poison Centers field around one million calls per year regarding unintentional ingestions in children six and younger.(1) During December, holiday bright lights, seasonal plants, new decorations and shiny ornaments present a variety of new temptations for youngsters to put in their mouths. New toys that may have small parts or button batteries also prove irresistible to this age group and can be dangerous. In addition, parents may be distracted from supervising their young children while hosting relatives, friends or parties. Here are some tips about holiday hazards for little ones and to help prevent common holiday ingestion mishaps during this time of year.
Foreign Body (FB) Ingestions
A 2019 retrospective study looked at holiday foreign body ingestions during an 18-year period and found over 22,000 ED visits, mainly in children two and younger. (2) The following objects should always be kept out of reach of young children.
Button Batteries
Topping the list of dangerous foreign bodies for young children are button batteries. Button batteries can be found in toys, remote controls, key fobs, singing cards, flameless candles or other products. If swallowed, the batteries can be extremely dangerous if lodged in the esophagus. They can cause corrosive burns in as little as two hours. Even “dead” batteries may still be emitting an electrical charge and cause complications. All known or possible battery ingestions should be referred in immediately for x-rays to detect and localize the battery. (Note: Button batteries can also cause permanent damage if stuck in nose or ear).
Disposition for all these calls: Go to ED Now.
First Aid for Battery Ingestion: Give honey if you have it (if over one year of age). Dosage: 10 mL (2 teaspoons) every 10 minutes until arrive in ED. Reason: Honey can protect the esophagus from some of the damage.
Magnets
Small magnets when swallowed are also very dangerous. When multiple magnets are ingested, gastrointestinal complications can occur. Magnets at different locations can become attracted to each other across a bowel wall, leading to bowel wall necrosis. This can cause perforation, obstruction and volvulus.
Disposition for all these calls: Go to ED Now.
Glass Ornaments and Light Bulbs
A retrospective study over 13 years looked at holiday ornament related injuries seen in the ED.(3) Over half the cases involved ingestions: 35 were of holiday ornaments and eight were of light bulbs. All but one of these ornaments were made of glass. In 28%, there was an associated bleed either from the mouth or as a delayed gastrointestinal bleed. Imaging was performed in 85%. A subspecialty consult was obtained in 23%, primarily addressing a foreign body ingestion.
Disposition: If symptomatic (e.g., bleeding, pain), Go to ED Now.
Note: Tiny chips of glass less than 1/8 inch or 3 mm generally pass without any symptoms, but if unsure send in.
Other Sharp Foreign Bodies
If ingested, any sharp FB can become stuck in the gut and lead to perforation. Sharp-tipped pine needles from live trees and tree ornament hangers fall into this category. There is even a report of a jingle bell being swallowed and an edge of the bell getting lodged in the esophagus.(4)
Disposition: Go to ED Now
Choking Hazards if Ingested
Toys with small parts may present a choking hazard to a young child. Read the product warning labels on toys and do not use around small children.
Window decorations, such as window clings, can also be ingested and a choking hazard in young children.
Food items that present choking hazards to young children during the holidays are nuts, hard candy, gummy candy and caramels. Non-food choking hazards are pieces of balloons, and candy or any plastic wrapping. Keep these out of reach of children five and younger.
Plant Ingestions
These are common calls to Poison Centers and most children are under the age of six. Calls regarding Poinsettia and Holly are the most common during the holiday season.(5) The colorful flowers and berries on these plants can be enticing to toddlers.
One common myth is that Poinsettias are extremely toxic. Evidence does not support this, and thus, parents can be reassured. However, it can cause some minor abdominal symptoms.(5)
Artificial Snow Ingestion (Flocking, Snow Spray, Fake Snow)
There are two types of products available. One is a powder mixed with water that dries. The other is an aerosol spray where the chemicals in the product evaporate and leave a solid substance that resembles snow. Both are considered non-toxic if swallowed, although the mouth should be rinsed.
If symptoms occur or if sprayed in the face, call Poison Center.
Recreational Party Drug Ingestions
Alcohol, nicotine (including cigarette butts or liquid products), and cannabis products can be toxic for a young child. Always clean up leftovers from a party and make sure your children are not exposed to these products.
Alcohol: Ethanol is the type of alcohol found in alcoholic drinks. Other household products can contain as much ethanol as spirits, like hand sanitizer or cooking extracts (vanilla, almond, etc). Alcohol ingestion in young children is extremely dangerous and can cause seizures, coma and death.
Nicotine: Small doses can cause symptoms. A teaspoon (5 mL) of liquid nicotine used in vaping devices can be fatal for a 1-year-old child. The initial symptoms are nausea and vomiting, excessive salivation, sweating, abdominal pain, headache, hypertension and tachycardia. With higher doses, seizures or coma may occur. Nicotine chewing gum and patches can also cause poisoning.
Marijuana (Cannabis): Legalization of recreational marijuana has increased the incidence of unintentional cannabis exposures in young children. Most common ingestions involve food products (edibles), such as cookies, candy and baked goods. The most common presenting symptom was lethargy in 71% of the children. Severe ingestions can result in hospitalization requiring intubation.
Disposition: If a young child ingests any of these products, call Poison Center.
Medication Ingestions
Of children treated in an ED for medicine poisoning, 38% got into a grandparent’s medicine.1 It is common during this time of year for children to find prescription medicines in a visiting relative’s purse or travel accessories left lying on the floor.
Disposition: Call Poison Center.
Prevention of Holiday Accidental Ingestions
It’s best to try to prevent holiday ingestions from happening in the first place. Follow these tips:
Keep all these hazards up and out of reach of children, especially those younger than six years old.
Provide extra supervision for young children during the holiday season. Assign a responsible adult or teen (babysitter) to watch young children during festivities.
Clean up quickly after parties and remove any leftover alcohol, cigarette butts, vaping products, cannabis edibles, etc.
Secure all battery compartments of products so not easily opened. Store all batteries away from children.
Put a gate or barrier around the Christmas tree if needed and/or hang ornaments high enough on the tree that they are out of reach. Consider not using glass ornaments or lights until children in the house are older than six.
Avoid having live toxic plants. Artificial mistletoe and holly can be hung instead. Keep any plant high out of the reach of young children and pets.
Lock up all medications and any recreational drugs. Keep in the original child-resistant packaging. Keep lids secured firmly on bottles. Provide a safe place for visitors to store purses, suitcases and other travel bags.
Parents should keep their local Poison Center number (1-800-222-1222 in US) handy and download the webPOISONCONTROL® app on their phone. The app might also be helpful for nurses. There is also an on-line tool available for caregivers. For more information, see https://www.poison.org.
Happy and safe holidays to all our STCC customers!
Co-Authors
Kelli Massaro, RN, STCC Pediatric Nurse Editor
G. Sam Wang, MD, Pediatric Emergency Medicine and Medical Toxicology
References
(1) National Capital Poison Center. Available at https://www.poison.org. Last accessed 12/5/23.
(2) Reeves PT, et al. Pediatric ingestions of Christmas past, present, and future: A review of holiday trends, 1997 to 2015. Clin Pediatr (Phila). 2019 May;58(5):571-577.
(3) Kimia A, et al. Holiday ornament-related injuries in children. Pediatr Emerg Care. 2009 Dec; 25(12):819-822.
(4) Oliveros L, et al. "Jingle all the way!": Sharp foreign bodies embedded within the esophageal mucosa during the holiday season. Cureus. 2022 Apr 26;14(4):e24493.
(5) Evens ZN, Stellpflug SJ. Holiday plants with toxic misconceptions. West J Emerg Med. 2012 Dec;13(6):538-42.
Schmitt, B. Pediatric Telehealth After Hours Guidelines. Schmitt Pediatric Guidelines, LLC. 2023.
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