What to do if your child ingests a caustic substance?

Corrosive ingestions pose a serious risk to children and are associated with significant early and long-term complications. Despite several educational and public health initiatives to prevent caustic ingestion in children, in the United States (US), an estimated 5000–15,000 cases of caustic ingestion (incidence 1.08 per 100,000) occur each year. It is estimated that 80% of caustic injuries worldwide occur in children. The most common caustic substances found at home are:

1. Drain Cleaners: These are often very strong alkaline products.

2. Oven Cleaners: These can contain caustic substances that cause chemical burns.

3. Toilet Bowl Cleaners: These can contain damaging caustic substances.

4. Dishwasher Detergents: Some of these detergents contain caustic substances.

5. Laundry Pod Detergents: Some of these detergents can cause chemical burns.

6. Swimming Pool Chemicals: Some of these chemicals are caustic.

7. Cleaning Products for Brick and Concrete: These can contain caustic substances.

What causes corrosive substance ingestion in children?

Most caustic ingestions occur at the child’s house. Improper storage of caustic substances in unlabeled containers continues to be a major risk factor and increases the severity of injury. As many as 82% of cases involve a child intending to drink water.

What happens in the body when a child ingests a caustic substance?

Acids cause coagulation necrosis; an eschar forms, limiting further damage. Acids tend to affect the stomach more than the esophagus. Alkalis cause rapid liquefaction necrosis; no eschar forms, and damage continues until the alkali is neutralized or diluted. Alkalis tend to affect the esophagus more than the stomach, but ingestion of large quantities severely affects both.

How is caustic substance ingestion diagnosed in children?

Diagnosis and treatment depend on the type of ingestion and the severity of the injury. Chest, neck and abdominal X-rays help evaluate the possible injuries to esophagus and stomach. An upper endoscopy (where a flexible camera with a light attached is placed in the throat) helps show the extent of the damage.

What is the treatment for caustic substance ingestion in children?

Immediate treatment includes observing and keeping the child from vomiting, choking, or having liquid get into the lungs. You should not give anything per mouth. Do not try to make your child vomit. Vomiting can cause more damage to the wall of the esophagus. Take your child to the emergency service and let the doctors decide for further treatment.

The doctor may perform endoscopy if he suspects burn in the esophagus or stomach. Endoscopy is the procedure that allows the doctor to see the esophagus, stomach and first part of the intestines. The child may have a nasogastric (NG) tube placed during endoscopy if the esophagus has extensive burns. This tube keeps the esophagus from closing off completely and provides a route for nutrition. Long-term treatment may include esophageal dilations to help treat the narrowing of the esophagus and a gastrostomy tube to help with long-term nutrition.