What is the management for a child who has ingested bleach?

From the Guidelines

The management for a child who has ingested bleach should focus on supportive care, including removing any remaining bleach from the mouth, giving small sips of water or milk to dilute the chemical, and contacting Poison Control immediately for specific guidance. According to the most recent guidelines, contacting Poison Control Centers is recommended to evaluate systemic toxicity of the ingested agents 1. The child should be monitored for signs of respiratory distress, drooling, vomiting, abdominal pain, or difficulty swallowing, which may indicate significant injury.

Key Considerations

• Most household bleach ingestions cause only mild irritation to the mouth and throat, but concentrated products can cause more severe burns 1.
• Inducing vomiting is not recommended as it can cause additional damage to the esophagus and airway.
• Activated charcoal should not be administered unless advised by poison control center or emergency medical personnel 1.
• Seek emergency medical attention if the child shows difficulty breathing, significant pain, persistent vomiting, drooling, or altered mental status.

Treatment and Prevention

• At the hospital, treatment may include airway assessment, IV fluids, pain management, and possibly endoscopy to evaluate for esophageal damage in severe cases.
• Prevention is crucial - always store bleach and other cleaning products in original containers out of children's reach.
• The quantity of ingested corrosive agent and the physical form of the ingested substance are major determinants of the damage pattern to the gastrointestinal tract 1.

From the Research

Management for Bleach Ingestion in Children

• The management of bleach ingestion in children is primarily focused on symptom-directed supportive care, as there is no specific antidote for sodium hypochlorite poisoning 2.
• In cases of accidental ingestion of household bleach, most children do not require hospitalization, corticosteroids, or antibiotics unless there are signs of severe injury or significant dysphagia 3.
• Esophagoscopy may not be necessary, but a fiberoptic examination of the pharynx and larynx should be included in the assessment of these children 3.
• The quantity and concentration of the ingested bleach are important factors in determining the management approach, with most centers recommending hospitalization for ingestions of concentrated bleach or large quantities of diluted bleach 4.
• Clinical signs, such as dysphagia or signs of significant injury, are important criteria for predicting gastrointestinal lesions and determining the need for further evaluation or treatment 4, 5.

Assessment and Evaluation

• A careful history, including details of the specific product used, its hypochlorite concentration, and the amount involved, is essential in making a diagnosis 2.
• Symptom-directed supportive care is the mainstay of management, with a focus on local corrosive injury in severe cases 2.
• Fiberoptic endoscopy and CT thorax/abdomen are useful in assessing the severity of injury, risk of mortality, and risk of subsequent stricture formation, and should be performed as soon as possible after ingestion 2, 5.

Treatment and Follow-up

• Treatment primarily consists of symptom-directed supportive care, with no specific antidote available for sodium hypochlorite poisoning 2.
• In cases of severe injury or suspected perforation, a surgical opinion should be sought, and urgent oesophagogastroduodenoscopy (OGD) should be arranged to grade the degree of injury and establish long-term prognosis 5.
• Asymptomatic pediatric patients should be treated with caution and observed for a period of time, as they are at risk of developing late complications 5.