What to do in case of bleach ingestion in a young child?

Emergency Management of Bleach Ingestion in Young Children

In case of bleach ingestion in a young child, immediately contact Poison Control Center (1-800-222-1222) and irrigate the affected area with copious amounts of water. Do not induce vomiting or administer activated charcoal. 1

Immediate Actions

• Contact Poison Control Center (1-800-222-1222) immediately for guidance specific to the situation 1, 2
• Dilute the bleach by giving small sips of water to the child 1
• Do NOT induce vomiting as this may cause additional harm to the esophagus 1
• Do NOT administer activated charcoal as it is not recommended for caustic substance ingestions 1
• Ensure the area is well-ventilated to prevent inhalation of toxic fumes 1

Assessment of Severity

• Determine the type of bleach ingested (household vs. industrial/homemade) as this significantly affects the risk of esophageal injury 3
• Assess for clinical symptoms that may indicate significant injury: 4
  • Oral burns or mucosal discoloration
  • Difficulty swallowing or excessive drooling
  • Vomiting
  • Respiratory distress
  • Chest or abdominal pain

Management Based on Bleach Type and Symptoms

For Household Bleach (Most Common)

• If small amount (<100 ml) of diluted household bleach with minimal or no symptoms: 5, 3

  • Home observation is generally appropriate after Poison Control consultation
  • Continue oral hydration with water
  • Monitor for development of symptoms

• If larger amount (>100 ml) or if symptoms are present: 5

  • Seek immediate medical attention
  • Medical evaluation may include examination of the oral cavity and throat

For Industrial or Homemade Bleach

• Immediate medical attention is required regardless of amount 3
• Hospital admission and endoscopic evaluation may be necessary 5, 3

Hospital Management

• Clinical evaluation including vital signs and examination of the oropharynx 6
• Laboratory tests may include electrolytes to check for hypernatremia and hyperchloremia 7
• Endoscopy may be considered based on:
  • Type of bleach (industrial/homemade vs. household) 3
  • Presence of significant symptoms 5
  • Amount ingested 5

Important Considerations

• Most accidental household bleach ingestions in children have a benign clinical course 3, 6
• The mean age of children with bleach ingestion is around 24 months 6
• Severe complications such as esophageal perforation are rare with household bleach but have been reported with concentrated products 8
• Never mix bleach with other household cleaning products, especially those containing ammonia, as this can create toxic gases 4, 1

Prevention

• Store all cleaning products in their original containers with child-resistant caps 4
• Keep household chemicals out of reach of children 2
• Educate caregivers about proper storage of household chemicals 4