What is the treatment for a 2-year-old child who has ingested perfume?

Management of Perfume Ingestion in a 2-Year-Old Child

For a 2-year-old who has ingested perfume, observe the child at home if they remain completely asymptomatic and the amount ingested was less than 105 mL (approximately 3.5 ounces), but immediately refer to an emergency facility if any symptoms of ethanol intoxication develop. 1

Immediate Assessment

Determine the volume ingested and assess for symptoms of ethanol toxicity:

• Perfumes typically contain 50-99% ethyl alcohol (ethanol), making them potential sources of alcohol poisoning in young children 1
• Ask caregivers specifically about the amount consumed (estimate in mL or ounces if possible) 1
• Look for signs of ethanol intoxication including: drowsiness, ataxia (appearing unsteady or "drunk"), slurred speech, altered mental status, or any behavioral changes 1, 2
• Check for hypoglycemia symptoms, as ethanol can cause dangerous drops in blood sugar in young children 2

Risk Stratification Based on Amount Ingested

The volume consumed determines the management approach:

• Less than 30 mL ingested: No children in this group experienced any symptoms in a large case series 1
• 30-60 mL ingested: Minimal risk, with only rare reports of transient drowsiness that resolved within one hour 1
• 60-105 mL ingested: Some children showed intoxication behaviors, though blood ethanol levels became undetectable within 2.5 hours 1
• Greater than 105 mL: Insufficient safety data; these children require emergency facility evaluation 1

Home Observation Protocol

If the child is asymptomatic and ingested less than 105 mL, implement the following:

• Instruct caregivers to observe the child closely at home for at least 2-3 hours after ingestion 1
• Watch specifically for drowsiness, confusion, unsteady gait, or any change in behavior 1, 2
• Do NOT induce vomiting, as this is not indicated and may cause aspiration 3, 4
• Do NOT give activated charcoal, as it is ineffective for ethanol and not recommended for this type of ingestion 5
• Ensure the child has access to food to prevent hypoglycemia, though forced feeding is not necessary if the child is eating normally 2

Immediate Emergency Referral Criteria

Transport to an emergency facility immediately if any of the following occur:

• Any symptoms of intoxication develop (drowsiness, confusion, ataxia, behavioral changes) 1, 2
• The child becomes difficult to arouse or loses consciousness 2
• Seizure activity or abnormal movements occur 2
• The amount ingested exceeds 105 mL 1
• There is uncertainty about the amount ingested and the child shows any concerning signs 1, 4

Why Perfume Ingestions Are Usually Benign

The relatively favorable outcomes in perfume ingestions relate to specific factors:

• The high ethanol concentration (50-99%) makes perfume extremely unpalatable and irritating to the mouth and throat 1, 2
• This unpalatability typically limits the volume children will voluntarily consume, unlike more palatable products like mouthwash which can cause severe poisoning 2
• Children usually spit out most of the perfume due to the burning sensation 1
• Even when intoxication occurs, ethanol is rapidly metabolized in children, with blood levels becoming undetectable within 2.5 hours 1

Critical Pitfall to Avoid

Do not assume all ethanol-containing cosmetic products carry the same risk:

• Mouthwash, despite having lower ethanol content than perfume, causes more severe poisoning because children drink larger volumes due to its palatability 2
• A case report documented hypoglycemia, coma, and seizure activity from just 75 mL of mouthwash 2
• If the ingestion involved mouthwash rather than perfume/cologne, maintain a much higher index of suspicion even with smaller volumes 2

Parent Education and Prevention

Counsel caregivers on prevention strategies:

• Store all cosmetic and personal care products in child-resistant containers and out of reach 6, 3
• Perfume and cologne ingestions are among the most commonly reported exposures to poison control centers, though serious outcomes are rare 6
• Emphasize that prevention is the most effective strategy, as these exposures represent preventable childhood injuries 6
• Provide poison control center contact information (1-800-222-1222 in the US) for future reference 4