Management of Single Tums Ingestion in a 13-Month-Old
Reassurance and observation at home is appropriate—a single regular-strength Tums tablet poses no significant risk to a 13-month-old child.
Calcium Content and Safety Assessment
A standard regular-strength Tums tablet contains approximately 500 mg calcium carbonate, which provides 200 mg of elemental calcium (calcium carbonate is 40% elemental calcium by weight) 1. This amount is well below any threshold for toxicity in this age group.
Why This Is Safe
The safe upper limit for total daily calcium intake in children aged 1 year and older is 2,500 mg per day 2, 3. A single Tums provides only 200 mg elemental calcium—less than 10% of this maximum safe threshold.
Calcium carbonate is well-tolerated in children of all ages 2. The KDOQI guidelines specifically note that calcium carbonate salts are routinely used even in infants as phosphate binders and supplements without significant adverse effects.
The recommended dietary allowance (RDA) for calcium in a 13-month-old is approximately 700 mg per day 2. A single tablet providing 200 mg elemental calcium represents less than 30% of the daily requirement, making accidental ingestion essentially equivalent to consuming a calcium-rich food.
Clinical Management Algorithm
Immediate Assessment (No Medical Intervention Required)
Observe for mild gastrointestinal symptoms only: The most common side effects of calcium carbonate are constipation and bloating 3, 1. These are unlikely with a single tablet but may occur.
No need for activated charcoal, gastric lavage, or emergency department evaluation for this minimal exposure.
No laboratory monitoring is necessary unless the child develops unexpected symptoms (which would be extraordinarily rare).
When to Seek Medical Attention
Contact a healthcare provider or poison control only if:
- The child develops persistent vomiting (unlikely from this dose)
- Signs of hypercalcemia appear (extremely unlikely): lethargy, excessive thirst, or altered mental status
- The ingestion involved multiple tablets or a higher-strength formulation (Tums EX, Ultra, or 500)
Important Context
Hypercalcemia from calcium carbonate requires chronic excessive intake, not single-dose exposure 4. The case report of hypercalcemic crisis involved prolonged excessive ingestion over time, not acute single-tablet exposure.
Common Pitfall to Avoid
Do not confuse this benign accidental ingestion with scenarios requiring intervention. The evidence on calcium toxicity relates to chronic supplementation exceeding 2,500 mg daily or acute ingestions of massive quantities 2, 4, 5—neither applies to a single tablet.