From the Guidelines
If a toddler has possibly ingested bleach, immediately call Poison Control or seek emergency medical attention, as prompt evaluation and management are crucial to prevent severe caustic injuries to the gastrointestinal tract. According to the World Journal of Emergency Surgery guidelines 1, identification of the nature, physical form, and quantity of the ingested agent, as well as the accidental-voluntary ingestion pattern, are essential for emergency management of corrosive injuries.
Key Considerations
- Contacting Poison Control Centers to evaluate systemic toxicity of the ingested agents is recommended (Grade 2B) 1.
- Oxidants, such as bleach, usually cause mild injuries but can occasionally result in severe damage requiring emergency resection 1.
- Caregivers should be aware that specific corrosives may also cause severe systemic effects, such as hypocalcemia, hyponatremia, hypokalemia, and acidosis 1.
Management
- Do not induce vomiting or give the child anything to drink unless specifically instructed by medical professionals.
- Remove any bleach from the child's mouth and rinse with water if the child is conscious and cooperative.
- Observe for symptoms such as vomiting, drooling, difficulty swallowing, abdominal pain, or respiratory distress.
- Medical evaluation may include assessment of the airway, breathing, and circulation, with possible endoscopy to evaluate for esophageal injury in severe cases.
- Treatment is primarily supportive, focusing on maintaining airway patency and hydration.
Prevention
- Always store bleach and other cleaning products in original containers with child-resistant caps, locked away out of children's reach.
- Never transfer these products to food or beverage containers.
From the Research
Management of Possible Bleach Ingestion in Toddlers
- The management of liquid household bleach ingestion in children is often associated with a benign clinical course and usually does not require hospitalization, corticosteroids, or antibiotics unless there is severe dysphagia or signs of significant injury 2.
- An algorithm for the management of accidental ingestion of liquid household bleach in children has been introduced, which includes assessment of the child's condition and potential treatment options 2.
- The quantity and concentration of the ingested bleach are important factors in determining the management approach, with diluted bleach ingestions typically requiring less intensive treatment than concentrated bleach ingestions 3.
- Clinical signs, such as dysphagia or oral mucosal discoloration, are important criteria for predicting gastrointestinal lesions and guiding management decisions 3.
- In some cases, esophagoscopy or fiberoptic examination of the pharynx and larynx may be necessary to assess the extent of injury 2.
- Activated charcoal may be administered to help absorb the bleach, but its effectiveness depends on the time of administration and the amount of bleach ingested 4, 5.
- Prehospital administration of activated charcoal by paramedics may be considered in selected cases to reduce delays in treatment 5.