by Dr Sam Thenabadu, Consultant in Adult & Paediatric Emergency Medicine.
Paediatric Accidental Poisonings
and the Legal Duty of Care
As we mark World Patient Safety Day 2025 under the theme “Safe care for every newborn and every child”, it’s vital to spotlight one of the most preventable yet persistently overlooked threats to paediatric safety: accidental poisoning. With the slogan “Patient safety from the start!”, this year’s campaign calls for urgent action to protect children from avoidable harm — a call that resonates deeply within both clinical and legal domains.
The Clinical Picture
Accidental poisoning remains a common reason for emergency department attendance among children, particularly those aged 1–5 years. According to RCEM guidance, most cases involve unintentional ingestion of household substances, medications, or environmental toxins. While many exposures are low-risk, some can lead to severe outcomes — including respiratory compromise, neurological symptoms, or multi-organ failure — requiring intensive care and long-term follow-up.
A nationwide surveillance study by the British Paediatric Surveillance Unit found:
- 2.4 cases of severe accidental poisoning per million children annually.
- 7.3 cases per million in children under 2 years.
- Prescription medications were the most common cause (42%), with opioids being the leading drug group 2.
- Fatal poisonings, though rare, occurred at a rate of 0.08 per million children, often involving methadone or tricyclic antidepressants 3.
Between 2012 and 2017, over 25,000 children under 5 were hospitalised in England due to accidental poisoning. Around 2% of all childhood ED presentations relate to poisoning, and half involve medications, often not prescribed to the child — typically belonging to a parent or grandparent 3.
RCEM guidance emphasizes:
- Age-specific assessment protocols, recognising children’s unique physiology.
- Avoidance of unnecessary interventions, such as gastric lavage.
- Early toxicology consultation and safeguarding referrals when circumstances are unclear 1.
Understandably these clinical standards form the basis of duty of care in paediatric emergency medicine however when care falls below these standards — through down triaging the asymptomatic patient, delayed assessment, misdiagnosis, or failure to escalate — the consequences can be life-altering.
All parties involved – families, clinicians and legal support need to be aware of:
- Failure to follow paediatric-specific protocols.
- Delayed recognition of poisoning symptoms, especially in non-verbal children.
- Poor communication with carers, leading to misunderstanding of discharge advice.
The legal implications are significant. Claims often hinge on whether clinicians acted within accepted standards of care, and whether harm could have been avoided with timely, appropriate intervention.
A Shared Responsibility
In the spirit of this year’s theme, let’s remember our shared commitment: to protect children from harm, to uphold the highest standards of care, and to ensure that patient safety truly is everyone business and support is offered at every stage to keep children safe.
Refrences:
(1) https://www.rcemlearning.co.uk/reference/paediatric-toxicology-considerations/
(2) https://adc.bmj.com/content/110/8/597
(3) https://www.thebts.org/wp-content/uploads/2022/07/Public-statement-on-toxicity-v1.1-July-2022-1.pdf