Toddlers who have accidentally ingested small objects, medicines or cleaning products are often seen in the paediatric ED. To put this into context, in 2013-14, the National Poisons Information Service received more than 14,000 calls from health professionals asking for advice regarding suspected childhood poisonings.

Although in the majority of cases of medicine ingestion severe side effects and deaths are rare, certain medicines can be particularly dangerous. These include opiates, tricyclic antidepressants, antipsychotics, quinine, calcium channel blockers and oral hypoglycaemic drugs.

An article recently published in the BMJ, shows Methadone causes more toddlers' deaths by unintentional poisoning in England and Wales than any other prescription drug.[1] The researchers analysed national data on childhood poisonings and hospital treatment or admissions to intensive care for unintentional poisoning from 2001 to 2013. During this period, they identified 28 children aged under 4 who had died in England and Wales as a result of unintentional poisoning with a prescribed drug. Methadone was implicated in 57% of cases.

Sometimes, it is difficult to establish which drug the child has ingested, and so knowing the various signs and symptoms of the clinical toxidromes is useful in narrowing down the potential causative agent. In our simulated case, we wanted our team to recognise the features of the opioid toxidrome (reduced respiratory drive, low HR, low BP, a drop in body temperature, reduced level of consciousness and constriction of the pupils) and use the reversal agent Naloxone. Following the acute medical stabilisation of this child, we then discussed the role of child safeguarding and social services teams in their ongoing MDT management.