Poisoning

J.A. Bay's exhaustive review of the world's literature of reported cases of nonaccidental poisoning as a form of child abuse identified certain agents that are commonly used by perpetrators ("Conditions Mistaken for Child Sexual Abuse," in Reece, R.M. (ed.): Child Abuse: Medical Diagnosis and Management). The most frequently used agents included barbiturates, psychoactive drugs, tranquilizers, insulin, ipecac, arsenic, laxatives, salt, water, alcohol, marijuana, and opiates. The children poisoned by such agents display a variety of presenting signs and symptoms, but nearly all have major changes in their mental status, ranging from irritability, listlessness, lethargy, stupor, and coma to convulsions. The peak age for accidental poisoning is 2 to 3 years, and it is rare under the age of 1 or over the age of 6. The usual history of nonaccidental poisoning is that either the ingestion was not witnessed or that it was administered by a sibling or another child. In addition, the history may change over time.