PEDIATRICS Vol. 83 No. 5 May 1989, pp. 772-776
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Parental Administration of Chemical Agents: A Cause of Apparent Life-Threatening Events

Gerald B. Hickson MD1, William A. Altemeier MD1, Elaine D. Martin MD1, and Preston W. Campbell MD1

1 The Department of Pediatrics, Vanderbilt University, Nashville, Tennessee

Nine infants with apparent life-threatening events that occurred as a result of poisoning by a caretaker are described. These episodes were characterized by apnea plus some combination of color change, choking or gagging, and abnormal muscle tone. Five of the infants responded to vigorous stimulation, and four required cardiopulmonary resuscitation. Most poisonings (seven infants) were detected by a urine drug screen. Medications detected included acetaminophen, amphetamine, benzodiazepines (two infants), cocaine, codeine, meperidine (two infants), Methadone, phenobarbital, and phenothiazines (three infants). Four infants received two or more drugs. Most perpetrators of the poisonings were mothers (seven) and five of the parents admitted administering the various agents. Reasons for the poisonings included an apparent attempt to harm an infant, the need to sedate a fussy infant, or a gross misunderstanding of the potential risk of various agents to infants. Because no history of drug administration was elicited at the time of hospital admission, six infants might have been discharged with a diagnosis of apnea of infancy had not an attempt been made to investigate the possibility of poisoning. These cases suggest that poisoning by a caretaker should be added to the differential diagnosis of any infant brought to medical attention because of an apparent lifethreatening event and that urine drug screening should be considered in the evaluation.

Key Words: child abuse • apnea • poisoning • apparent life-threatening event

Submitted on February 26, 1988
Accepted on April 4, 1988




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