Allison Muller understands the dangers of pills that find their way into a toddler's hands. As director of the Poison Control Center at the Children's Hospital of Philadelphia, she knows that one to two tablets of certain medications can be lethal to a toddler.
So when her 1-year-old son had nearly swallowed a potentially dangerous pill, she said she "panicked."
Upon arriving home from work, Muller learned from her husband that her infant son had found a pill on the floor and put it in his mouth.
"You can't turn your back for a second, or he's putting something in his mouth," she said.
The pill turned out to be Tramadol, a medication known to increase the risk of seizure. She later learned that the pill had fallen out of the pocket of one of her friends who had visited her home recently.
Muller said that the episode showed her that even though she keeps the family's medications in a locked tackle box, the threat of accidental ingestion remains.
Indeed, such cases are all too common, statistics suggest. According to the American Association of Poison Control Centers, in 2002 there were 2.4 million toxic ingestions, and more than half of these occurred in children younger than 6. Children aged 18 to 36 months seemed to be at the highest risk, and in these little bodies, just one pill can be deadly.
Even more worrisome is the fact that, after taking some of these pills, a child can appear perfectly fine until it is too late.
"They may look OK for now, but they're not," said Dr. Henry Spiller, director of the Kentucky Regional Poison Center in Louisville. "Within two hours, we have seen patients go from ingestion to death -- even after taking only one to two pills."
A review paper published earlier this month in the journal Pediatric Emergency Medicine Practice outlined the risks of more than three dozen medicines that, the authors noted, could kill kids in a single swallow.
"People don't know that just one of these pills can cause such bad problems in a child, but it's true," said Dr. Erica Liebelt, president of the American College of Medical Toxicology and a pediatric emergency physician at the University of Alabama in Birmingham.
Even parents who keep medicines out of their children's reach are at risk of such an emergency; the Emergency Medicine Clinics of North America notes that in 50 percent of all childhood accidental poisonings, the medication bottle was only "out" for a short amount of time as it was being used.
Also, as in Muller's case, a visitor might drop a pill. Or, as Dr. Carl Baum, a pediatric emergency physician and toxicologist at Yale University noted, "Kids find pills off the floor in a hotel room all the time. Parents bring them in having no idea what they took".
For these reason, emergency medicine specialists urge, parents should recognize the high risk of accidental ingestions and be prepared to act. Call 911 immediately, experts say, or call the Poison Control Center at 1-800-222-1222. Parents should also be prepared to take their child to the hospital immediately, and they should bring the bottle of whatever the child took in the ambulance and to the ER. Importantly, new guidelines from the American Association of Pediatrics urge against the use of Ipecac or any other mechanism to induce vomiting.
Fortunately, once children are in the emergency room, doctors can rapidly respond, as some medications have antidotes, reversal agents or supportive therapy.