What to do, in order
- Take it away and look in the mouth. Remove whatever is left, and gently clear anything still in the mouth with a finger — this is one of the few situations where that is right, because there is no airway obstruction to push further in.
- Find the container. Not the substance, the packaging: the name, the strength and the ingredients list are what the poisons service needs, and guessing from memory wastes the call.
- Phone. 999 for the red flags below, 111 for everything else. Both have access to specialist poisons advice, and 111 will escalate without being asked twice.
- Keep the child still, upright and watched while waiting, rather than walking them about.
- Take the container to hospital, along with any tablets left in the strip, so that what was taken and roughly how much can be worked out from what is missing.
What not to do
Four pieces of inherited advice, all of them wrong, and the first three actively harmful.
- Do not make the child sick. Not with fingers, not with salt water, not with anything. A corrosive substance burns a second time on the way back up, vomit can be inhaled, and nothing useful is achieved. Salt water carries its own risk of serious harm and has no place in first aid.
- Do not give anything to drink. Fluid can speed absorption, and if an anaesthetic or a procedure turns out to be needed, an empty stomach is better. Milk is not an antidote and does not neutralise anything. If the mouth or lips are burning, the advice is to say so on the phone rather than to improvise.
- No home antidotes. No charcoal from a cupboard, no bicarbonate, no vinegar, no oil.
- Do not wait to see what happens. This is the one that causes the most harm. Several of the commonest things a child swallows — paracetamol and iron tablets in particular — produce no symptoms at all for hours while damage is being done. A child who seems completely fine is not evidence that nothing happened.
When it is 999 rather than 111
Straight to 999 or A&E for any of:
- Drowsiness, floppiness, confusion or agitation
- A fit or seizure
- Difficulty breathing, or choking
- Pale, mottled or blue skin
- Difficulty swallowing, or drooling
- Severe tummy pain
- Burning or pain in the mouth, throat or eyes
- Anything corrosive — drain cleaner, oven cleaner, dishwasher tablets or powder, descaler, bleach
- Anything petroleum-based — petrol, paraffin, lamp oil, white spirit, barbecue lighter fluid — because the danger is less the swallowing than the inhaling of the vapour into the lungs
- A button battery, or more than one magnet
For everything else, 111 is the right number, and it is the right number even when the answer turns out to be that nothing needs doing. Also worth a call rather than a wait: anything that is a medicine at all, and anything whose packaging carries a hazard symbol or a first aid instruction.
Useful to have ready for the call: what it was, when, how much at most, and the child's age and rough weight, along with any conditions or medicines of their own.
On the skin, and in the eyes
Chemical on skin: remove contaminated clothing and rinse the area with plenty of cool running water, then phone for advice. Laundry capsules are the common culprit and can burn skin as well as the inside of the mouth.
Chemical in an eye: rinse immediately with gently running lukewarm water for at least ten minutes, holding the lid open, with the head tilted so the water runs away from the other eye rather than across it. This happens before the phone call, not after, because the rinsing is the treatment. Then 999 or straight to A&E. Capsule contents squirted into an eye are a common and genuinely sight-threatening injury in toddlers.
Fumes
With inhaled fumes — a mixture of bleach and limescale remover is the classic accidental one — the first step is fresh air for everyone, including the adult, and the second is 999 if there is any coughing, wheeze or breathlessness.
Carbon monoxide belongs here too, and it is the one hazard on this page that cannot be smelled, seen or stored out of reach. An audible alarm to the current British standard, in any room with a fuel-burning appliance, is the whole of the answer. Headaches, nausea and drowsiness that affect several people in a household at once, or that improve on going outdoors, are the pattern to notice.
Medicines
The commonest route into a child, and the one most often underestimated, because a strip of tablets does not look like a chemical.
- Handbags are the single most productive hiding place in any house — a bag on the floor by the sofa, usually a visitor's. Grandparents' handbags, in particular, often contain a week's worth of tablets in a dosette box, and a dosette box has no child-resistant closure at all.
- Bedside tables are the second. Painkillers kept there for the night are at exactly toddler height.
- Counted out and left on a worktop for later is how a dose becomes an accident.
- Paracetamol and ibuprofen are so ordinary that they are not thought of as dangerous. Paracetamol in particular causes liver damage that is entirely silent at first and treatable if caught early, which is the whole argument for ringing rather than watching.
- Iron tablets, including pregnancy supplements, are seriously toxic to a small child and come in quantities that make it easy.
- Medicine is never described as sweets to get it taken, however tempting that is in the moment, because it works too well.
Cleaning products and laundry capsules
Liquid laundry capsules deserve their reputation. They are brightly coloured, soft, the size of a sweet, and filled with a highly concentrated detergent under enough pressure to squirt when bitten. They burn mouths and eyes and are a frequent cause of admission.
- They go in a high or locked cupboard, not on top of the machine and not on the pile of washing.
- The tub goes back immediately after use, not after the load is loaded.
- Products containing a bittering agent such as Bitrex are worth choosing — a child who tastes one tends to spit it out.
For everything else, the rule that matters is that products stay in the bottle they came in. Decanting bleach into a squash bottle or a plant mister removes both the hazard warning and the first aid instructions, and creates something that looks like a drink. The under-the-sink cupboard is the most common storage place for cleaning products and the worst, and a cupboard catch there is one of the better uses of ten minutes.
Vapes, alcohol and the rest of the sitting room
- E-liquid and refill pods. Nicotine is toxic in small quantities to a small child, and refill bottles are sweet-smelling, brightly flavoured and routinely left on arms of chairs and coffee tables. Disposable vapes contain both liquid and a battery.
- Alcohol. The risk in a young child is not drunkenness but a collapse in blood sugar, which can be severe. Half-finished glasses after a party are the classic scenario, and the morning-after tidy-up is worth doing the night before.
- Essential oils and aromatherapy. Small volumes of eucalyptus, tea tree, camphor and clove oil are genuinely harmful swallowed, and the bottles are small, attractive and rarely locked away. Oil burners and reed diffusers sit at coffee-table height.
- Perfume, aftershave, nail varnish remover, hand sanitiser — all alcohol-based, all usually within reach.
- Water beads, sold as toys and as plant granules, swell after being swallowed and can cause an obstruction. They are a hospital matter rather than a wait-and-see.
The garden, the shed and the garage
Weedkiller, slug pellets, plant food, patio cleaner, antifreeze and screenwash all tend to live in a shed with a bolt rather than a lock, or in an open garage, and antifreeze in particular is sweet-tasting and very toxic. Garden plants and berries are a smaller risk than they are usually given credit for, and which ones genuinely matter is covered under garden safety for children.
Objects that block or burn rather than poison — button batteries above all, along with magnets and small parts — are covered under choking in babies and children.
Child-resistant is not childproof
This is the misunderstanding that most often sits behind an accident. A child-resistant closure is tested to be difficult for most young children for a short period. It is not a lock. Plenty of three-year-olds manage one, often faster than the adult who bought it, and blister packs merely slow things down rather than stop them.
So the packaging is the last line rather than the first. What actually works, roughly in order of effect:
- High, or locked. Above adult shoulder height is the practical threshold, and out of sight matters as much as out of reach, because what is not seen is not wanted.
- Put away immediately after use, rather than at the end of the job. Almost every incident happens during the few minutes a product is out.
- Original containers only.
- A cupboard catch under the sink and in the bathroom, which is cheap and takes minutes.
- A clear-out. Expired medicines go back to a pharmacy rather than into a drawer, and most households are carrying several years of them.
Other people's houses
A house that is not set up for a small child is where a good proportion of these events happen, and the usual reason is that nobody thought to look. Tablets in a dosette box or a saucer, a handbag on the floor, cleaning products in an unlatched cupboard, a half-finished drink, a vape on the arm of a chair. Older relatives often take more medicines and have fewer reasons to lock them up, and raising it feels awkward in a way that is worth getting over once.
The useful version of the conversation is specific and brief — somewhere high for the tablets while the children are visiting — rather than a general request to childproof a house.
Worth doing before it is needed
Having 111 saved in a phone is a small thing that helps, because the number is easy to forget at the moment it is wanted, and a parent who is not sure whether a situation is serious enough for 999 tends to delay rather than dial. It is always serious enough for 111.
Further detail on prevention is published by the Child Accident Prevention Trust, and the British Red Cross sets out the first aid steps with illustrations.