Caustic Substance Ingestion in Children

Caustic substance ingestion is one of the most serious accidental poisonings in childhood, most commonly involving alkalis such as drain cleaners and oven cleaners, acids such as toilet bowl cleaners and battery fluid, and oxidizers such as bleach. Alkalis cause deep liquefactive necrosis whereas acids cause coagulative necrosis with rapid eschar formation.

Initial assessment focuses on airway, breathing and circulation. Provoked vomiting, neutralization with acid or alkali, gastric lavage and activated charcoal are contraindicated. Children should not be given anything by mouth until evaluated. Symptomatic patients with drooling, refusal to drink, oral burns, vomiting, stridor or chest pain are at high risk for severe esophageal injury.

Upper endoscopy within 12 to 24 hours grades injury and guides management. Treatment includes intravenous fluids, proton pump inhibitors, parenteral nutrition for severe injuries and antibiotics for selected cases. Long-term complications include esophageal stricture, malabsorption and risk of esophageal carcinoma decades later, requiring lifelong endoscopic surveillance.