Opioid Poisoning in Children Increasing Alongside Adult Misuse

Fentanyl found to be the most common drug causing the increase, according to new research.

  Orlando, Fla.—The impacts of the ongoing opioid crisis are trickling down to young children, according to research presented during the American Academy of Pediatrics 2024 National Conference & Exhibition at the Orange County Convention Center from Sept. 27-Oct. 1. 

One abstract, “Characteristics of Children with Opioid Poisoning Consulted by a Child Protection Service,” examined the demographic and medical records of 69 children who were assessed by a child protection team in the Philadelphia, PA area. 

The study found that over a 10-year period from June 2012 to Dec. 2023, there was an increase in cases of children ingesting opioids, with a four-fold increase from 2019 to 2023. Most of the children were under the age of 2, with the youngest being 19 -days old. 

Dr. Maria Quidgley-Martin, Pediatric Emergency Medicine Attending and Clinical Assistant Professor of Emergency Medicine at the University of Florida and lead author on the study, found that fentanyl was the drug most often found in these cases. 

“As parents and other adults increasingly misuse opioids, it’s becoming more and more possible for those drugs to end up in children’s hands,” Quidgley-Martin explained. “Children are most often coming across these drugs in familiar settings such as their home or the home of a relative.” 

Non-Hispanic Black children were overrepresented as this group experienced an 11-fold increase from 2019 to 2023, a sharp increase even when compared to the four-fold general increase over that same timeframe. 

Typical symptoms of opioid poisoning in children include changes in behavior, unresponsiveness, difficulty breathing and seizures. According to Dr. Quidgley-Martin, most patients who were brought to hospitals by first responders weren’t given naloxone (a powerful nasal drug used to counteract the effects of opioid overdose) prior to arrival. 

“Children are the overlooked tragic victims of the United States’ opioid epidemic and fentanyl is now the greatest danger,” Dr. Quidgley-Martin said. “We need our first responders to always consider administering naloxone to unconscious pediatric patients in case they have unknowingly been exposed.” 

Over half of the patient’s families had previous contact with Child Protective Services, with 65% reporting a family history of opioid abuse. These numbers highlight the ongoing crisis opioids are perpetuating on families across the country. 

Of the 69 patients studied, four died. They were all younger than 2 -years-old and all tested positive for fentanyl. 

“As a pediatric emergency medicine doctor, I have seen children injured and killed by fentanyl way too often,” Dr. Quidgley-Martin said. “We need to speak about this more and work together to protect our children.” 

Study author Dr. Maria Quidgley-Martin, is scheduled to present her research, which is below, at the Council on Child Abuse and Neglect at 1:20 p.m. on Sunday, Sept. 29 in the Regency Ballroom R at the Hyatt Regency Orlando. To request an interview with the authors, contact Joey McCool Ryan at MCCOOL@chop.edu. 

Please note: only the abstract is being presented at the meeting. In some cases, the researcher may have more data available to share with media, or may be preparing a longer article for submission to a journal.    

 
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The American Academy of Pediatrics is an organization of 67,000 primary care pediatricians, pediatric medical subspecialists and pediatric surgical specialists dedicated to the health, safety and well-being of infants, children, adolescents and young adults. For more information, visit www.aap.org. Reporters can access the meeting program and other relevant meeting information through the AAP meeting website at http://www.aapexperience.org/

Abstract 

Program Name: 2024 AAP National Conference-Abstracts

Submission Type: Council on Child Abuse and Neglect

Abstract Title: Characteristics of Children with Opioid Poisoning Consulted by a Child Protection Service

Maria Quidgley Martin
Philadelphia, PA, United States
mquidgley@gmail.com

The opioid epidemic in the United States significantly affects children, with rising opioid exposures, notably fentanyl, leading to fatal poisonings among young children. Increased adult opioid misuse also correlates with heightened child abuse and neglect, requiring intervention from the child welfare system. However, to date, there is no literature that describes the demographic, clinical, and social characteristics, as well as acute medical outcomes of children with opioid poisoning evaluated for child maltreatment. This study aims to address this gap by detailing these features among children consulted by the child protection team at our institution.

This retrospective cohort study conducted at a quaternary urban children's hospital analyzed children who received a Suspected Child Abuse and Neglect (SCAN) team consultation for opioid exposure between June 2012 and December 2023. Demographic, clinical, and social de-identified data were collected from medical records from an existing patient registry and entered into a REDCap database. Descriptive statistics were used to characterize the population, and comparisons were made based on age and fentanyl exposure.

There were 69 consults for opioid ingestions, with a four-fold increase observed from 2019 to 2023. Most patients were under two years old (72%), with a notable proportion being non-Hispanic Black children (11-fold increase from 2019 to 2023). Fentanyl was the most common opioid. The majority (87%) of cases occurred in the patient's home or a relative's residence. The most common chief complaints were altered mental status, abnormal breathing, and seizures. Eleven patients presented in cardiac arrest (9 under age 2), and 71% had respiratory arrest or depression on presentation. Emergency medical services initially cared for 59% of patients, and 61% were transferred from 23 area hospitals. Naloxone was administered to 71% of patients, with higher odds in children under age 2 (OR 3.2, (1.04-9.8, p=0.04)). Fifty-eight percent were admitted to the ICU, with higher odds for those under age 2 (OR 3.33 (1.1 to 10, p=0.03)). Four children died, all under 2 due to fentanyl poisoning. Fifty-two percent of patients' families had prior child protective services (CPS) involvement, with higher odds in children under age 2 (OR 4.57 (1.42 to 14.7), p=0.01)). A family history of opioid abuse was reported in 65% of cases. Nearly half of patients were discharged to an out-of-home placement.

The increase in SCAN consults for opioid ingestions, primarily fentanyl-related, highlights the urgent need to address opioid exposure among children. Young children and non-Hispanic Black patients are disproportionately affected. Most ingestions occur in familiar settings, and pre-hospital care is often provided by emergency medical services, with many children transferred from general emergency departments. Results from this study can guide education, advocacy, and policy efforts to address the impact of the opioid crisis on children.

Race and Ethnicity Trends Over Time

There was an eleven-fold increase in the number of Non-Hispanic, Black patients consulted by the SCAN team between 2019 and 2023 compared to previous years.

Urine Drug Screen Results Over Time

There were 45 patients (65% of all) who tested positive for fentanyl, mostly all after 2019.