Introduction
Alcohol ingestion by young children can lead to a dangerous drop in blood sugar levels that can produce seizures, coma, permanent neurological damage and even death. Alcohol is more pervasive in the homes of North Americans than one would expect, and younger children are at risk of alcohol ingestions, too. Alcohol is present in a number of household items in addition to popular alcoholic beverages and many of these items, such as mouthwash and cosmetics, are readily accessible to children.

Household products that contain alcohol can be categorized into medicinal, cosmetic, personal hygiene or cleaning products. Medicinal products include items such as over-the-counter cold medications and non-prescription items.

Cosmetics include perfumes, colognes, make-up and hairstyling items. Personal-hygiene products include deodorants, shampoos, face and body washes, shaving-related items, toothpastes, mouthwashes, and hand sanitizers. Finally, cleaning products encompass most household cleaners such as deodorizers, surface polishes, hand and dish liquids, detergents and softeners.

Alcohol is the second-most common active principal ingredient in childhood poisoning seen in emergency departments. Serious adverse events that result from alcohol poisoning include decreased blood sugar levels, seizures and death.

It should be noted that many children may have been safely observed at home after ingesting a small quantity of a substance and the actual incidence of ingestion of household substances containing ethanol may be higher. Due to the widespread accessibility of household items to children, parents and other caregivers should be aware of household agents that contain alcohol to institute proper storage and prevent childhood poisonings.

Medicinal Products
Alcohol has a well-documented history of being used for medicinal purposes, including being given to infants for conditions such as teething pain or for pain management of circumcision. Parents should be cautioned to refrain from rubbing alcohol on baby’s gums to relieve teething pain.

Alcohol is often added to nonprescription cough and cold medications and overdosing or misuse of this medication can lead to intoxication. Alcohol may be an ingredient in some alternative or “natural” medicinal products and parents should be cautious about the alcohol content and the use of these products in young children.

Cosmetic Products
Perfumes and colognes have 50-99% alcohol content. Fortunately, the frequency of significant poisonings is low and may be due to the poor palatability of these agents.

As ingestion of very small amount of these products with high alcohol concentrations by infants and toddlers can lead to significant poisoning and associated drop in blood sugar, however, all children that ingest these products should be checked by a health care professional.

Personal Hygiene Products
Hygiene products such as toothpaste and mouthwashes are readily accessible items to children, are especially attractive to children due to their typical usage in oral care, or are infused with fragrances and flavors associated with foods (such as vanilla or fruit.)

Of particular concern is mouthwash. Mouthwashes contain a significant amount of ethanol, approximately 26.9% in some brands, which is comparable to the alcohol content in liquor. Teenagers intentionally ingest mouthwash solely for its alcohol content-to get drunk. YouTube videos and media reports of teenagers getting drunk on mouthwash highlight the prevalence of this problem. (Toddlers even drink it due to their easy accessibility, eye-catching colors, and sweetened flavor.) Parents should know that there are mouthwashes on the market that do not contain alcohol and may want to purchase them for use at a home.

Cleaning products
Cleaning products are often scented to smell like fruits or flowers, may come in eye-catching colors and packaging, and are found in kitchen and bathroom cupboards-all of which make them attractive and easily accessible to children. Although some cleaning products contain alcohol, the serious effects of ingesting a cleaning product is usually due to other corrosive substances such as acids or alkali.

Disinfectants are considered low risk for severe adverse effects when ingested in small quantities, but in larger amounts can cause corrosive effects, acidosis, depressed level of consciousness, aspiration pneumonia, or liver and kidney damage due to other potentially toxic ingredients rather than alcohol alone.

Alcohol-based hand sanitizers provide a significant risk of intoxication due to their 60-95% ethanol content. Absorption of alcohol through the skin, regardless of frequency of use, is considered unlikely. Some hand sanitizers have a pleasant citrus odor, which increases the likelihood of accidental ingestion. Ingestions of sanitizers have been reported to be associated with significant alcohol poisoning, drop in blood sugar and coma.

Discussion
Many household items that are easily accessible to young children contain significant amounts of alcohol in them (please see Household Products Database http://hpd.nlm.nih.gov/cgi-bin/household/brands?tbl=chem&id=151 for full information)

Preventing ingestion of common household products containing alcohol is the most effective strategy to reduce childhood poisonings due to household products. The 1995 Consumer Product Safety Commission legislation mandated that mouthwashes with greater than 3gms ethanol content required childproof closures.

Current mouthwash formulas typically have less ethanol content, ranging typically from 5 to 25% ethanol, which may have acted to reduce the severity of mouthwash ingestions seen despite increased mouthwash sales in the United States.

Labels of hand sanitizers currently state that the product should be kept out of reach of children, but do not mention the risks of ingestion. Labels should also clearly highlight whether the product contains a significant quantity of alcohol to provide parents and health care providers key information for management strategies.

Parents should pay attention to proper storage of alcohol-containing products to avoid accidental ingestions. The recommended management for alcohol ingestion, in both pure and household product compositions, is largely supportive with close monitoring. Ingestion of the equivalent of 1.2 ml/kg pure ethanol often necessitates hospitalization and regular glucose checks, while ingestion of 0.4 ml/kg or more should be monitored for at least four hours.

As such, children who have ingested significant amounts of products containing ethanol or those who show any change in behavior or other signs and symptoms should be promptly taken to a health care facility. This also applies to the toddler who drank some of the parent’s alcoholic drink when it was left unattended. Letting a child sleep off a significant ingestion is not a good idea as unrecognized drops in blood sugar can have catastrophic consequences.

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From issue: 29/01-02