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Caustic esophageal injury in children

Douglas S Fishman, MD
Section Editor
Craig Jensen, MD
Deputy Editor
Alison G Hoppin, MD


Accidental ingestion of caustic agents continues to be a major concern for pediatric emergency department clinicians and the many pediatric sub-specialties involved in the management of the acute injury and long-term complications, especially the development of esophageal strictures [1-5]. Caustic ingestion is seen most often in young children between one and three years of age [6], with boys accounting for 50 to 62 percent of cases [4,5].

The evaluation and management of a child with suspected ingestion of a caustic substance is described here. Caustic esophageal injury in adults is discussed separately. (See "Caustic esophageal injury in adults".)


The National Poison Data System (NPDS) compiles data annually from a population of approximately 300 million people served by the American Association of Poison Control Centers (AAPCC). In 2014, 2.1 million toxic exposures in humans were reported in the United States, of which 48 percent occurred in children five years or younger [7]. The exposure to household cleaning products comprised 11 percent of the cases in young children, among which household bleaches were particularly common. Other potentially caustic substances frequently involved in accidental ingestions were cosmetic products including hair relaxer, automatic dishwasher agents, laundry detergents, swimming pool products, and toilet bowl and oven cleaners. Alkaline agents were more commonly ingested compared with acidic agents.

Most ingestions by children are accidental and the amounts ingested tend to be small. The opposite is the case in adolescents and adults, in whom ingestion often is deliberate and related to attempted suicide [8,9]. In such cases, the amount ingested may be large and the injury to the esophagus and stomach often severe [10]. Cases of alkali ingestion as a result of child abuse have been reported [11,12].

Risk of injury by type of ingestion — Esophageal burns account for most of the serious injuries and leads to the chronic complications associated with toxic ingestions, and have been reported in 18 to 46 percent of caustic ingestions in children [6,13-18]. Injury to the lips, oropharynx, and upper airway also may occur.


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Literature review current through: Sep 2016. | This topic last updated: Aug 15, 2016.
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