Official reprint from UpToDate®
www.uptodate.com ©2016 UpToDate®

Management of radiation exposure in children following a nuclear disaster

Joseph Y Allen, MD
Erin E Endom, MD
Section Editor
Daniel F Danzl, MD
Deputy Editor
James F Wiley, II, MD, MPH


Radiation exposure in children is a rare occurrence. However, the potential for radiation exposure is significant.

Physicians who treat patients who are exposed to radiation must understand the biologic effects of the various types of radiation in order to determine which patients are at risk for radiation injury, to manage patients with radiation exposure, and to minimize the risk of contamination of hospital equipment and personnel.

The management of the various types of radiation injury in children will be reviewed here. Clinical features of radiation injury in children and adults, treatment of radiation injury in adults, and the emergency care of thermal burns in children and adults are discussed separately:

(See "Clinical features of radiation exposure in children".)

(See "Biology and clinical features of radiation injury in adults".)


Subscribers log in here

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information or to purchase a personal subscription, click below on the option that best describes you:
Literature review current through: Sep 2016. | This topic last updated: Jul 23, 2015.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2016 UpToDate, Inc.
  1. Mettler FA, Royal HD, Drum DE. Radiation accidents. In: Textbook of Pediatric Emergency Medicine, 5th ed, Fleisher GR, Ludwig S, Henretig FM (Eds), Lippincott Williams & Wilkins, Philadelphia 2006. p.1033.
  2. American Academy of Pediatrics Committee on Environmental Health. Radiation disasters and children. Pediatrics 2003; 111:1455.
  3. National Council on Radiation Protection and Measurements. Management of Terrorist Events Involving Radioactive Material. National Council on Radiation Protection and Measurements, Bethesda, MD 2001.
  4. American Thyroid Association. American Thyroid Association endorses potassium iodide for radiation emergencies. American Thyroid Association, Falls Church, VA, 2001. www.thyroid.org/professionals/publications/statements/ki/02_04_09_ki_endrse.html. (Accessed on October 07, 2010).
  5. Vyas DR, Dick RM, Crawford J. Management of radiation accidents and exposures. Pediatr Emerg Care 1994; 10:232.
  6. Leonard RB, Ricks RC. Emergency department radiation accident protocol. Ann Emerg Med 1980; 9:462.
  7. Mettler FA Jr, Voelz GL. Major radiation exposure--what to expect and how to respond. N Engl J Med 2002; 346:1554.
  8. Guidance for Radiation Accident Management. www.orau.gov/reacts/guidance.htm. (Accessed on July 06, 2015).
  9. Shannon BE, Jenkins JL, Braen GR. Radiation Injury. In: Manual of Emergency Medicine, Lippincott Williams & Wilkins, Philadelphia 2000. p.435.
  10. Linnemann RE. Medical experience and preparedness for handling radiation injuries. J Med Assoc Ga 1989; 78:95.
  11. Jacob P, Kenigsberg Y, Zvonova I, et al. Childhood exposure due to the Chernobyl accident and thyroid cancer risk in contaminated areas of Belarus and Russia. Br J Cancer 1999; 80:1461.
  12. Rutherford, MW, Seward, JP. Radiation injuries and illnesses in pediatric emergency medicine. Clin Pediatr Emerg Med 2001; 2:141.
  13. Sholtis J. Ionizing radiation and their interactions with matter. In: Military Radiobiology, Conklin JJ, Walker RI (Eds), Academic Press, Orlando 1987. p.57.
  14. Darte JM, Little WM. Management of the acute radiation syndrome. Can Med Assoc J 1967; 96:196.
  15. Jones F. Neuropsychiatric casualties of nuclear, biological, and chemical warfare. In: Textbook of Military Medicine, Zajtchuk R (Ed), Office of the Surgeon General, Washington DC 1995. p.98.
  16. Jarrett, DG. Medical management of radiological casualities. Military Medical Operations Office. Armed Forces Radiobiology Research Institute. Bethesda, MD 1999. www.afrri.usuhs.mil.
  17. Littlefield LG, Joiner EE, DuFrain RJ, et al. Cytogenetic dose estimates from in vivo samples from persons involved in real or suspected radiation exposures. In: The Medical Basis of Radiation Accident Preparedness, Hubner KF, Fry SA (Eds), Elsevier, North Holland 1980. p.375.
  18. Reeves GI. Radiation injuries. Crit Care Clin 1999; 15:457.
  19. Guidance for Radiation Accident Management. www.orau.gov/reacts/guidance.htm (Accessed on December 07, 2005).
  20. Mettler FA, Royal HD, Drum DE. Radiation accidents. In: Textbook of Emergency Medicine, 5th ed, Fleisher GR, Ludwig S, Henretig FM (Eds), Lippincott Williams & Wilkins, Philadelphia 2006. p.1033.
  21. Fong F, Schrader DC. Radiation disasters and emergency department preparedness. Emerg Med Clin North Am 1996; 14:349.
  22. Asch SM. Radiation exposure. In: Pediatric Emergency Medicine: Concepts and Clinical Practice, Barkin RM, Caputo GL, Jaffe DM, et al (Eds), Mosby, St. Louis 1997. p.522.
  23. Management of Persons Contaminated with Radionuclides: Handbook. NRCP report no. 161, National Council on Radiation Protection and Measurement; Bethesda, MD, 2009.
  24. Zanzonico PB, Becker DV. Effects of time of administration and dietary iodine levels on potassium iodide (KI) blockade of thyroid irradiation by 131I from radioactive fallout. Health Phys 2000; 78:660.
  25. U.S. Food and Drug Administration, Home preparation procedure for emergency administration of potassium iodide tablets to infants and children using 130 milligram (mg) tablets. www.fda.gov/Drugs/EmergencyPreparedness/BioterrorismandDrugPreparedness/ucm072254.htm (Accessed on June 09, 2009).
  26. Conklin JJ, Walker RI, Hirsch EF. Current concepts in the management of radiation injuries and associated trauma. Surg Gynecol Obstet 1983; 156:809.
  27. Saenger EL. Radiation accidents. Ann Emerg Med 1986; 15:1061.
  28. Dubois A, Walker RI. Prospects for management of gastrointestinal injury associated with the acute radiation syndrome. Gastroenterology 1988; 95:500.
  29. Gale RP. Medical response to radiation and nuclear accidents: lessons for the future. J Natl Cancer Inst 1988; 80:995.
  30. Becker SM. Psychosocial assistance after environmental accidents: a policy perspective. Environ Health Perspect 1997; 105 Suppl 6:1557.