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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. Caustic ingestions are seen most often in young children between one and three years of age, and can cause severe acute injury and long-term complications, especially the development of esophageal strictures [1-5].

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 2015, 2.2 million toxic exposures in humans were reported in the United States, of which about half occurred in children five years or younger [6]. The most commonly ingested caustic substances were household cleaning products (particularly household bleach), which accounted for 11 percent of the toxic ingestions in young children and cosmetics or personal care products. Caustic ingestion is most common in young children between one and three years of age [7], with boys accounting for 50 to 62 percent of cases [4,5].

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].


A substance is caustic if it is capable of burning or corroding organic tissue by chemical action, typically due to strong acid or alkaline properties.

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Literature review current through: Nov 2017. | This topic last updated: Nov 22, 2017.
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