Acute Exposures

Poison Control Center data shows over 35,000 calls related to pesticide exposure concerns for children ≤5 years old in 2018. Most serious acute poisonings occur after unintentional ingestion, although poisoning may also follow inhalational exposure or significant dermal exposure, such as in drift events. Misuse, such as violating label instructions, may also lead to overexposure. It is well recognized that pesticide poisonings are likely to be underreported because of difficulty with diagnosis, incomplete reporting and symptoms not being recognized as a poisoning. High-risk children may include those who:

• Spend time where pesticides are applied or stored
• Live next to agricultural land
• Work in agriculture or on family farms
• Live in households with someone who works with or around pesticides

Pesticide Toxicity

Pesticides are toxic by design. Insecticides and rodenticides are most commonly associated with acute pediatric poisoning. Warfarin-type rodenticides are also a significant ingestion risk for young children. Many insecticide chemical classes designed to be neurotoxic for insects have been shown to be neurotoxic in humans, such as the cholinesterase-inhibiting organophosphate and carbamate insecticides and the pyrethroids. Toxicity varies by the active ingredient(s) and formulation.

Making the Diagnosis

Many signs and symptoms related to acute pesticide exposure are nonspecific and resemble other common childhood illnesses. Diagnosis depends on identifying an exposure and determining that the exposure scenario was likely to lead to significant uptake and the signs and symptoms experienced.

Exposure History

Determine if the child might have been exposed to pesticides in suspected illness events.

Verify:

• Active ingredient(s), and associated concentration of the pesticide(s) involved (best if can access the pesticide product label)
• Route and duration of the exposure (dermal, oral, ocular, inhalation)
• Timing of the exposure in relation to onset of symptoms
• If exposure is ongoing (on skin, clothes, hair, personal items, household environment)

Determine if the pesticide of concern is associated with the signs and symptoms. The EPA’s Recognition and Management of Pesticide Poisonings offers a comprehensive online Index of Signs and Symptoms organized by pesticide class.

Linkage of signs and symptoms to pesticide exposure, further workup, and poisoning management may require specialist consultation. For poisoning management, contact the Poison Control Center (800-222-1222). The regional Pediatric Environmental Health Specialty Units (PEHSU) programs can provide consultation for subacute concerns, post-acute phase questions, or assistance in determining pesticide active ingredients and potential toxicity.

Diagnostics and Laboratory Tests

Cholinesterase testing may be useful for guiding the early treatment of suspected organophosphate and carbamate poisoning. Preserved urine or clothing samples may be useful for future analysis as evidence of exposure or to assist in public health investigations. Samples should be obtained as soon as possible as many pesticides metabolize quickly.

Reporting

Clinician reporting of suspected pesticide-related illnesses is required by law in many states. Regardless, clinicians should notify the local or state public health department or state pesticide regulatory agency if the exposure source may present a hazard to others or if help is desired in identifying an environmental exposure source. State-specific reporting requirements can be found at PERC-med.

Download Acute Pediatric Pesticide Poisoning Resource

Download Chronic Pediatric Pesticide Poisoning Resource

References

1. Pesticide Educational Resources Collaborative – Medical (PERC-med). (2021). /med/
2. Roberts, J. R., & Karr, C. J. (2013). Council on environmental health. Technical report: pesticide exposure in children. Pediatrics, 131(5), 1013–1014. https://doi.org/10.1542/peds.2013-0577
3. Roberts, J. R., & Reigart, J. R. (2013). Recognition and management of pesticide poisonings. United States Environmental Protection Agency, Office of Pesticide Programs.

Acknowledgments

The Pesticide Educational Resources Collaborative – Medical is a cooperative agreement (agreement #X-83935901) between the U.S. EPA's Office of Pesticide Programs and University of California Davis Extension, in collaboration with Oregon State University.

Adapted from material originally supported by the American Academy of Pediatrics (AAP) and funded (in part) by the cooperative agreement award number 5 NU61TS000296-02-00 from the Agency for Toxic Substances and Disease Registry (ATSDR). The U.S. Environmental Protection Agency (EPA) supports the PEHSU by providing partial funding to ATSDR under Inter-Agency Agreement number DW-75-95877701. Neither EPA nor ATSDR endorse the purchase of any commercial products or services mentioned in PEHSU publications.