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Unsuspected cocaine exposure in young children
S J Kharasch1, D Glotzer, R Vinci
1Department of Pediatrics, Boston (Mass) City Hospital 02118.
Insights
Cocaine exposure is unexpectedly common in inner-city children under five, with 2.4% testing positive. This study highlights a significant public health concern in a clinically unsuspected population.
Area of Science:
- Pediatric Environmental Health
- Toxicology
- Public Health
Background:
- Childhood exposure to illicit substances poses significant health risks.
- Clinical signs of cocaine exposure in young children are often subtle or absent.
- Inner-city populations may face higher risks due to socioeconomic factors.
Purpose of the Study:
- To determine the prevalence of cocaine exposure in preschool children presenting with non-specific symptoms.
- To identify the incidence of cocaine metabolite benzoylecgonine in urine samples of young children.
- To assess the clinical presentation of children with unsuspected cocaine exposure.
Main Methods:
- A prevalence study was conducted in a pediatric emergency department.
- Urine assays for cocaine metabolite benzoylecgonine were performed on 250 children aged 2 weeks to 5 years.
- Children were selected prior to discharge, regardless of presenting complaint.
Main Results:
- Six (2.4%) of 250 children tested positive for benzoylecgonine.
- All positive cases involved children under 24 months of age.
- None of the children with positive tests had symptoms typically associated with cocaine exposure.
Conclusions:
- A significant proportion of inner-city infants and young children are exposed to cocaine.
- Cocaine exposure in this population is often clinically unsuspected.
- Potential exposure routes include breastfeeding, ingestion, and passive inhalation.
Objective:
To determine the prevalence of cocaine exposure among preschool children with clinically unsuspected signs and/or symptoms.
Design:
Prevalence study.
Setting:
Pediatric emergency department in an inner-city hospital.
Participants:
250 children aged 2 weeks to 5 years who underwent urine assays for cocaine prior to discharge from the emergency department.
Interventions:
None.
Measurements/Main Results:
Six (2.4%) of the 250 urine assays (95% confidence interval, 0.5% to 4.3%) were positive for benzoylecgonine, the major urinary cocaine metabolite. Four of the positive urine assays were from children younger than 1 year and all children with positive urine assays were younger than 24 months. None of these children presented with a complaint or was identified as having clinical problems currently associated with childhood exposure to cocaine. Possible exposure routes include breastfeeding, intentional administration, accidental ingestion of cocaine or cocaine-contaminated household dust via normal hand-to-mouth activity, and passive inhalation of "crack" vapors.
Conclusion:
Among the inner-city children served by this hospital, significant numbers of infants and young children are being exposed to cocaine, and this exposure occurs in a clinically unsuspected population.