With 2020 thankfully drawing to a close, the holiday season is upon us. The joy of the season can be marred though by accidental exposure to some widely-owned holiday articles. Possible, although probably not going to be as common this year, will be pediatric exposures to visiting family members’ medications.
HOLIDAY ORNAMENTS AND LIGHT
These generally present a foreign body hazard and not anything toxic. Licking the painted surfaces of ornaments would be considered such a minor exposure that toxicity would not be a concern. Biting down on an ornament or light would possibly present a laceration and/or choking concern.
One exception regarding lights would be the bubbling type. Although I have not seen them in stores this year, families might have older light sets. These can contain methylene chloride. It is a solvent and can irritate and possibly cause GI upset. Methylene chloride in sufficient quantities can be more problematic though – it is metabolized to carbon monoxide. With the small amount available in bubbling lights, it would unlikely to cause a CO problem.
HOLIDAY PLANTS
The notorious Poinsettia has a undeservedly bad reputation. Regardless of internet lore, this plant is minimally toxic. It would take many leaves to cause GI upset. The biggest concern would be a ‘grazing’ dog or cat which might ingest an appreciable amount.
The Christmas cactus which we see this time of year is not toxic.
Evergreen sprigs which we see in wreaths and mailbox hangings are not toxic, but can present a choking hazard.
Mistletoe which is used this time of year is, more often than not, of the artificial variety and, of course, not toxic.
If someone is using true mistletoe, the American varieties are not considered terribly toxic. It can cause GI upset most commonly. The European varieties can be cardiotoxic (glycosides). If using real plant material, it is best to limit amounts used and protect children from ingesting any material from these.
ALCOHOL
‘Tis the season to imbibe! However, pediatric exposure to ethanol can present a problem. With alcoholic drinks possibly laying about, curious children might ingest them. As a general guideline, more than a swallow of alcohol might pose a problem to a toddler. A mixed drink might be more dilute – but, can be pleasant-tasting and prone to larger ingestions.
Children can develop hypoglycemia, as well as the expected neurologic depression.
MEDICATIONS
With possible visits from grandparents and other relatives, medications not usually in the house will be available to curious children. “Pill minders” are a commonly encountered scenario at the Poison Center. As we see so many times, multiple lids opened, and pills spilled about make it difficult to know what drugs might have been ingested. Antidepressants, cardiovascular drugs and hypoglycemics are some of our most common acute concerns. Some drugs in these categories would require a holiday-ruining 24-hour admission.
This is a brief overview of what might be available during the holidays.
As always, the Poison Center is available 24/7 for questions and concerns.
Wishing you all a happy and healthy Holiday season!
Prepared by Scott Muir, Certified Poison Specialist, Tennessee Poison Center
I am interested in any questions you would like answered in the Question of the Week. Please email me with any suggestion at donna.seger@vumc.org.
Donna Seger, MD
Executive Director
Tennessee Poison Center
Poison Help Hotline: 1-800-222-1222