O3188: Characteristics of Children with Opioid Poisoning Consulted by a Child Protection Service

Background: The opioid epidemic in the United States significantly affects children, with rising opioid exposures, notably fentanyl, leading to fatal poisonings among young children. Increased adult opioid misuse also correlates with heightened child abuse and neglect, requiring intervention from the child welfare system. However, to date, there is no literature that describes the demographic, clinical, and social characteristics, as well as acute medical outcomes of children with opioid poisoning evaluated for child maltreatment. This study aims to address this gap by detailing these features among children consulted by the child protection team at our institution.

Methods: This retrospective cohort study conducted at a quaternary urban children's hospital analyzed children who received a Suspected Child Abuse and Neglect (SCAN) team consultation for opioid exposure between June 2012 and December 2023. Demographic, clinical, and social de-identified data were collected from medical records from an existing patient registry and entered into a REDCap database. Descriptive statistics were used to characterize the population, and comparisons were made based on age and fentanyl exposure.

Results: There were 69 consults for opioid ingestions, with a four-fold increase observed from 2019 to 2023. Most patients were under two years old (72%), with a notable proportion being non-Hispanic Black children (11-fold increase from 2019 to 2023). Fentanyl was the most common opioid. The majority (87%) of cases occurred in the patient's home or a relative's residence. The most common chief complaints were altered mental status, abnormal breathing, and seizures. Eleven patients presented in cardiac arrest (9 under age 2), and 71% had respiratory arrest or depression on presentation. Emergency medical services initially cared for 59% of patients, and 61% were transferred from 23 area hospitals. Naloxone was administered to 71% of patients, with higher odds in children under age 2 (OR 3.2, (1.04-9.8, p=0.04)). Fifty-eight percent were admitted to the ICU, with higher odds for those under age 2 (OR 3.33 (1.1 to 10, p=0.03)). Four children died, all under 2 due to fentanyl poisoning. Fifty-two percent of patients' families had prior child protective services (CPS) involvement, with higher odds in children under age 2 (OR 4.57 (1.42 to 14.7), p=0.01)). A family history of opioid abuse was reported in 65% of cases. Nearly half of patients were discharged to an out-of-home placement.

Conclusion: The increase in SCAN consults for opioid ingestions, primarily fentanyl-related, highlights the urgent need to address opioid exposure among children. Young children and non-Hispanic Black patients are disproportionately affected. Most ingestions occur in familiar settings, and pre-hospital care is often provided by emergency medical services, with many children transferred from general emergency departments. Results from this study can guide education, advocacy, and policy efforts to address the impact of the opioid crisis on children.