Toxic Exposures

Differences between children and adults place children at increased risk for exposure in many toxicological disasters (Box 1). Shorter stature can make children more vulnerable than adults. Many chemical agents are more dense or heavier than air and consequently exist in higher concentrations closer to the ground. The same principle applies to nuclear contamination. A shorter person will be exposed to a higher concentration of chemicals and radiation simply by being closer to the ground.

Children also have a larger skin surface area to body mass ratio than adults. This increases their risk of absorption of toxins through the skin. A larger skin area to body mass ratio together with less subcutaneous fat places a child at higher risk for hypothermia with decontamination. A child’s skin has less keratinization, allowing corrosives to cause greater injury. Children also have higher minute ventilation per body mass. Therefore, pediatric exposures to aerosolized or gaseous toxins will be more extensive than with adults.

Children also have a decreased fluid reserve compared with adults, and are at increased risk for dehydration with repetitive vomiting or diarrhea associated with toxic exposures or food-born illness. In addition, immature motor skills and cognitive functioning may make it less likely that the children will remove themselves from a dangerous situation.