Infant and toddler deaths associated with potent opioid exposure

Abstract

Learning Overview: After attending this presentation, attendees will understand the dangers of potent medications as they relate to infants, toddlers,
and young children. Case studies from the state of North Carolina will demonstrate what substances can harm an infant or child with environmental
exposure—one swallow or pill.
Impact on the Forensic Science Community: This presentation will impact the forensic science community by increasing awareness of the impact
of the opioid epidemic on infants and toddlers and by educating forensic investigators, pathologists, and postmortem toxicologists.
While most ingestions of household products are benign, there are a handful of substances in which one pill or a small dose of medication will be
sufficient to cause death in a small child, toddler, or infant. This concept is even more alarming with the modern-day opioid epidemic, which was
initially fueled by generous prescribing habits and later gave rise to potent illicit fentanyl analogues. Unlike a typical adult ingestion for purposes of
self-harm or pleasure, pediatric poisonings are usually the result of curiosity, exploration, a decreased or lack of sense of danger, or imitation of adults
and older sibling behavior.
Due to body composition and size of an infant or toddler compared to an adult, it’s not surprising to see that what may not cause death in an adult can
easily cause a small child to succumb. Ingestions of a single dose of prescription medication can produce elevated concentrations in postmortem blood
that may be confused with an intake of multiple doses. Without careful consideration and thorough investigations, these rulings may be considered
intentional homicidal poisonings instead of accidental poisonings. Cases involving oxycodone, liquid methadone, and fentanyl will be discussed in
detail. The popularity of highly potent opioids makes modern-day illicit substances far more dangerous to children. North Carolina has seen two cases
of fentanyl analogue poisoning that have been certified as means of poisoning with undetermined manner by the pathologists.
Multiple opioid case studies in toddlers and infants will be explained in detail to show incidents in which, after a thorough investigation, it was
concluded that a child was exposed to a small amount of illicit substance or pharmaceutical preparation.