Unsuspected cocaine exposure in young children
S. J. Kharasch, D. Glotzer, R. Vinci, M. Weitzman and J. Sargent
Department of Pediatrics, Boston (Mass) City Hospital 02118.
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.
