Signs of Pediatric Medication Overdose and When to Call Poison Control

When a child accidentally swallows too much medicine, time isn’t just important-it’s life or death. Many parents assume they’ll know right away if something’s wrong. But that’s not always true. Some overdoses don’t show symptoms for hours. Others look like a bad cold, a stomach bug, or just a sleepy kid. By the time you notice something’s off, it might already be too late. That’s why knowing the signs of pediatric medication overdose and when to call Poison Control isn’t optional-it’s essential.

What Counts as a Pediatric Medication Overdose?

A pediatric medication overdose happens when a child takes more than the safe dose of any medicine-prescription, over-the-counter, or even herbal. It doesn’t have to be intentional. A child finds a bottle, a caregiver misreads the label, or two different medicines with the same active ingredient are given by accident. In fact, 70% of acetaminophen overdoses in kids happen because parents unknowingly give two products that both contain it-like a cold medicine and a pain reliever.

Children under 6 are at the highest risk. According to the American Association of Poison Control Centers, nearly half of all medication exposures in the U.S. involve kids this young. And while child-resistant packaging helps, 20% of poisonings still happen because it wasn’t used properly-or the child figured out how to open it.

Common Signs of Overdose by Medication Type

Not all overdoses look the same. The symptoms depend on what was taken. Here’s what to watch for, broken down by category.

Opioids: Fentanyl, Oxycodone, Codeine

Opioids slow down breathing-and in kids, that can happen fast. The signs are often subtle at first, then sudden:

• Pinpoint pupils (tiny, dark dots in the center of the eyes)
• Unresponsive to loud noises or shaking
• Slow, shallow, or stopped breathing
• Gurgling or choking sounds (like they’re drowning but awake)
• Limp body, cold and clammy skin
• Lips, fingernails, or skin turning blue, purple, or gray

If you see even one of these, don’t wait. Call 911 immediately. If you have naloxone (Narcan), use it right away. One dose, then wait 2-3 minutes. If there’s no change, give a second dose. Keep giving doses every 2-3 minutes until help arrives.

Acetaminophen (Tylenol)

This is the most common single substance involved in pediatric poisonings. The problem? You might not see any symptoms for 24 hours. By then, liver damage is already happening.

Early signs (within the first 24 hours) are mild and easy to miss:

• Nausea or vomiting
• Loss of appetite
• Abdominal pain
• General tiredness

But here’s the catch: even if your child seems fine after taking too much, you still need to act. The Cleveland Clinic says N-acetylcysteine (NAC), the antidote, is 100% effective if given within 8 hours. After 16 hours, its effectiveness drops to 40%. That’s why calling Poison Control immediately-even if your child seems fine-is critical.

Stimulants: ADHD Medications (Adderall, Ritalin)

These drugs speed up the body. An overdose can turn a hyperactive child into someone in medical crisis:

• Extreme irritability or panic
• Rapid or irregular heartbeat
• High blood pressure
• High body temperature (over 104°F)
• Seizures
• Confusion, hallucinations, or paranoia
• Blurred vision or loss of coordination

Children may also have chest pain, trouble breathing, or pass out. This isn’t a wait-and-see situation. Call 911 right away.

Cough and Cold Medicines

These are common culprits, especially in toddlers. Many contain antihistamines, decongestants, or cough suppressants that can be dangerous in high doses.

Watch for:

• Drowsiness or extreme sleepiness
• Fast heart rate
• Flushed skin
• Difficulty urinating
• Seizures or tremors
• Blurred vision or dilated pupils

The American Academy of Pediatrics warns that cough and cold medicines account for nearly 8% of all pediatric poisonings. And since they’re often kept in the bathroom or kitchen, they’re easy for kids to reach.

When to Call Poison Control vs. 911

This is where confusion kills. You need to know the difference.

Call Poison Control at 1-800-222-1222 if:

• You suspect your child took medicine but they have no symptoms yet
• You’re unsure how much was taken
• You need advice on whether to go to the ER
• You’re dealing with a non-life-threatening exposure (like a small amount of ibuprofen)

Poison Control is staffed 24/7 by nurses and pharmacists trained in toxicology. They’ll ask what was taken, how much, and when. Then they’ll tell you exactly what to do. Don’t wait for symptoms. Even if your child seems fine, call.

Call 911 immediately if your child has:

• Lost consciousness or can’t be woken up
• Stopped breathing or is breathing very slowly
• Is having seizures or uncontrollable shaking
• Has blue or gray lips or skin
• Is having trouble swallowing or has facial swelling
• Is having a severe allergic reaction (hives, swelling of tongue or throat)

Don’t waste time trying to figure it out yourself. If it looks life-threatening, dial 911. Then call Poison Control while you wait for help.

What to Do While Waiting for Help

If your child is unresponsive:

1. Check if they’re breathing. Look for chest movement. Listen and feel for air.
2. If they’re not breathing, start rescue breaths. Tilt their head back slightly, pinch the nose, and give one breath every 3 seconds.
3. If you have naloxone and suspect opioids, give one dose into the nose or muscle. Wait 2-3 minutes. If no response, give another.
4. Stay with them. Keep them on their side if they’re breathing but unconscious. This keeps their airway open.
5. Don’t try to make them vomit. Don’t give them water, milk, or anything else unless Poison Control says so.

If they’re awake and alert, gather the medicine bottle, any leftover pills, and the time it was taken. Bring this with you to the hospital.

Prevention: How to Keep Medications Out of Reach

Most pediatric overdoses happen at home. Here’s how to stop them before they start:

• Lock up all medicines-even vitamins and supplements-in a cabinet with a childproof lock. The CDC says 60% of poisonings happen in the child’s own home.
• Never call medicine “candy.” Kids remember words. If you say it’s candy, they’ll think it’s okay to eat.
• Use the measuring tool that comes with liquid medicine. A kitchen spoon is not accurate. A teaspoon can be 20% more or less than it should be.
• Keep a list of all medications in your home, including doses and times. This helps if you need to explain what was taken.
• Dispose of old or expired medicines properly. Many pharmacies have take-back bins. Don’t flush them or throw them in the trash.
• Be extra careful with visitors’ medications. A grandparent’s painkiller or aunt’s anxiety pill can be deadly in a child’s hands.

What’s Changed in Recent Years

The landscape of pediatric poisoning is shifting. Since 2020, the FDA required liquid acetaminophen to come with standardized measuring devices and clearer labeling. That’s helped reduce dosing errors by 19%.

But new risks are rising. Medical marijuana products-edibles, oils, patches-have seen a 1,475% increase in pediatric exposures since 2017. In 2022 alone, over 4,500 children were exposed. Many of these products look like candy or juice boxes.

And fentanyl is showing up in unexpected places. Illicit pills sold as oxycodone or Xanax may contain deadly doses of fentanyl. Even a tiny amount can kill a child.

The good news? Poison Control’s online tool, webPOISONCONTROL®, launched in 2023, now handles over 120,000 cases a year. You can go online, answer a few questions, and get instant advice for non-emergencies. But if there’s any doubt-call the hotline. Or call 911.

Final Reminder: When in Doubt, Call

You don’t need to be sure. You don’t need to wait for symptoms. You don’t need to be a doctor. If you think your child might have taken too much medicine-call Poison Control. Now.

It’s not alarmist. It’s science. The window for treatment is narrow. The body doesn’t wait. And in pediatric medicine, seconds matter more than you think.