February 1991

Unsuspected Cocaine Exposure in Young Children

Author Affiliations

From the Department of Pediatrics, Boston (Mass) City Hospital, and Boston University School of Medicine.

Am J Dis Child. 1991;145(2):204-206. doi:10.1001/archpedi.1991.02160020096025

• 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 breast-feeding, 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.(AJDC. 1991;145:204–206)