Signs of Pediatric Medication Overdose and When to Call Poison Control

When a child swallows too much medicine-whether it’s a cough syrup, a painkiller, or even a pill meant for an adult-it can turn dangerous in minutes. Unlike adults, children’s bodies process drugs differently. Their organs are still growing, their weight is smaller, and their brains haven’t learned to avoid things that look like candy. That’s why even a single extra drop of liquid medicine can cause serious harm. You might not see symptoms right away, but damage could already be happening inside. Knowing the signs and acting fast can save a life.

What Does a Medication Overdose Look Like in a Child?

The signs of an overdose depend on what the child took. Some drugs cause drowsiness. Others make them hyperactive. Some affect breathing. Others cause seizures. Here’s what to watch for, broken down by type of medication.

Opioids-like oxycodone, hydrocodone, or fentanyl-slow down the body. If a child has taken these, you might notice:

• Pupils that look like tiny pinpricks
• Unresponsiveness-even if you shake them or shout
• Slow, shallow, or stopped breathing
• Blue or gray lips and fingernails
• Cold, clammy skin
• Gurgling or choking sounds, like they’re drowning

These are life-threatening. If you see any of these, call 911 immediately. Don’t wait. Fentanyl is especially dangerous-even a tiny amount can kill a child.

Acetaminophen (Tylenol) is the most common cause of pediatric poisoning. It’s in cold medicines, pain relievers, and fever reducers. The scary part? A child might seem fine for hours-even a full day-while their liver is quietly being damaged. Symptoms that show up later include:

• Nausea and vomiting
• Stomach pain
• Loss of appetite
• Yellowing of the skin or eyes (jaundice)
• Extreme tiredness or confusion

By the time these show up, it’s already serious. But if you catch it early-within 8 hours-there’s a treatment called N-acetylcysteine (NAC) that can prevent liver failure. After 16 hours, that treatment becomes much less effective.

Stimulants-like ADHD medications (Adderall, Ritalin)-can cause the body to go into overdrive. Watch for:

• Fast or irregular heartbeat
• High fever
• Agitation, panic, or hallucinations
• Seizures
• Difficulty breathing
• Extreme sweating or flushed skin

These can lead to stroke, heart attack, or organ failure. Even if the child seems “just hyper,” don’t assume it’s normal behavior.

Cough and cold medicines often contain antihistamines, decongestants, or cough suppressants. In kids, these can cause:

• Drowsiness or extreme agitation
• Blurred vision or hallucinations
• Fast heartbeat
• Difficulty urinating
• Seizures

Many of these medicines are sold in liquid form-and it’s easy to accidentally give too much. A common mistake? Giving both a cold medicine and a pain reliever, not realizing both contain acetaminophen. That’s how 70% of acetaminophen overdoses happen.

When to Call Poison Control vs. 911

This is the most important decision you’ll make.

Call Poison Control (800-222-1222) immediately if you suspect your child swallowed any medication they weren’t supposed to-even if they seem fine. Don’t wait for symptoms. Don’t try to Google it. Don’t wait to see if they “get better.” Call now. Poison Control experts are trained to ask the right questions: What was taken? How much? When? How old is the child? They’ll tell you exactly what to do next.

They can also guide you through the webPOISONCONTROL® tool, which gives real-time advice for non-emergency cases. It’s free, available 24/7, and used by hospitals across the U.S.

Call 911 immediately if your child shows any of these signs:

• Cannot be woken up
• Is not breathing or breathing very slowly
• Is having seizures or uncontrollable shaking
• Has blue or gray skin, lips, or nails
• Is having trouble swallowing or is drooling uncontrollably
• Has swelling of the face, lips, or tongue

These are emergencies. Every second counts. While you wait for help, if you have naloxone (Narcan) and suspect an opioid overdose, give one dose in the nose or muscle. Wait 2-3 minutes. If there’s no change, give another dose. Keep giving doses every 2-3 minutes until help arrives.

Why Waiting Is Dangerous

Parents often think: “They’re sleeping, but they’re breathing. Maybe they’ll wake up.” Or: “They didn’t throw up. Maybe they didn’t swallow much.” That’s how tragedies happen.

Acetaminophen doesn’t cause vomiting or pain right away. But liver cells start dying within hours. By the time the child looks sick, the damage may be irreversible.

Fentanyl-even in tiny amounts-is often mixed into other pills that look like prescription drugs. A child might think they’re taking a painkiller, but it’s actually a deadly dose of fentanyl. There’s no safe amount for a child.

Studies show that 47% of all medication exposures in kids happen under age 6. Most of those happen at home. Not in a stranger’s house. Not at school. Right where you store your meds.

How to Prevent Accidental Overdose

You can’t be perfect. But you can reduce the risk dramatically.

• Lock it up. Store all medications-prescription, OTC, vitamins, even CBD-in a locked cabinet. Not on the counter. Not in a purse. Not in a drawer the child can reach. CDC data shows 60% of poisonings happen in the child’s own home.
• Use child-resistant caps properly. They’re not foolproof. 20% of poisonings still happen even when caps are used. Always lock the cabinet after.
• Never call medicine “candy.” Even jokingly. Kids learn fast. If you say, “Here’s your medicine, it tastes like candy,” they’ll believe it.
• Use the right measuring tool. Never use a kitchen spoon. Use the dropper, syringe, or cup that came with the medicine. Many overdoses happen because people guess the dose.
• Check labels for acetaminophen. If you’re giving a cold medicine, check if it already has acetaminophen. Don’t give Tylenol on top of it. That’s the #1 mistake.
• Dispose of old meds. Don’t keep expired or unused medicines around. Take them to a pharmacy drop-off. Don’t flush them-unless the label says to.

What Happens After You Call for Help

If you call Poison Control, they’ll ask you to describe what was taken, how much, and when. They might tell you to:

• Give activated charcoal (only if directed)
• Watch for symptoms and call back in an hour
• Take the child to the ER

If you call 911, paramedics will check vital signs, give oxygen, start IV fluids, and may give antidotes like naloxone or NAC. At the hospital, they’ll run blood tests to check liver and kidney function. They’ll monitor breathing and heart rate for hours-even if the child seems fine.

Many parents feel guilty after an overdose. But this isn’t about blame. It’s about learning. The system is designed to protect us, but mistakes happen. What matters now is acting fast and getting help.

What’s Changing to Keep Kids Safer

There’s good news. Things are getting better.

In 2020, the FDA required liquid acetaminophen to come in unit-dose packaging. That means each dose is pre-measured in a single-use container. Since then, accidental overdoses in kids have dropped by 19%.

By 2025, all liquid medications will need standardized labels and measuring tools. That should cut another 45,000 dosing errors a year.

But the biggest threat now? Illicit drugs. Fentanyl is showing up in pills meant for kids. Marijuana products are being ingested by children who think they’re gummies. Between 2017 and 2022, pediatric exposures to medical marijuana jumped 1,475%.

That’s why prevention isn’t just about locking up your own meds. It’s about talking to grandparents, babysitters, and other caregivers. It’s about asking: “Do you keep your pills out of reach?”

Because in the end, it’s not about being perfect. It’s about being prepared. And knowing what to do when things go wrong.