Exposure to potentially toxic plants is a common occurrence in children, especially among those who are ≤5 years of age.^1,2 The risk associated with plant exposures is very low, resulting in minimal morbidity and nearly no mortality.^1,2 The American Association of Poison Control Centers reports that plant exposures are the 10th most common causes of toxicity in children ≤5 years.² In the most recent annual report, there were only two plant-related fatalities. One involved the unintentional ingestion of the highly toxic Aconitum napellus (monk’s-hood, aconite, wolfsbane), while the other occurred in a child of an unknown age who ingested Manihot esculenta (cassava).² Ingestion is the most common route of exposure, and unless stated otherwise, all of the information in this chapter will pertain to the ingestion route of exposure.

Although most plant exposures have a positive outcome and do not require medical attention, the exposures often result in caretaker anxiety and emergent interaction with the health care system. Children ≤5 years are vulnerable to unintentional plant exposures for a variety of reasons, which include carelessness by adults (placing plants in areas that are accessible to children), curiosity and hand-to-mouth activity of children, attractive plant colors and fragrances, and associating household and exterior plants as food. Contrary to poisoning exposures in general, where only 52.1% of the exposures involve children ≤5 years, 81.2% of all plant exposures occur in children ≤5 years.¹ Even more noteworthy is the preponderance of those exposures in children ≤1 year of age, where nearly 60% of the plant exposures occurred.¹ Children in this age group are vulnerable due to their rapidly developing mobility, hand-to-mouth activity, and improving motor skills, which allow them to ingest plant material such as leaves, stems, and berries that have fallen onto the floor or low tables.

Unintentional (accidental) plant exposures are uncommon in children aged 6 to 12. Fatalities rarely if ever occur, and the outcomes of exposures are generally positive. However, in the 13- to 19-year age group, plant exposure is typically due to recreational substance use. Morbidity increases, and there are rare fatalities.

The physician managing a child who has ingested a plant is faced with four challenges: identification of the plant, determining if it is toxic, determining whether the ingestion was accidental, intentional, or if the botanical material was prepared as a home remedy, and determining if emergent intervention is necessary. Plant identification is often difficult. Consider sending a digital photo of the plant to a resource with expertise, such as a regional poison information center, a florist, or a botanist. Be wary of common names for plants, because nicknames and regional common names can refer to different plants. The regional poison information center is a valuable resource to advise whether intervention is indicated. In the United States and its territories, regional poison information centers provide 24/7/365 service and can be accessed by calling 1-800-222-1222.

Another consideration is the reason for the exposure. Toxicity is more likely and more pronounced if the ingestion is intentional for either abuse or medicinal purposes, because larger doses are involved.¹

Most plant exposures are nontoxic and can be managed with reassurance. If the young child is seen soon after ingestion of the plant, check the mouth for residual plant debris and remove if present. It may be useful to provide the child with a beverage to eradicate the adverse taste of the plant and to dilute any irritants within the oral cavity and stomach. Gastrointestinal decontamination utilizing emesis or lavage does not change patient outcome, since most of the exposures are nontoxic and because those interventions have no demonstrated utility.^3,4 The administration of activated charcoal may be beneficial if administered within the first hour after the ingestion, but its use should be restricted to the treatment of plant ingestions that are associated with significant toxicity or life-threatening potential.⁵ Antidote use is limited to a minimal number of rare indications, which are discussed in this chapter.

Thousands of plants have the potential to be toxic, but the majority of exposures involve a limited number of species that are found in and around the home. In Table 130-1, the 15 most common plant exposures are listed by rank, with their botanical name and a common name.¹ Frequency of exposure is a function of the prevalence of the plant in and around homes.

Potentially toxic plants are grouped by toxic effect; for example, gastrointestinal irritant, or by specific toxin, such as oxalate.

GASTROINTESTINAL IRRITANTS WITHOUT OXALATE

The majority of plants with the potential for at least minor toxicity belong to this category and it is the general caveat for most plant ingestions. These plants have the potential, if ingested in significant quantity, to produce nausea, vomiting, abdominal cramping, and diarrhea. Examples of this group are found in Table 130-2.^6–11