New Guidelines to Come for Poison IngestionCharcoal replaces Ipecac syrup as most effective home remedy

A bottle of Ipecac syrup is about as common in homes with children as rubbing alcohol, a thermometer or a box of bandages. For decades, parents have been encouraged to keep a bottle on hand to induce vomiting if their child swallows poison. But now new research suggests this may do more harm than good, and the research is so convincing that the syrup may soon no longer be available over the counter. In fact, The American Association of Poison Control Centers and the American Academy of Pediatrics are currently scribing new guidelines, due out later this fall, that may discourage the use of Ipecac in almost every poisoning. "Ipecac usually just returns half of what the child ingested. When you give it to them, you have to wait 20 minutes, and then they vomit for an hour; so if have to give them additional medication, you have to wait until their stomach settles. Ipecac can actually delay appropriate, life-saving treatment,” says Maria Mercurio-Zappala, the associate director of the New York City Poison Control Center in Manhattan. Rarely but seriously, the vomiting induced by Ipecac can even be violent enough to trigger brain hemorrhaging or tears in the stomach. Those are just a couple of reasons why poison control centers no longer recommend Ipecac to concerned parents when they call the poison control hotlines. In fact, last year poison control centers recorded 16,000 cases of Ipecac treatment for poison ingestion — down from 150,000 in 1996. Each year, unintentional poisonings from medicines and household chemicals kill about 30 children and prompt more than 1 million calls to the nation's poison control centers. According to the New York poison control center, in New York and the five boroughs, the most common source of poisoning is medication including aspirin, Tylenol and Motrin; for non-medication poisonings, the top culprits tend to be household cleaners and dish detergents. So what should concerned parent do now in the event of an accidental poisoning?

First and foremost, call your local poison control center, health professionals say. “Never use anything until you call us,” Mercurio-Zappala stresses. All experts agree that the best thing any parent can do when it comes to poison control and prevention is memorize this number: 1-800-222-1222. For poison ingestion, the most benign thing a parent can do, even while they are calling poison control, is give their child water to drink, as it will slow absorption; if the child inhaled something, like Clorox, bring them to fresh air, she urges. Depending on the source of the poisoning, poison control experts may very well tell you to use activated charcoal, Mercurio-Zappala explains. “We consider it a better product,” she says. Activated charcoal is charcoal powder that has been specially treated to attract and hold a wide range of chemicals including poisons. By binding to the charcoal, the poisons can't get into the bloodstream and travel throughout the body. "Over the years, we have been experimenting with how to give it to children, and we’ve found that when given cold in a cup, with a cover and straw, the majority of the time kids can get it down,” Mercurio-Zappala says. The standard dosage is one gram per kilogram of body weight, and it can be mixed with diluted juice or water. "We use it for everything except for iron overdoses,” she adds. The bottom line, Mercurio-Zappala says, “is that Ipecac has more problems than benefits, and there are very, very rare instances where we recommend Ipecac.” Sue Leahy, president of American Safety and Health Institute (ASHI) in New Paltz, N.Y., says that another problem with Ipecac is that “it smells horrible…and if a kid is suffering from poisoning, he or she is not about to take it!” The problem with poisoning, she says, "is that there are so many poisons out there and so many different ways of dealing with poisons. For example, if the ingested poison is corrosive in any form, you don’t want to bring it back up, so you use activated charcoal to bind to it. Ipecac is only for throwing up." “The biggest thing is don’t panic and call 911…and have them put you through to poison control and say what you think they took, how much they took of it, when they took it, and what the child is experiencing now,” Leahy says. And “follow their advice,” she warns. Any medical history on the child is also important because it may make a difference, Leahy urges. "Be sure to tell the poison specialist what allergies your child has or if they take any medications. And importantly, they will need to know the weight of the child because that affects how much medicine they get,” she says. Leahy’s advice? “Keep the Ipecac, have the activated charcoal just in case that is what you are told to use, but wait for instructions from poison control.”

Rose Ann Soloway, associate director of the American Association of Poison Control Centers (AAPC), in Washington, D.C., says, “The AAPCC is reviewing literature about the use of Ipecac. This review has been in the works for some time.” Soloway says new guidelines should be completed some time this fall. For now, she says, "Our message for parents is unchanged: In case of a poison emergency, call your poison center immediately.” If you have a poisoning emergency, call 1-800-222-1222. In New York City call, (212)-POISONS (764-7667). For more information, visit the AAPCC’s website at

The ABCs of Poison Prevention • Keep the number of your poison control center on or near your telephone • Keep all medicines and household poisons in their original, labeled child-resistant containers • Keep all potential harmful products high up in a locked cabinet, not under the sink • Don’t put food in non-food containers, and don’t store food with non-food products