Unintentional Confusion of Semantics Is Not Accidental

To the Editor:

At a recent national meeting cosponsored by the American College of Medical Toxicology, I was present as a research project was criticized for characterizing exploratory childhood ingestions of medications as “accidents.” The curiosity-driven ingestions of pharmaceuticals, chemicals, and plants by young children have often been referred to as “accidental” ingestions [1] because these children were not motivated by self-harm. However, most childhood ingestions may not be best classified as accidents, as the agents do not fall into the gastrointestinal tract by chance (they get there by deliberate action). Indeed, in 1998 the Journal of Toxicology—Clinical Toxicology published an editorial suggesting that the adjective “accidental” be removed from the lexicon of medical toxicology [2]. Despite this admonishment, a Medline search of publications regarding ingestions and poisonings among children aged 5 years and younger found 85 citations, between January 2000 and the third week of July 2002, that used “accidental” as a descriptor. Three of these citations were published within the Journal of Toxicology—Clinical Toxicology.

Other authors have chosen to classify exploratory consumption of potential toxins by young children as “unintentional ingestions” [3]. However, this descriptor is not entirely satisfying as most toddlers actually do mean to eat or drink the offending substance—they just do not realize that it may be harmful.

Effective communication is the foundation for scientific advancement, and the discipline of pediatric toxicology might benefit from affording more careful consideration to precision of semantics. Since physicians should know that oral exploration is a normal developmental process responsible for much of the observed epidemiology of early childhood poisoning, perhaps no modifiers need to be used when describing ingestions within the toddler age group. However, there may be times when a more accurate descriptive phrase for the curiosity-driven oral ingestions of young children is warranted. In such cases, descriptors such as “ingestions without intent of harm,” or “unintentional poisoning exposures,” might be more appropriate. The annual reports of the American Association of Poison Control Centers Toxic Exposure Surveillance System notably chooses to use the category of “unintentional,” rather than “accidental,” in its characterization of pediatric poisoning exposures. Again, since toddler-aged children rarely have intent of self-harm, such ingestion followed by physiologic derangement could be described as an “unintentional poisoning.”

Kevin C. Osterhoudt, M.D.

The Children's Hospital of Philadelphia

Philadelphia, Pennsylvania, USA