Signs of Pediatric Medication Overdose and When to Call Poison Control

What to Watch For When a Child Might Have Taken Too Much Medicine

If your child swallowed a pill they weren’t supposed to, or you’re not sure how much they took, don’t wait for symptoms to show. Many dangerous overdoses don’t start with crying or vomiting - they start quietly, and by the time you notice, it’s already too late.

Children’s bodies process medicine differently than adults. A single extra pill, a teaspoon too much, or even a few drops of liquid can push a child into medical danger. The most common culprits? Acetaminophen (Tylenol), cough syrups, ADHD meds, and opioids like oxycodone or fentanyl - even when they’re prescribed.

Here’s what you need to know: signs of pediatric medication overdose aren’t always obvious. Some show up in minutes. Others take hours. And some? They don’t show up at all until the damage is done.

Key Signs of Overdose by Medicine Type

Not all overdoses look the same. The symptoms depend on what the child took. Knowing the red flags for each category can save a life.

Acetaminophen (Tylenol)

This is the most common single substance involved in pediatric poisonings. The scary part? A child can seem perfectly fine for 24 hours after swallowing too much - even if their liver is already being destroyed.

Early signs (within 24 hours) may include:

• Nausea or vomiting
• Loss of appetite
• Abdominal pain, especially on the right side
• Extreme tiredness or drowsiness

After 24 to 48 hours, symptoms worsen: yellowing skin or eyes (jaundice), confusion, bleeding easily, or even coma. The good news? If you act fast, there’s a treatment called N-acetylcysteine (NAC) that can stop the damage - but only if given within 8 hours. After 16 hours, it’s only about 40% effective.

Opioids (Oxycodone, Hydrocodone, Fentanyl)

These are used for pain, but even a small amount can shut down breathing. Fentanyl is especially dangerous - it’s 50 to 100 times stronger than morphine, and it’s now found in counterfeit pills sold as oxycodone or Adderall.

Warning signs include:

• Pinpoint pupils (tiny dots in the center of the eyes)
• Unresponsive to loud voices or shaking
• Limp body, slumped over
• Slow, shallow, or stopped breathing
• Blue or gray lips and fingernails
• Cold, clammy skin
• Gurgling or choking sounds (like they’re drowning)

If you see any of these, call 911 immediately. If you have naloxone (Narcan), give it now - even if you’re not sure it’s an opioid. One dose, then wait 2-3 minutes. If no improvement, give another. Keep giving doses until help arrives.

Stimulants (ADHD Medications like Adderall, Ritalin)

These drugs speed up the body. Too much can cause a dangerous spike in heart rate, temperature, and blood pressure.

Signs of overdose:

• Fast, shallow breathing
• High fever (over 104°F)
• Severe agitation, panic, or hallucinations
• Seizures or uncontrollable shaking
• Chest pain or racing heartbeat
• Confusion or loss of coordination

These kids may look hyper, not sleepy. But their body is in crisis. Don’t wait. Call poison control or 911.

Cough and Cold Medicines

These are often mixed with acetaminophen or antihistamines. Parents think they’re safe because they’re sold over the counter. But a few extra teaspoons can cause seizures, coma, or death in young children.

Watch for:

• Drowsiness or extreme lethargy
• Blurred vision or hallucinations
• Fast or irregular heartbeat
• Difficulty urinating
• Flushed, dry skin

These symptoms can appear within 30 minutes. And if the child took multiple products - like a cold syrup and a pain reliever - you could be looking at a double overdose.

When to Call Poison Control vs. 911

You don’t have to be sure. If you think your child took too much medicine, call Poison Control. Now. Even if they seem fine.

The national Poison Control number is 800-222-1222. It’s free, confidential, and available 24/7. You can also use webPOISONCONTROL® online for non-emergency cases.

But if your child has any of these symptoms, call 911 immediately:

• Unresponsive or can’t be woken up
• Not breathing or breathing very slowly
• Seizures or violent shaking
• Blue or gray lips, face, or fingernails
• Swelling of lips, tongue, or throat
• Severe rash or hives spreading quickly

Don’t wait to see if they get worse. Don’t try to make them throw up. Don’t give them milk or charcoal unless a professional tells you to. Just call.

And here’s the most important thing: call Poison Control even if you think it’s a small amount. A child weighing 20 pounds can have a fatal reaction to just one adult-strength pill. And with acetaminophen, you might not know it’s dangerous until it’s too late.

What to Do Right Now - Even Before Help Arrives

While you’re waiting for emergency services or talking to Poison Control, do this:

1. Check if your child is breathing. Look for chest movement. Listen for breath sounds.
2. If they’re not breathing, start rescue breathing if you know how.
3. If they’re unresponsive, rub your knuckles firmly against their sternum or upper lip. This can sometimes wake them up.
4. If you have naloxone and suspect opioids, give it now. One spray in one nostril. Wait 2-3 minutes. If no response, give another dose.
5. Keep the medicine container. Bring it with you to the hospital.
6. Don’t give anything by mouth unless told to.

Time matters. The sooner you act, the better the outcome.

Why Most Overdoses Happen - And How to Prevent Them

Over 60% of childhood poisonings happen in the child’s own home. And 70% of acetaminophen overdoses happen because parents give two medicines that both contain it - like giving Tylenol for fever and a cold syrup that also has acetaminophen.

Here’s how to prevent this:

• Store all medications in a locked cabinet - not just out of reach. Kids are smarter than we think.
• Use child-resistant caps correctly. But don’t rely on them. They’re not foolproof.
• Never call medicine “candy.” Even joking about it teaches kids to trust pills.
• Always read labels. Look for the active ingredient. If two medicines have the same one, don’t give both.
• Use the measuring device that comes with the medicine. Don’t use kitchen spoons.
• Keep track of what your child takes. Write it down. Set phone reminders.

Since 2020, the FDA required liquid acetaminophen to come with unit-dose packaging and clearer labels. That alone has cut unintentional overdoses by 19%. But mistakes still happen.

What You Need to Remember

Medication overdose in children isn’t rare. It’s the second leading cause of unintentional injury death for kids ages 1 to 4. Between 2018 and 2022, over 1,500 children died from medication poisoning in the U.S.

But most of these deaths are preventable.

If you suspect your child took too much medicine - call Poison Control at 800-222-1222. Don’t wait. Don’t Google it. Don’t hope they’ll be fine. The window for saving a life is narrow, especially with acetaminophen or opioids.

And if they’re not breathing, unresponsive, or turning blue - call 911 right now. Seconds count.

Keep the Poison Control number saved in your phone. Tell every caregiver who watches your child where it is. Post it on the fridge. Teach your older kids what to do if they find medicine.

You can’t control everything. But you can control how fast you respond.

Frequently Asked Questions