Paediatric poisoning fatalities: toxicological, forensic, and child protection considerations

Childhood poisoning remains a significant global public health concern and continues to rank among the leading causes of unintentional injury-related deaths in children aged 0–14 years. Even though many of these exposures are thought to be accidental, it can occasionally be challenging to determine the reason and purpose behind a particular occurrence. This review examines the epidemiology, mechanisms, and classifications of paediatric toxicological deaths, with emphasis on accidental, abuse-neglect-related -associated poisonings in children. The review discusses global and regional trends in paediatric poisoning mortality, highlighting age-specific risk patterns and the most commonly implicated toxic agents. It further explores the medico-legal classification of toxicological deaths, differentiating between natural and unnatural causes and emphasizing the critical role of forensic toxicology in determining the manner of death. Particular attention is given to intentional poisoning associated with child abuse, including drug-facilitated abuse and Munchausen syndrome by proxy, alongside key clinical and forensic indicators. The review also addresses toxic exposures resulting from neglect, including environmental toxins such as lead and carbon monoxide, unsafe living conditions, and patterns of chronic versus acute exposure. In addition, accidental poisonings involving household chemicals and medications are examined, with discussion of contributory factors such as inadequate supervision and unsafe packaging. Prevention strategies, public health interventions, and the importance of early recognition are emphasized throughout. This review highlights the need for multidisciplinary approaches involving healthcare professionals, forensic specialists, and public health systems to reduce paediatric toxicological mortality and improve child safety outcomes.