Sir.—We describe three young children with suspected cocaine toxicity believed secondary to accidental ingestion or indirect exposure. Cocaine toxicity and its manifestations are well known for infants of mothers using cocaine and in adolescent or adult use. However, little has been reported of accidental exposure in preschool children. We suggest that children with new onset of seizures or unusual clinical presentations should be screened for cocaine and its metabolites.
Use of cocaine has reached epidemic proportions today. The Drug Abuse Warning Network is showing an 86% increase in cocaine-related emergency department admissions in 1 year. Patients present with emergent symptoms caused by cocaine or "crack" (free-base cocaine) use, including loss of consciousness, seizures, chest pain, "cocaine-bugs" or severe itching, sudden death, and malnutrition. Most patients are adults or teenagers, but recently infants born to addicted mothers and newborn infants who are breast-fed have also been found to be affected.