Children are natural explorers with a tendency to get into things they shouldn't. Whether it's a colorful berry on a walk or a decorative plant in the living room, kids are constantly putting the world in their mouths, literally. So, it's no surprise that plant ingestions are among the most common calls to poison control centers across the globe.
While most of these exposures result in little to no clinical concern, a small number can pose genuine hazards. For healthcare providers, especially those in pediatrics or emergency medicine, knowing which plant exposures are benign and which could spiral into cardiac arrhythmias, seizures, or fatal toxicity is key.
Understanding Pediatric Plant Exposures
In 2023, poison control centers in the United States alone reported over 28,000 calls related to plants. Many of these cases resulted in no symptoms or only mild, self-limiting effects. In the past, Germany and Switzerland reported similarly high volumes of pediatric plant exposures with minimal clinical consequences. Serious outcomes requiring hospitalization or resulting in death occurred in a small number of cases. In Australia, fewer than 1% of pediatric plant poisoning cases involved moderate or severe toxicity, with most of those occurring in adults rather than children.
Despite the volume of calls, most plant ingestions involve low-toxicity species, such as peace lilies, philodendrons, and poinsettias. Even when the plants have known toxins, the quantity ingested in exploratory bites is usually minimal. That said, there are exceptions, and those are the ones we need to recognize quickly.
Identifying Low- and High-Risk Plants
Toxicity varies depending on multiple factors. Some parts of the plant are more dangerous than others. Roots and stems often have higher concentrations of toxins compared to flowers or berries. However, exceptions exist, such as the castor bean, which contains the deadly toxin ricin in its outer shell. Preparation matters too. Boiling certain plants, such as pokeweed, into teas can concentrate their toxic components. Chewing seeds or leaves, as seen with apricot pits or castor beans, can activate compounds that would otherwise pass through the gastrointestinal (GI) tract relatively harmlessly. Local growing conditions, soil content, and even the age of the plant can influence toxicity levels.
Recognizing Symptoms and Red Flags
Common Symptoms and Mild Reactions
Most pediatric plant ingestions present with GI symptoms. Nausea, vomiting, abdominal pain, and diarrhea are the bread and butter of toxic plant exposures. These symptoms are typically self-limited, particularly with ingestion of daffodil bulbs, mistletoe berries, or pokeweed leaves. The latter, however, can cause more intense symptoms, including hemorrhagic gastritis, especially when consumed as a concentrated folk remedy.
Some plants lead to mucosal irritation. Members of the Araceae family, like dieffenbachia and peace lilies, contain calcium oxalate crystals. These needle-like structures, known as raphides, cause localized swelling and pain when ingested. In rare cases, children may present with significant oral swelling, dysphagia, or airway concerns, but most experience only mild discomfort that resolves without intervention.
Serious Cardiac and Neurologic Risks
Where things take a more dangerous turn is in the realm of cardiotoxicity. Several plants contain cardiac glycosides that act similarly to digoxin. Foxglove, lily of the valley, and oleander can cause serious arrhythmias, hyperkalemia, and in extreme cases, death. These are not common in toddlers but are more likely in older children, teens, or adults who ingest these plants either intentionally or while foraging. Other plants, such as monkshood and yew, affect sodium or calcium channels, leading to ventricular arrhythmias, bradycardia, and even asystole.
On the neurologic side, water hemlock is notoriously toxic and often mistaken for safe root vegetables like parsnips or carrots. The toxin cicutoxin antagonizes gamma-aminobutyric acid (GABA) receptors and triggers severe, repeated seizures that are frequently refractory to first-line anticonvulsants. Abrus precatorius (jequirity bean) is similarly dangerous if chewed, though intact beans often pass harmlessly through the GI tract.
Anticholinergic toxicity is a whole other beast, commonly seen in adolescents experimenting with jimson weed or angel's trumpet. The classic toxidrome, hot, dry, red, blind, and mad, shows up alongside hallucinations and occasionally seizures. These cases may be increasing in frequency due to social media trends promoting the recreational use of these substances.
Rare but Severe Toxicities
Cyanide toxicity is rare in children, but it is worth knowing about. Fruit pits, such as those from cherries or apricots, contain amygdalin, which gut bacteria convert into hydrogen cyanide when the seeds are chewed. Symptoms, when they occur, include vomiting, metabolic acidosis, and cardiovascular collapse. Similarly, unripe ackee fruit and lychee, common in parts of West Africa, the Caribbean, and India, can cause hypoglycemia,encephalopathy, and fatal Reye-like syndromes, particularly in malnourished children.
Clinical Assessment and Management
The clinical approach to plant ingestion begins with a careful history. What was eaten? Which part of the plant? How much? How long ago? If the identity of the plant is unknown, a sample or photo can be beneficial. Poison control centers often have access to botanists who can assist with identification, and digital images can be sent for rapid evaluation. Apps for plant identification are improving, but should not be the sole tool in critical clinical decision-making.
Physical exam findings vary based on the plant. Most kids are asymptomatic or present with mild GI symptoms. However, red flags include bradycardia or tachycardia, altered mental status, seizures, mucosal burns, and signs of dehydration. In these cases, labs should be directed by the presentation: glucose for hypoglycemia, electrolytes for suspected cardiac glycoside toxicity, creatine kinase (CK) and myoglobin for seizures or weakness, and electrocardiogram (ECG) monitoring for any cardiac effects.
Conclusion
In the end, while the vast majority of pediatric plant ingestions are benign, it's essential to keep the outliers in mind. Timely consultation with poison control, clinical vigilance, and a structured approach to symptoms can help prevent the rare bad outcomes from slipping through the cracks. Also, keeping a plant identification app handy or at least knowing someone good with greenery might save you a few gray hairs.
Poison Control Hotline: 800-222-1222
About the Author:
Jennifer "Jenny" Huynh, BSN, RN, NCSN, graduated from the University of Massachusetts Lowell (UMass Lowell) and is certified as a school nurse. She has worked as an RN for six years, focusing on school nursing. Currently, Jenny is working on her Master's in Nursing Education and is an Adjunct Instructor at UMass Lowell.
Jenny is an independent contributor to CEUfast's Nursing Blog Program. Please note that the views, thoughts, and opinions expressed in this blog post are solely those of the independent contributor and do not necessarily represent those of CEUfast. This is not medical advice. Always consult with your personal healthcare provider for any health-related questions or concerns.
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