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S. A. ARONOW ET AL.

performed. Table 1 displays patient demographics. The median age of our cohort was 14.0 months (range 9 to 31 months). Patients who ingested hair relaxer were younger than those who ingested other agents ( P < 0.001). The age distribution of ingestions was bimodal, and was consistent with previous observations of acci- dental ingestion among toddlers and intentional (i.e., sui- cide gestures or attempts) ingestion in teenagers (Fig. 2). The cohort was evenly divided in gender. All of our patients were of African-American ethnicity. The most common symptoms at presentation were drooling and emesis. No patients presented with respira- tory symptoms. Mucosal injury was most commonly noted at the lips with decreasing frequency of injury more distally toward the stomach (Fig. 3). Six patients (20.7%) had Grade 1 esophageal mucosal injury. Five patients (17.2%) had Grade 1 gastric mucosal injury. No patients had mucosal injury greater than Grade 1 (10,15, 18,19). No complications resulted from the procedure or its sedation. The median (25 th –75 th percentile) length of stay was 1 (1,2) day, while the median (25 th –75 th per- centile) post-procedure length of stay was 1 (0,1) day. Eight weeks after ingestion, no adverse clinical events had occurred. The pH of three different brands of hair relaxers ranged from 11.4 to 12. (Cream of Nature TM and Bone Strait TM : ph of 12; Luster’s Pink TM : pH of 11.4). Clinical Presentation, Endoscopic Findings and Outcomes

TABLE 1. Patient characteristics (n = 29)

Mean age at presentation (mo)

14 (range, 9–31)

Male

15 (51%) 29 (100%)

African American Presenting symptoms Drooling

20 (69%)

Stridor

0 0

Dyspnea

Emesis

6 (21%)

endoscopic sequelae. Continuous variables are expressed as medians with interquartile ranges because of their non-normal distribution. Categorical variables are displayed as frequencies and percents. Mann-Whitney U testing was used to compare continuous variables. All analyses were conducted using SAS version 6.12 (Cary, NC).

RESULTS Patient Characteristics

During the study period, the most common caustic ingestion was hair relaxer, which was responsible for 33 (34.4%) of the 96 total cases at our institution. Other common ingestions included household bleach (12%), drain cleaners (9%), or other detergent housecleaners (8%) (Fig. 1). The remaining ingestions (36%) included a variety of products ingested by no more than three patients. Twenty-nine of the 33 patients (88%) who in- gested hair relaxer served as our study cohort. The re- maining four patients were excluded, since EGD was not

FIG. 2. Histogram of age (in months) of the children who ingested a caustic substance (n = 96).

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