• Harmful interventions - forced emesis, unverified home remedies and limited availability and awareness of poison control services pose significant risks 
• Solutions include addressing trad. misconceptions and modern misinfo; telephonic and digital poison helplines-hotlines; automated poison info systems; digital campaigns including SMS reminders 

In Sri Lanka, first-aid practices following paediatric poisoning vary widely and often fall short of guideline recommendations, particularly in resource-limited and culturally diverse settings, with harmful interventions which pose significant risks — forced emesis and unverified home remedies — being prevalent.

These findings were gathered in an article on "Crisis and care: Global trends in paediatric poisoning first-aid practices (2000-2025)" which was authored by K. Dayasiri (attached to the Kelaniya University's Paediatrics Department) and published in the Journal of Desk Research Review and Analysis' Third Volume's Second Issue.

Acute poisoning remains a significant cause of morbidity and mortality among paediatric populations globally (M. Peden, K. Oyegbite, J. Ozanne-Smith, A.A. Hyder, C. Branche, A.K.M.F. Rahman, F. Rivara and K. Bartolomeos's "World Report on Child Injury Prevention, Chapter Six, Poisoning"). Children’s natural exploratory behaviours, coupled with developing physiological systems and smaller body mass, render them uniquely susceptible to adverse outcomes following toxic exposures (M.J. Carroquino, M. Posada and P.J. Landrigan's "Environmental toxicology: Children at risk"). The World Health Organisation (WHO) estimates that unintentional poisoning accounts for approximately 45,000–50,000 deaths per year in children under five, with a disproportionately higher burden in low- and middle-income countries (LMICs) where regulatory and safety measures around household chemicals, pesticides, and pharmaceuticals may be inadequate.

The first few minutes to hours following ingestion or exposure to a toxin are critical (J. Chandran and B. Krishna's "Initial management of poisoned patient"). Pre-hospital first aid measures administered by caregivers or lay responders can mitigate absorption, reduce symptom progression, and improve the overall prognosis (L. Goldfrank, N. Flomenbaum, N. Lewin, M.A. Howland, R. Hoffman and L. Nelson "Goldfrank’s Toxicological Emergencies"). International guidelines — such as those published by the American Academy of Paediatrics, the European Resuscitation Council, and the International Liaison Committee on Resuscitation — provide evidence-based recommendations for initial management, the avoidance of forced emesis unless directed by poison control experts, and the prompt transfer to professional care.

Despite these guidelines, persistent gaps have been documented between recommended and actual first aid practices. Traditional remedies - ranging from coconut milk to herbal concoctions — are still widely used in various cultural contexts (M. Ekor's "The growing use of herbal medicines: Issues relating to adverse reactions and challenges in monitoring safety"). In certain regions, inducing vomiting with manual stimulation or administering household agents like salt water persists due to deep-rooted beliefs about decontamination. Such practices can delay definitive treatment and may exacerbate toxin-related injury, leading to complications such as aspiration pneumonia, caustic injuries, or electrolyte disturbances.

Understanding the landscape of caregiver behaviours in the immediate aftermath of paediatric poisoning is vital for designing effective interventions (T. Weerasinghe, R. Dassanayake, M. Senapathy, R. Thennakoon and K. Dayasiri's "The role of primary caregivers' knowledge, attitudes, and practices in paediatric medication safety"). 

Methods

Studies were deemed eligible if they involved children aged zero–18 years (the WHO's "Adolescent health: Definition of young people") who had experienced acute poisoning and reported on any pre-hospital or immediate first-aid interventions administered by lay caregivers. 

The first-aid measures were categorised as dilution, emesis induction, adsorbent use, home remedies, or no intervention.

Results

A total of five studies geographically originated from Sri Lanka. Descriptive cross-sectional studies included several hospital- and community-based investigations from Sri Lanka (M.B.K.C. Dayasiri, S.F. Jayamanne and C.Y. Jayasinghe's "Patterns of acute poisoning with pesticides in the paediatric age group", "Plant poisoning among children in rural Sri Lanka", and "Kerosene oil poisoning among children in rural Sri Lanka"). Sample sizes ranged from 21 to 9,256 participants.

Poisoning agents

Common agents included household chemicals (detergents, disinfectants), medications (analgesics, anticonvulsants), pesticides (organophosphates, aluminium phosphide), and miscellaneous toxins (cleaning solvents) (M.B.K.C. Dayasiri, S.F. Jayamanne and C.Y. Jayasinghe's "Accidental and deliberate self-poisoning with medications and medication errors among children in rural Sri Lanka"). 

First-aid practice patterns

First aid interventions were categorised into five primary types.

Dilution strategies

Administering water or milk to dilute ingested toxins was reported in 35–60 per cent of cases. In Sri Lanka, M.B.K.C. Dayasiri's "Patterns and determinants of potentially harmful first aid practices in children with acute poisoning" found that 13.8% of caregivers administered water and 11% provided milk or coconut milk as first-aid measures before bringing the child to the hospital, reflecting common cultural practices and beliefs about neutralising ingested poisons. Caregivers giving water, administering milk, and using other methods to induce emesis, highlight a pattern of potentially harmful pre-hospital interventions driven by limited awareness and the lack of access to evidence-based guidance (an Egyptian study). These findings underscore the global need for targeted educational interventions to improve community-level first-aid responses in paediatric poisoning cases.

Emesis induction

The induction of vomiting, either through manual methods such as finger stimulation or via pharmacological means, was reported in 10%–40% of paediatric poisoning events. A key driver of this practice was advice from relatives or traditional healers, cited in up to 50% of cases involving emesis, particularly in LMI settings (an Indian study). In high-income countries, the influence of erroneous online recommendations was also notable. For instance, caregivers acted on inaccurate internet-sourced advice and such contributed to inappropriate first-aid responses. These findings emphasise the persistent impact of misinformation and culturally embedded practices on first-aid behaviours, underscoring the need for accessible, evidence-based guidance tailored to diverse settings.

Adsorbent use

The home administration of activated charcoal was rare (2%–5%), primarily in high-income countries where poison control centres recommended its use. Less than 5% of caregivers self-administered charcoal without professional guidance.

Alternative/home remedies

The administration of herbal concoctions, oils, and sugar solutions was documented in 5%–15% of cases. In Sri Lanka, coconut oil and herbal teas were commonly given, based on traditional medicine practices.

No pre-hospital intervention

A substantial proportion (20%–45%) of caregivers opted for immediate transport to medical facilities without any first aid measures, often driven by fear, urgency, or the awareness of the poisoning severity.

Determinants of first-aid behaviours

Three thematic determinants emerged.

Caregiver factors

Caregiver characteristics played a significant role in determining the type and appropriateness of the first-aid measures administered during paediatric poisoning incidents. Lower levels of formal education were consistently associated with a higher likelihood of engaging in potentially harmful practices. For example, in Sri Lanka, caregivers with only primary education or no formal schooling had an odds ratio of 2.1 (1.3–3.4) for inducing emesis, often based on traditional or non-medical advice. In contrast, prior experience with poisoning episodes appeared to foster more appropriate responses. Caregivers who had dealt with similar incidents in the past were more likely to demonstrate guideline-consistent behaviours, such as refraining from home remedies and waiting for professional medical advice before taking action. These findings suggest that both educational attainment and experiential learning significantly influence caregiver decision-making in poisoning emergencies.

Socio-cultural factors

Cultural beliefs and misinformation played a critical role in shaping caregivers' first-aid responses to paediatric poisoning. In many communities, deep-rooted traditions heavily influence treatment choices. For instance, in parts of South Asia, coconut milk was widely regarded as a universal antidote, believed to have 'cooling' properties that could neutralise ingested toxins — an idea rooted more in cultural symbolism than in medical evidence. Alongside traditional practices, misinformation from unverified internet sources and community-held myths further contributed to the continuation of potentially harmful first-aid measures, such as inducing vomiting or administering home remedies. These findings highlight the urgent need for culturally sensitive public education campaigns that address both traditional misconceptions and modern misinformation.

System-level factors

Healthcare accessibility significantly influenced caregiver responses during paediatric poisoning incidents. In many LMICs, long distances to health facilities, limited transport options, and associated costs often deterred families from seeking immediate professional care. As a result, caregivers frequently resorted to home remedies and traditional first-aid practices as initial responses. Compounding this issue was the limited availability and awareness of poison control services. In LMICs, fewer than 10% of caregivers reported knowledge or use of poison helplines, in stark contrast to high-income countries, where 60%–75% of poisoning cases involved the use of automated poison information systems. This disparity underscores the critical need to expand and promote poison control infrastructure in resource-limited settings.

Impact of educational and policy interventions

Targeted educational interventions have shown considerable promise in improving caregiver knowledge and practices related to paediatric poisoning. In Egypt, a study evaluated the impact of a structured educational program focused on aluminium phosphide poisoning, and following the intervention, the proportion of caregivers with satisfactory overall knowledge rose dramatically from 0.2% to 73.4%, while appropriate first aid knowledge improved from 23.4% to 57.1%, and furthermore, the percentage of caregivers engaging in unsatisfactory first-aid practices dropped significantly from 71.6% to 17.4%, indicating the effectiveness of structured, context-specific training. In a separate initiative in the United States, a digital campaign using short message service reminders about poison hotline numbers and basic first-aid steps resulted in a notable reduction in unnecessary emergency department visits. These findings highlight the transformative potential of both in-person and digital educational strategies in promoting safer and more informed responses to paediatric poisoning events.

Gaps and limitations of evidence

Despite growing interest in improving first-aid responses to paediatric poisoning, significant gaps remain in the evidence base. First-aid practices are notably linked to clinical outcomes, such as the hospitalisation duration, complication rates, or recovery trajectories. Additionally, while some interventions demonstrated short-term improvements in knowledge and behaviour, longitudinal follow-up data were scarce, leaving uncertainties about whether these positive changes persist beyond six months. Another limitation is the lack of qualitative research; only a handful of studies included qualitative components that explored caregiver beliefs, fears, and motivations — insights that are crucial for designing culturally appropriate and sustainable interventions (M.B.K.C. Dayasiri, S.F. Jayamanne and C.Y. Jayasinghe's "A qualitative study of acute poisoning related emergencies in the paediatric age group"). Finally, there is a marked geographic skew in the literature, highlighting the need for more regionally diverse research to understand and address context-specific challenges in first-aid responses to childhood poisoning.

Discussion

This scoping review synthesises global evidence on first aid practices following paediatric poisoning, revealing substantial heterogeneity and frequent divergence from evidence-based guidelines. Harmful behaviours — particularly forced emesis and unverified home remedies — remain common in diverse settings.

Despite clear recommendations against routine emesis induction, this practice persists at rates up to 40%. The physiological risks — aspiration, mucosal damage, electrolyte disturbances — underscore the need for targeted education. Similarly, traditional remedies, though culturally ingrained, lack scientific validation and may delay care or cause adverse reactions. Caregiver education emerged as a pivotal determinant; those with higher schooling levels demonstrated greater guideline adherence. This suggests that literacy and health education interventions may yield significant benefits. Cultural beliefs — while deeply rooted — present an opportunity for culturally sensitive messaging that leverages community influencers and integrates local knowledge systems. System-level barriers, including limited poison control infrastructure in LMICs, inhibit access to professional guidance. Strengthening telephonic and digital helplines, subsidising toll-free numbers, and integrating poison information into primary healthcare can bridge this gap (E.W. Rothwell, L. Ellington, S. Planalp and B.I. Crouch's "Tele-health: Lessons and strategies from specialists in poison information").

Educational programs — whether community workshops, school curricula, or digital campaigns —consistently improved knowledge and behaviours. Notably, interventions combining multiple modalities (face-to-face training plus printed materials plus digital reminders) achieved the greatest impact (A. Giguère, H.T.V. Zomahoun, P.H. Carmichael, C.B. Uwizeye, F. Légaré, J.M. Grimshaw, M.P. Gagnon, D.U. Auguste and J. Massougbodji's "Printed educational materials: Effects on the professional practice and healthcare outcomes"). Policy-level initiatives, such as mandatory poison education during prenatal classes or school safety regulations, hold promise for broader reach (the US Institute of Medicine Committee on Poison Prevention and Control's "Forging a poison prevention and control system, Chapter Eight, Prevention and public education"). Evaluations of these policies are scarce, indicating a need for systematic monitoring and reporting.

Future research should adopt longitudinal designs to assess the durability of caregiver behaviour changes over time and to establish clear links between pre-hospital interventions and clinical outcomes. Mixed-methods studies are also needed to elucidate the complex decision-making processes of caregivers, thereby informing the optimisation of intervention design and delivery. In addition, investigations into the cost-effectiveness of both educational and system-level strategies will be essential for guiding resource allocation and policy decisions. Finally, expanding research efforts to underrepresented regions and incorporating gray literature searches will help ensure a more comprehensive global understanding of first-aid practices in paediatric poisoning.

Conclusions and recommendations

Caregiver education, system-level support through poison control services, and policy integration are key to improving pre-hospital management. Educational interventions across multiple platforms consistently yield knowledge and behaviour gains, but the long-term impact and linkage to clinical outcomes require further study. Strengthening telephonic and digital poison information services, integrating first aid training into maternal-child health and school programs, and embedding monitoring systems will enhance the reach and sustainability.