Carbon Monoxide Poisoning in Children

What is carbon monoxide poisoning in children?

Carbon monoxide poisoning is an illness that occurs from breathing in carbon monoxide (CO) gas. It's a medical emergency and needs treatment right away. Everyone is at risk for carbon monoxide poisoning. But it is more dangerous for children because they breathe faster and inhale more CO per pound of body weight.

What causes carbon monoxide poisoning in a child?

CO is a colorless, odorless gas made when fuel burns. Fuels include wood, gasoline, coal, natural gas, propane, and kerosene. Breathing in carbon monoxide fumes prevents the body from using oxygen normally. This can harm the brain, heart, and other organs.

Most carbon monoxide exposure happens in the winter. This is because the most common source of CO poisoning is an unvented, kerosene- or gas-fueled space heater in the home. It vents the gases into the room, instead of outdoors. A space heater that's not installed right or not working correctly can release carbon monoxide and other toxic fumes into the room. It can use up much of the oxygen in the room.

Most space heaters use kerosene or natural gas for fuel. Newer models have oxygen sensors. These sensors shut off the heater when the oxygen level in the room falls below a certain level. Older models don’t have this safety feature. Because of these safety problems, some states ban unvented space heaters.

Carbon monoxide can also leak from home or camping appliances that use oil, wood, gasoline, natural gas, propane, or coal and are not working correctly, such as a:

• Stove or oven.

• Clothes dryer.

• Water heater.

• Gas log burner.

• Ceiling-mounted heating unit.

• Heating furnace.

• Barbecue grill.

• Pool or spa heater.

Other sources of carbon monoxide include:

• Gas fueled generators.

• Wood burning fireplaces.

• Clogged chimneys.

• A vehicle with the engine running.

• Boats.

• Tobacco smoke.

• Fire.

Which children are at risk for carbon monoxide poisoning?

A child is more at risk for carbon monoxide poisoning if they live in a house with any of these:

• An appliance powered by oil, wood, gasoline, natural gas, propane, or coal

• A space heater

• A faulty fireplace and chimney

What are the symptoms of carbon monoxide poisoning in a child?

Symptoms can occur a bit differently in each child. They can include:

• Headache.

• Dizziness.

• Weakness or clumsiness.

• Nausea and vomiting.

• Confusion.

• Chest pain.

• Loss of consciousness or coma.

• Fast or irregular heartbeat.

• Shortness of breath.

• Loss of hearing.

• Blurry vision.

• Seizures.

• Cardiac arrest.

• Respiratory failure.

• Death.

It may be CO poisoning if symptoms occur at home and not at school. Or it may be CO poisoning if more than one person in the home has these symptoms.

The symptoms of carbon monoxide poisoning can be like other health conditions, such as the flu and food poisoning. Make sure your child sees their health care provider for a diagnosis.

How is carbon monoxide poisoning diagnosed in a child?

The health care provider will ask about your child’s symptoms and health history. They may ask about recent exposure to fuel-burning appliances. A provider often diagnoses CO poisoning based on known exposure. They will give your child a physical exam. The physical exam may include a test of mental status. The key to being sure about the diagnosis is measuring the patient’s level of carboxyhemoglobin in the blood. This means how much carbon monoxide is attached to hemoglobin in the red blood cells. (Hemoglobin is the part of the red blood cell that carries oxygen to the body.) Your child may also have tests to check oxygen levels in the blood.

Sometimes an image test like a CT scan or an MRI may be advised to identify any brain damage.

Injury to the heart during poisoning increases the risk of mortality over 10 years after poisoning. So, for patients with severe CO poisoning, it may be important to perform an EKG. This test measures troponin and cardiac enzymes in the blood to check for damage to the heart.

How is carbon monoxide poisoning treated in a child?

CO poisoning is a medical emergency. If your child has signs of CO poisoning:  

• Leave the area and take your child into fresh air right away. Call 911.

• Turn off the carbon monoxide source, if you can do so quickly and safely without putting yourself or others in danger.

• If your child has stopped breathing, start CPR right away. Don’t stop until your child breathes on their own, or someone else can take over. Have someone call 911 right away. If you're alone, do CPR for 2 minutes, and then call 911.

Oxygen therapy is the main treatment for carbon monoxide poisoning. Your child may be given oxygen through a face mask right away. In some cases, a child may be treated in a hyperbaric oxygen chamber.

Talk with your child’s health care providers about the risks, benefits, and possible side effects of all treatments.

What are the possible complications of carbon monoxide poisoning in a child?

A child may have long-lasting (permanent) damage to the brain or heart. This depends on the amount of CO exposure. Severe carbon monoxide poisoning can cause nervous system or psychiatric symptoms days or weeks later. This is known as delayed neuropsychiatric syndrome. Follow-up should include a repeat medical and neurological exam in 2 weeks. In some cases, CO poisoning can lead to death.

How can you help prevent carbon monoxide poisoning in your child?

You can protect your family from carbon monoxide poisoning in these ways:

• Install carbon monoxide detectors in areas with appliances that burn fuel.

• Have furnaces, water heaters, gas ovens, wood stoves, and any other fuel-burning appliances checked each year.

• Have your fireplace cleaned and inspected each year.

• Use fuel-burning space heaters only in well-ventilated areas.

• Don't start up or let the engine run (idle) on gas lawn mowers, cars, trucks, or other vehicles in an enclosed area, even with the garage doors open.

• Vent fuel-burning appliances outside when possible.

• Don't use a charcoal grill inside your home, garage, tent, or camper.

• Don't use portable heaters or lanterns while sleeping in enclosed areas such as tents, campers, and other vehicles. This is especially important at high altitudes, where the risk for CO poisoning is increased.

• Don't use a gas oven or stovetop for supplemental heat.

• Never use a gas-powered generator inside your garage or house, even if it's by an open window. Keep generators outside and more than 20 feet away from your home, garage, and windows.

Key points about carbon monoxide poisoning in children

• Carbon monoxide poisoning is an illness that occurs from breathing in carbon monoxide (CO) gas. It's a medical emergency and needs treatment right away.

• CO is a colorless, odorless gas made when fuel burns. Fuels include wood, gasoline, coal, natural gas, propane, and kerosene. Breathing in carbon monoxide fumes prevents the body from using oxygen normally. This can harm the brain, heart, and other organs.

• Carbon monoxide can also leak from home or camping appliances that use oil, wood, gasoline, natural gas, propane, or coal and are not working correctly.

• Symptoms can include headache, dizziness, nausea, and vomiting.

• If your child has signs of CO poisoning, take your child into fresh air right away and call 911.

• Oxygen therapy is the main treatment for carbon monoxide poisoning.

Next steps

Tips to help you get the most from a visit to your child’s health care provider:

• Know the reason for the visit and what you want to happen.

• Before your visit, write down questions you want answered.

• At the visit, write down the name of a new diagnosis and any new medicines, treatments, or tests. Also write down any new directions your provider gives you for your child.

• Know why a new medicine or treatment is prescribed and how it will help your child. Also know what the side effects are.

• Ask if your child’s condition can be treated in other ways.

• Know why a test or procedure is advised and what the results could mean.

• Know what to expect if your child does not take the medicine or have the test or procedure.

• If your child has a follow-up appointment, write down the date, time, and purpose for that visit.

• Know how you can contact your child’s provider after office hours. This is important if your child becomes ill and you have questions or need advice.