Invisible victims: rising pediatric cocaine exposures in France (2020–2024) – insights from the national poison center database

BackgroundCocaine use remains prevalent in Europe and has been associated with pediatric exposures through accidental ingestion, passive inhalation, and perinatal or postnatal transmission, potentially leading to significant toxicity in young children.ObjectiveThis study aimed to quantify the number of pediatric cocaine exposures for which consultation with a French poison center was requested, characterize clinical presentations and severity, evaluate medical interventions and outcomes, and assess child protection service involvement.MethodsWe conducted a retrospective observational study of children aged 0–10 years with suspected or confirmed cocaine exposure reported to French Poison Centers from 1 January 2020, to 31 December 2024. Data collected included demographics, exposure route, clinical manifestations, toxicological analyses, treatments, outcomes, and Poisoning Severity Score (PSS).ResultsA total of 113 suspected pediatric exposures were identified, of which 76 (67%) were confirmed by toxicological analysis. Median age was 1.8 years, and 63 children were younger than 3 years. Exposure routes included intrauterine exposure (n = 7), breastfeeding (n = 12), ingestion (n = 9), and inhalation (n = 1). Most cases were symptomatic, with 25 minor (PSS 1), 24 moderate (PSS 2), and 8 severe cases (PSS 3), one fatality (PSS 4). No consistent association between measured cocaine or metabolite concentrations and clinical severity was observed in the limited number of cases with quantitative data (n = 15). Supportive care was sufficient in most cases, while 17 children required specific medical interventions.ConclusionPediatric cocaine exposures represent a significant clinical and public health concern, occurring through multiple pathways without predictable dose-response relationships. Clinical assessment must be guided by physical examination rather than quantitative toxicology alone. Prevention efforts must target households with substance use disorders.