Were two children being exposed to drugs?

Background: Children and exposure to substance misuse

To establish if a child has been exposed to substance misuse or deliberate administration of drugs, is a very complex issue because children are not ‘little adults’, children’s bodies and organ functions are in a continuing state of development throughout their paediatric age. It is not surprising therefore, that the way their bodies respond and deal with drug exposure can differ profoundly from findings in adults.

However, with experience and knowledge in this field, the test results from a child’s hair can not only provide crucial evidence and insight into the potential risks and danger they have been exposed to that would otherwise go undetected, but can also provide reassurance that risks claimed to be present may not be.

A question was raised: Were two children being exposed to drugs?

A question was raised as to whether two children were being exposed to drugs, which was finally investigated following evidence of acute intoxication of both children attending A & E. However, the question remained: had this been a single toxic exposure to drugs or was this systemic (involving ingestion) exposure regular and persistent? Both parents had strongly denied the use of drugs.

FTS established the key facts

• Two children, toddlers under 2 years of age, presented at A & E with clinical signs of drug intoxication.
• Child 1 had been removed from the biological home due to neglect and presented sedated.
• Child 2 presented sedated, vomiting with loss of coordination and urine tested positive for THC.

Investigation was carried out using hair analysis of both children and parents to establish the extent and source of drug exposure.

• Child 1 had 5cm of hair segmented and tested. All sections tested positive for THC and metabolite THC-COOH and also cocaine and metabolites Be and Nc, covering approximately 5 months.
• Child 2 had 6cm of hair segmented and tested. All sections tested positive for THC and metabolite THC-COOH, covering approximately 6 months

In both child cases, the levels and drug profile of the hair test results were consistent with chronic drug ingestion.

• Significantly and perhaps surprisingly, both parents’ hair samples provided no evidence of cannabis or cocaine use or exposure and no other substances were detected.

Closing comments

This case highlighted the value and sometimes necessity of using hair analysis in identifying chronic drug exposure in pre-verbal children, incapable of self-reporting their experiences before it is too late.

Testing the parents alone would not have identified the childrens’ significant chronic exposure to drugs in this case, in addition and critically, earlier hair testing of these children could have prevented this toxic exposure.

This case also demonstrated that hair testing must be combined with experience and knowledge of testing in children, enabling meaningful and reliable interpretation of results, to differentiate chronic systemic exposure (ingestion, inhalation and skin absorption) from environmental contamination of the hair wherever possible, to minimise the risk of misleading the courts.