Research In Action

In Pennsylvania and Delaware, an average of 157 cases of carbon monoxide poisoning concerns among children are reported yearly to our Poison Control Center. These poisonings can have fatal consequences: between 2020 and 2024, at least eight children died from carbon monoxide poisoning in the region. Here, we describe an example case of carbon monoxide poisoning and answer relevant questions to raise awareness for this preventable exposure.

The case:

A 3-year-old boy came into the emergency department with a headache and vomiting for twelve hours. The boy’s father, who brought him in, also had a mild headache. They thought that they had contracted the flu which was spreading rampantly in the community. Once in the emergency department, a series of tests were performed, and the family was surprised to learn the boy had carbon monoxide poisoning. Of note, the day before their symptoms developed, the boy’s family lost power in their home due to a winter storm. The family used a generator to charge their phones, keep their refrigerator running, and keep the lights on inside the house.

What is carbon monoxide?

Carbon monoxide is a colorless, odorless gas that interferes with the body’s ability to use oxygen effectively and causes inflammation. Incomplete combustion, from sources such as stoves, portable generators, cigarette smoke, and vehicles, produces carbon monoxide. While very small amounts of carbon monoxide are present in the atmosphere, the concentration of carbon monoxide can significantly increase within minutes indoors if there is a source, especially with poor ventilation. The health consequences range from mild flu-like illness—headaches, nausea, vomiting, and fatigue—to seizures, coma, and death. Younger children less than one-year-old are thought to be at higher risk for carbon monoxide poisoning.

When and where does it occur?

In Pennsylvania and Delaware, most cases of carbon monoxide poisoning occur during the heating season (October-March), when kids and parents alike spend more time indoors and use alternative heating sources. Moreover, over 90% of reported carbon monoxide cases occurred from exposure in a residential setting. Recent research has found strong associations between power outages and carbon monoxide poisoning among children. These findings suggest portable generator use and alternative heating sources such as wood-burning ovens are risk factors for carbon monoxide poisoning. Sometimes, carbon monoxide poisoning can also happen in unsuspected places like in indoor ice rinks.

How can families prevent carbon monoxide poisoning?

Abrupt, dangerously high carbon monoxide levels are best prevented by avoiding using fuel-burning products indoors or too near to indoor living areas.

• If the power goes out, ensure generators are run outside of the home (at least 20 feet away from an entrance)
• Never use a gas or charcoal ovens, grills, or stovetops to heat a home
• Ensure gas furnaces are inspected regularly
• Do not leave a motor vehicle running in a garage

As carbon monoxide is not noticeable by our senses, we agree with the U.S. Agency for Toxic Substances and Disease Registry, which recommends carbon monoxide detectors in all homes to prevent carbon monoxide poisoning.

• Maintain functioning carbon monoxide and smoke detectors inside all homes / apartments
• Check batteries at regular intervals, such as at the beginning and end of daylight savings time
• Check short-term living spaces, such as hotels and vacation rentals, to make sure that they have detectors too

What can be done to prevent future severe cases of carbon monoxide poisoning?

 Interventions aimed at preventing carbon monoxide poisoning, and at providing swift identification and treatment when it occurs, are crucial to prevent severe carbon monoxide injury.

• For high-risk consumer products that produce carbon monoxide, such as portable generators, encourage automatic shutoff features to protect from dangerously high levels of carbon monoxide
• Increase clinician awareness of the risk factors of carbon monoxide poisoning such as inclement weather, power outages, and the heating season in the region
• Provide public service announcements during high-risk events like hurricanes or winter storms to alert to the causes and symptoms of carbon monoxide poisoning

If you suspect that a child is experiencing carbon monoxide poisoning, please call the Children’s Hospital of Philadelphia Poison Help Hotline at 1-800-222-1222 to be connected to a specialist. If the child has fainted, is having trouble breathing, or is having a seizure, call 911.