Absence of esophageal injury in pediatric patients after hair relaxer ingestion

Objective: To review the initial signs, symptoms, and endoscopic findings in children admitted to the hospital for ingestion of caustic hair relaxer. Design: Retrospective medical chart review of all children admitted to the hospital with a diagnosis of caustic ingestion from January 1, 1992, to June 30, 1997. Demographics, admission signs and symptoms, and operative findings were recorded from the medical records. Setting: An urban tertiary care children's hospital. Patients: Fifty-nine children (<3 years old) admitted to the hospital for ingestion of hair relaxers. Results: Two hundred nine patients were evaluated for possible caustic ingestion. Only 163 medical charts were available for review. Of these, 59 (36.2%) ingested hair relaxers. Initial signs and symptoms ranged from none to drooling and vomiting and second-degree oral cavity burns. Fifty-six patients (95%) underwent endoscopy, which revealed normal esophageal mucosa in 53 of them, mild erythema of the distal esophagus in 2, and mild esophagitis in 1. Conclusions: In our experience, hair relaxer ingestion makes up a significant proportion of all children admitted to the hospital for caustic ingestion. No significant esophageal injury was associated with hair relaxer ingestion, suggesting that endoscopy may not be necessary in these patients. Alternative management is suggested. We believe that patients who ingest hair relaxer should be admitted to the hospital for observation if parents are thought to be unreliable, and should undergo endoscopy if they cannot tolerate oral intake. Asymptomatic patients may be cared for as outpatients if they demonstrate adequate oral intake.