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Reported case of methadone poisoning among children is infrequent in Malaysia. Since the implementation of methadone maintenance therapy (MMT) programme by Malaysian Ministry of Health in year 2006, there are only three case reports of methadone poisoning in children. Methadone toxicity in children can be deadly if antidote and supportive measures are not instituted in time. We report a case of accidental ingestion of about 25 mg of methadone in a 4-year-old boy. The methadone syrup belonged to his father, a former intravenous drug user (IVDU), who is currently a participant of the MMT detoxification programme under the supervision of a licensed general practitioner. The child presented with typical early signs and symptoms opioid toxicity. Upon examination, vital signs were normal, but he appeared lethargic and drowsy. Venous blood gas results noted mild respiratory acidosis and complete blood count revealed leukocytosis. He was treated with continuous intravenous infusion (CIVI) naloxone 10 µg/kg/h for approximately 78 h. He was hospitalized for 6 days and discharged well. Advice should be given to family who has patient under MMT programme with take-home doses to be more cautious in storage of methadone syrup at home, and to keep the bottle far from the reach of children. Methadone poisoning in children can be deadly and early administration of naloxone as CIVI can effectively reverse its toxicity. Int J Clin Pediatr. 2021;10(1):18-23 doi: https://doi.org/10.14740/ijcp386

BackgroundDeveloping countries still struggle with late detection and mortality from pertussis. A review of clinical case definitions is necessary for early disease detection. This paper aimed to study possible clinical characteristics for earlier pertussis detection in a sporadic setting.MethodsWe conducted a retrospective review of medical and laboratory records in a general paediatric ward of a district hospital in a developing country. Inclusion criteria were all children hospitalised with nasopharyngeal swab taken for Bordetella pertussis. We compared sensitivity and specificity of World Health Organization diagnostic criteria with other clinical characteristics. Polymerase chain reaction Bordetella pertussis was the gold standard used.ResultsOut of 207 eligible admissions, the study retrieved 128 complete records. Approximately half of the children were less than 3 months old. The World Health Organization diagnostic criteria had a low sensitivity (15%), but high specificity (92%). In comparison, combinations that included paroxysmal cough, ill contact and facial congestion had higher sensitivity. Increasing cough duration improved specificity while compromising sensitivity.ConclusionSeveral clinical characteristics such as paroxysmal cough, facial congestion and a history of ill contact have potential for early clinical detection. Conventional emphasis on cough duration may hamper early detection.