Adapted from Henretig FM, Cieslak TJ, Eitzen EM Jr Biological and chemical terrorism J Pediatr 2002;141:311–326 Copyright © 2002 Elsevier With permission FIGURE 132.7 Autoinjector-packaged pralidoxime can be injected into an empty vial for subsequent reuse in small pediatric patients (Reprinted from Henretig FM, Mechem C, Jew R Potential use of autoinjector-packaged antidotes for treatment of pediatric nerve agent toxicity Ann Emerg Med 2002;40:405–408 Copyright © 2002 American College of Emergency Physicians With permission.) Specific Pediatric Considerations The thinner skin of children might make them more susceptible to dermal absorption of chemical toxins in comparison to adults ( Table 132.2 ) Likewise, the immature blood–brain barrier in infants might increase the relative risk of CNS toxicity Children have smaller airway diameters, anatomic subglottic narrowing, and higher respiratory rates as well as exhibit limited endurance of the accessory muscles of breathing; these characteristics could predispose to earlier and more severe respiratory effects from nerve agents In addition, children have a greater susceptibility to seizures Although OP-pesticide poisoning in children may certainly manifest by dramatic muscarinic findings, including respiratory compromise (see Chapter 102 Toxicologic Emergencies ), one case series of anticholinesterase pesticide poisoning in children found that depressed sensorium and muscle weakness and flaccidity were more prominent than muscarinic findings Nevertheless, more than half of these patients did demonstrate miosis (80%), tearing and excess salivation (60%), and GI findings (52%) Other studies have shown an absence of