Carbon Monoxide Poisoning in Children and Pregnant People: Recognition and Prevention
A Resource for Health Professionals
Summary of Key Points posted on Jan 31, 2022
What is Carbon Monoxide? posted on Jan 31, 2022
What are Potential Sources of CO? posted on Jan 31, 2022
Carbon Monoxide Detectors posted on Jan 31, 2022
Who is at Risk? posted on Jan 31, 2022
Does CO Poisoning Impact Pregnancy Outcomes? posted on Jan 31, 2022
What is the Pathophysiology of CO Poisoning? posted on Jan 31, 2022
What are the Symptoms of CO Poisoning? posted on Jan 31, 2022
How to Diagnose and Evaluate CO Poisoning? posted on Jan 31, 2022
If it is suspected that a child has been poisoned by Carbon Monoxide: posted on Jan 31, 2022
Important CO Poisoning Prevention Tips for Families posted on Jan 31, 2022
To download this page as a fact sheet, click here.
Additional Resources for Health Professionals
- American Academy of Pediatrics. Carbon Monoxide. In: Etzel, RA, Balk SJ. Pediatric Environmental Health. American Academy of Pediatrics. 2018:451 - 462.
- American Thoracic Society. In utero exposure to carbon monoxide increases infants' risk of poor lung function. Science Daily. Accessed on June 10, 2020 https://www.sciencedaily.com/releases/2018/05/180521092740.htm
- Beppu T. The role of MR imaging in assessment of brain damage from carbon monoxide poisoning: a review of the literature. American Journal Neuroradiology. 2014: 35(4), 625–631. https://doi.org/10.3174/ajnr.A3489
- Centers for Disease Control and Prevention. Nonfatal, unintentional, non-fire-related carbon monoxide exposures--United States, 2004-2006. Morbidity and Mortality Weekly Report (MMWR). 57(33), 896–899.
- Delomenie M, Schneider F, Beaudet J, Gabriel R, Bednarek N and Graesslin O. Carbon monoxide poisoning during pregnancy: presentation of a rare severe case with fetal bladder complications. Case Reports in Obstetrics and Gynecology. 2015;687975 https://doi.org/10.1155/2015/687975
- Friedman P, Guo XM., Stiller RJ, Laifer SA. Carbon Monoxide Exposure During Pregnancy. Obstetrical and Gynecological Survey. 2015:70(11), 705–712. https://doi.org/10.1097/OGX.0000000000000238
- Gomez C, Berlin I, Marquis P, Delcroix M. Expired air carbon monoxide concentration in mothers and their spouses above 5 ppm is associated with decreased fetal growth. PrevMed. 2015,40:10–15. https://doi: 10.1016/j.ypmed.2004.04.049
- Gummin, DD, Mowry JB, Spyker, DA, Brooks DE, Osterthaler KM, Banner W. 2017 Annual Report of the American Association of Poison Control Centers' National Poison Data System (NPDS): 35th Annual Report. Clinical Toxicology. 2018; 56(12), 1213–1415. https://doi.org/10.1080/15563650.2018.1533727
- Hampson NB. Racial and ethnic trends in unintentional carbon monoxide poisoning deaths. Undersea Hyperbaric Medical. 2019;46(4), 495–501. https://pubmed.ncbi.nlm.nih.gov/31509905/#:~:text=Results%3A%20The%20absolute%20number%20of,population%20did%20not%20significantly%20change.
- Ralston JD, Hampson NB. Incidence of severe unintentional carbon monoxide poisoning differs across racial/ethnic categories. Public Health Reports. 2000;115(1):46-51. doi:10.1093/phr/115.1.46
- Johnson-Arbor K, Liebman DL, Carter EM. A survey of residential carbon monoxide detector utilization among Connecticut Emergency Department patients. Clinical Toxicology. 2012;50(5):384-389. doi:10.3109/15563650.2012.683576
- Schimmel J, George N, Schwarz J, Yousif S, Suner S, Hack JB. Carboxyhemoglobin Levels Induced by Cigarette Smoking Outdoors in Smokers. Journal of Medical Toxicology. 2018;14(1):68-73. doi:10.1007/s13181-017-0645
- Juul N, Friedenberg A. Carboxyhemoglobin as High as K2. In: C43. DRUG INDUCED LUNG DISEASE: CASE REPORTS. American Thoracic Society International Conference Abstracts. American Thoracic Society; 2017:A5573-A5573. doi:10.1164/ajrccm-conference.2017.195.1_MeetingAbstracts.A557
- Hampson NB, Piantadosi CA, Thom SR, Weaver LK. Practice recommendations in the diagnosis, management, and prevention of carbon monoxide poisoning. American Journal of Respiratory and Critical Care Medicine. 2012;186:1095–1101. https://doi.org/10.1164/rccm.201207-1284CI
- Hampson NB. Noninvasive pulse CO-oximetry expedites evaluation and management of patients with carbon monoxide poisoning. American Journal of Emergency Medicine. 2012;30(9), 2021–2024. https://doi.org/10.1016/j.ajem.2012.03.026
- Koren G, Sharav T, Pastuszak A, Garrettson LK, Hill K, Samson I, Rorem M, King A, Dolgin JE. A Multicenter, Prospective Study of Fetal Outcome Following Accidental Carbon Monoxide Poisoning in Pregnancy. Reproductive Toxicology. 1991; 5:397-403. doi: 10.1016/0890-6238(91)90002-w
- Kuschner WG, Blanc PD. Gases and other airborne toxicants. Current Diagnosis And Treatment: Occupational And Environmental Medicine (pp. 559 - 591). McGraw-Hill Medical.
- Suner S, Jay G. Carbon Monoxide Has Direct Toxicity on the Myocardium Distinct from Effects of Hypoxia in an Ex Vivo Rat Heart Model. Academic Emergency Medicine. 2008;15(1):59-65. https://doi.org/10.1111/j.1553-2712.2007.00012.x
- Buboltz JB, Robins M. Hyperbaric Treatment of Carbon Monoxide Toxicity. StatPearls. Accessed February 10, 2021. http://www.ncbi.nlm.nih.gov/books/NBK470531/
- Macnow TE, Waltzman, ML. Carbon monoxide poisoning in children: diagnosis and management in the emergency department. Pediatric Emergency Medical Practice. 2016;13(9), 1–24. PMID: 27547917.
- Mimura K, Harada M, Sumiyoshi S, Tohya G, Takagi M, Fujita E, Takata A, Tatetsu S. Seishin shinkeigaku zasshi. Psychiatria Neurology Japonica. 1999; 101(7), 592–618.
- Parkinson RB, Hopkins RO, Cleavinger HB, Weaver LK, Victoroff J, Foley JF, Bigler ED. White matter hyperintensities and neuropsychological outcome following carbon monoxide poisoning. Neurology. 2002;58(10), 1525–1532. https://doi.org/10.1212/wnl.58.10.1525
- Penney DG. Chronic Carbon Monoxide Poisoning: A Case Series. CRC Press. 2008. https://www.taylorfrancis.com/chapters/edit/10.1201/9780849384189-31/chronic-carbon-monoxide-poisoning-case-series-david-penney
- Centers for Disease Control and Prevention. QuickStats: Number of Deaths Resulting from Unintentional Carbon Monoxide Poisoning, by Month and Year, National Vital Statistics System, United States, 2010–2015. Morbidity and Morality Weekly Report (MMWR). 2017;66:234. DOI: http://dx.doi.org/10.15585/mmwr.mm6608a9.
- Rajaonarison JJC, Nithart A, Rakotomahenina H, Randaoharison PG, Dallay D,et al. Unintentional Acute Carbon Monoxide Poisoning During Pregnancy: Five Years of Experience in Bordeaux. Global Journal of Reproductive Medicine. 2018; 6(1): 555679. DOI: 10.19080/GJORM.2018.06.555679.
- Rose JJ, Wang L, Xu Q, McTiernan CF, Shiva S, Tejero J, Gladwin MT. Carbon Monoxide Poisoning: Pathogenesis, Management, and Future Directions of Therapy. American Journal of Respiratory and Critical Care Medicine. 2017;195(5), 596–606. https://doi.org/10.1164/rccm.201606-1275CI
- Specific Poisons and Drugs: Diagnosis and Treatment (2012). In K.R. Olson, I.B. Anderson, N.L. Benowitz, P.D. Blanc, R.F. Clark, T.E. Kearney, S.Y. Kim-Katz, A.B. Wu (Eds.), Poisoning & Drug Overdose. McGraw-Hill Education;
- Suner S, Partridge R, Sucov A, Valente J, Chee K, Hughes A, Jay G. Non-invasive pulse CO-oximetry screening in the emergency department identifies occult carbon monoxide toxicity. Journal of Emergency Medicine. 2008;34(4), 441–450. https://doi.org/10.1016/j.jemermed.2007.12.004
- Thompson LM, Clark M, Cadman B, Canúz E, Smith KR. (2011). Exposures to high levels of carbon monoxide from wood-fired temazcal (steam bath) use in highland Guatemala. International Journal of Occupational and Environmental Health. 2011;17(2), 103–112. https://doi-org.ucsf.idm.oclc.org/10.1179/107735211799030979
- Unsal SR, Taşar MA, Bostanci, I, Şimşec Y, Bilge-Dallar Y. Characteristics of Children with Acute Carbon Monoxide Poisoning in Ankara: A Single Centre Experience. Journal of Korean Medical Science. 2015; 30(12), 1836–1840. https://doi.org/10.3346/jkms.2015.30.12.1836
- Weaver LK, Hopkins RO, Churchill SK, Deru K. Neurological outcomes 6 years after acute carbon monoxide poisoning. Undersea and hyperbaric Medical Society. 2008; 35:258–259
- Weaver LK. Clinical practice, Carbon monoxide poisoning. New England Journal of Medicine. 2009;360(12), 1217–1225. https://doi.org/10.1056/NEJMcp0808891
- Weaver LK, Orrison WW, Deru K, McIntosh J. Brain imaging abnormalities in carbon monoxide–poisoned patients with ongoing symptoms at least 6 months after poisoning. Undersea Hyperbaric Medical Society. 2015;42:469–470.
- Wylie, BJ. The Ghana randomized air pollution and health study: A cluster-randomized trial of clean cookstoves to improve obstetric outcomes. American Journal of Obstetrics and Gynecology. 2017;216(1)S23. https://doi.org/10.1016/j.ajog.2016.11.923
- Klees M, Heremans M. Dougan S. Psychological sequelae to carbon monoxide intoxication in the child. Science of The Total Environment. 1985; (44)2, 165-176. https://doi.org/10.1016/0048-9697(85)90120-2
- Kim JK, Coe CJ. Clinical Study on Carbon Monoxide Intoxication in Children. Yonsei Medical Journal. 1987 Dec;28(4):266-273. https://doi.org/10.3349/ymj.19188.8.131.526
- Khan K, Sharief N. Chronic carbon monoxide poisoning in children. Acta Paediatrica. 1995;84(7):742. doi: 10.1111/j.1651-2227.1995.tb13747.
The information contained on this website should not be used as a substitute for the medical care and advice of your/your child’s primary care provider. There may be variations in treatment that your provider may recommend based on individual facts and circumstances.
This webpage was supported by the American Academy of Pediatrics (AAP) and funded (in part) by a cooperative agreement with the Centers for Disease Control and Prevention/Agency for Toxic Substances and Disease Registry (CDC/ATSDR). The U.S. Environmental Protection Agency (EPA) supports the PEHSUs by providing partial funding to CDC/ATSDR through an Inter-Agency Agreement. The findings and conclusions presented have not been formally disseminated by CDC/ATSDR or EPA and should not be construed to represent any agency determination or policy. Use of trade names that may be mentioned is for identification only and does not imply endorsement by the CDC/ATSDR or EPA.
Last updated: January 2022