Mothballs are solid pesticides intended to kill clothes moths, typically containing naphthalene or paradichlorobenzene (PDB). Both chemicals are toxic, but naphthalene ingestion is particularly dangerous for children and constitutes a medical emergency. Naphthalene is a polycyclic aromatic hydrocarbon that, even in small amounts, can cause serious systemic effects, primarily by destroying red blood cells. Immediate action is required upon the discovery of ingestion due to the severity of the potential reaction.
Immediate Emergency Protocol
The first step is to immediately contact a medical professional by calling Poison Control at 1-800-222-1222 or local emergency services (911). Poison Control experts provide life-saving, tailored advice while you prepare for transport to an emergency room. When speaking with the operator, be ready to provide the child’s age, approximate weight, and the exact type and estimated number of mothballs ingested, if known.
Secure any remaining mothballs or the original packaging to take to the hospital; this information is essential for medical staff to confirm the toxic agent and plan treatment. Follow expert instructions exactly, including the strict negative instruction: never try to make the child vomit. Do not give the child milk, oils, fats, or activated charcoal unless specifically directed by Poison Control or a doctor, as some substances can increase the body’s absorption of naphthalene.
Recognizing the Signs of Toxicity
Naphthalene’s toxicity stems from its ability to act as a potent oxidizing agent once metabolized. This process generates free oxygen radicals that cause oxidative stress, leading to the breakdown of red blood cells, a condition known as acute intravascular hemolysis. Children with an undiagnosed genetic condition called Glucose-6-Phosphate Dehydrogenase (G6PD) deficiency are particularly susceptible because their red blood cells lack a protective enzyme against oxidative damage.
The physical signs of toxicity result from the destruction of red blood cells and the body’s response to this severe event. Initial reactions after ingestion commonly include gastrointestinal symptoms like nausea, vomiting, and abdominal pain. As hemolysis progresses, the child may develop noticeable signs of anemia, such as pale skin, and jaundice (yellowing of the skin and eyes due to bilirubin buildup).
A specific sign of internal damage is the appearance of dark or reddish-brown urine, which occurs when hemoglobin from destroyed red blood cells is excreted by the kidneys. In severe cases, the central nervous system can be affected, leading to symptoms like lethargy, confusion, headache, and seizures. These symptoms, especially urine discoloration, indicate a dangerous systemic reaction requiring immediate medical intervention.
Hospital Care and Management
Upon arrival at the emergency department, medical staff will stabilize the child and begin diagnostic testing. Initial blood work includes a Complete Blood Count (CBC) to check for anemia and a screen for methemoglobinemia, a condition where oxidized iron prevents hemoglobin from carrying oxygen effectively. Further tests assess liver and kidney function, as these organs can be damaged by the circulating byproducts of red blood cell destruction.
Treatment for naphthalene poisoning is primarily supportive, focusing on managing symptoms and complications. This often involves administering intravenous (IV) fluids to maintain hydration and protect the kidneys from damage caused by free hemoglobin. If the child has significant anemia or dangerously high methemoglobin levels, blood transfusions may be necessary to restore oxygen-carrying capacity.
Specific interventions combat the two main toxic effects: methemoglobinemia and hemolysis. Ascorbic acid (Vitamin C) may be given to reduce oxidized hemoglobin back to its normal state. In severe methemoglobinemia cases, methylene blue is the specific treatment, though a G6PD deficiency test must be performed first, as this antidote can paradoxically worsen hemolysis in those individuals. For patients with G6PD deficiency and severe toxicity, an exchange transfusion may be required to rapidly remove toxic chemicals and damaged blood cells.
Prevention and Safer Alternatives
Once the child has recovered, preventing future exposure becomes the priority for household safety. Mothballs must be stored securely out of sight and reach of children, ideally in a locked cabinet or container. Even the vapor from naphthalene is toxic, so these products should be used with extreme caution or replaced entirely.
Several safer, non-toxic alternatives exist for protecting clothing from moths. Natural repellents like cedar chips, blocks, or balls can be placed in storage areas, as the wood’s oils naturally deter moths. Sachets filled with dried lavender, rosemary, or cloves offer a pleasant scent that moths avoid, but these must be refreshed periodically. The most effective prevention method is to clean clothes before storing them and use airtight containers, which physically exclude pests without relying on toxic chemical agents.