Trending Topics

Investigating drug overdoses involving infants and toddlers

Keep the following in mind if you find yourself responding to a possible child overdose


When small children have ingested narcotics, it is likely they obtained it through the carelessness of their caregiver.

image/ iStock

“Child not breathing” is among the most dreaded calls you can receive on patrol. Once the child has been turned over to medical personnel, law enforcement should ascertain:

  • Why did this occur?
  • Is it a medical issue?
  • Did they have a pre-existing condition?
  • Was it child abuse or something else?

One consideration is that the child overdosed. The Centers for Disease Control and Prevention reports that there were an estimated 107,622 drug overdose deaths in the United States during 2021, an increase of nearly 15% from the 93,655 deaths estimated in 2020. With that many people struggling with addiction, it is no surprise that children may become exposed to illicit substances. A Yale study examining age-specific mortality rates for prescription/illicit opioid poisonings found that between 1999 and 2016, there was a 225% increase in deaths among children aged 0-4 years of age.

As law enforcement, it is imperative we ascertain what happened to determine if a crime occurred and what if any intervention is needed. A thorough investigation holds offenders accountable and assists child protective services in making decisions about what is best for the child going forward.

Keep the following in mind if you find yourself responding to a possible child overdose.

Was Narcan administered?

It should go without saying that adults are responsible for keeping the children in their homes safe. When small children have ingested narcotics, it is likely they obtained it through the carelessness of their caregiver. Expecting that same person to disclose their drug use to you is not realistic. If there are signs of drug abuse present, it is imperative that the information be relayed to the treating medical professionals.

The paramedics and/or hospital staff are going to be focused on treating the child and determining the cause of the distress, they won’t have much time to interview the caregiver or examine the scene for clues. Knowing the child was exposed to opioids so appropriate treatment actions can be taken is paramount.

Once the child is with paramedics or at the hospital, you can best assist by gathering information to help in treating the child. Don’t miss the opportunity to save a life by assuming it’s a medical issue. The parents may or may not have the child’s best interest at heart, which may prevent them from telling you the whole story. The nature of these incidents means they often happen at home where the offender has ample opportunity to hide evidence and clean up the scene prior to your arrival so you need to be observant. If Narcan is used successfully, this could indicate an opioid overdose.

[RELATED: Watch: Ala. deputy revives toddler from fentanyl overdose]

What did the caregivers tell medical personnel?

A child’s caregiver may lie to the police to avoid arrest but may convey information to medical personnel trying to save their child’s life. Investigators should speak to the paramedics, nurses and attending physicians, however, due to patient confidentiality and HIPAA issues, a subpoena may be required to obtain detailed information regarding the child’s health.

What was said cannot only help to determine the truth, but it can also help to establish criminal intent later on in court if charges are later brought. If the investigation shows they clearly should have known their child ingested drugs and did not tell the hospital, it becomes apparent to everyone that they were more concerned with concealing their criminal activities than they were with the child’s life.

One of the coldest things I’ve witnessed in my career was standing in a hospital emergency room watching a father tell the nurses there were no drugs in the house as his infant daughter slowly died in front of him. Further investigation would show that he was a mid-level dealer who packaged fentanyl at his apartment, which was then distributed at different locations in the area. Blood testing from the autopsy showed an extremely high concentration of fentanyl in his daughter’s system. To this day, I’ve wondered if Narcan could have changed the outcome in that case.

Investigative considerations

Talk with hospital staff to make sure they are testing specifically for fentanyl and its derivatives. If they don’t have the capability, consider seeking a search warrant to draw blood from the victim for submission to your local crime lab.

Who was the child with when the overdose occurred? Did they leave drugs out? What were they doing that they didn’t notice the child had accessed the drugs? Did they call 911 right away? Is there a history of drug use in the home? Check criminal histories, past calls for services and other databases for any history of drug use in the house. Documenting all of these factors will be important when the case goes to court later on.

Another consideration is search warrants for blood draws on the caregivers. In all likelihood, whatever substance is in the child is also in them as well. Making that connection eliminates the “I don’t know how drugs got in my house” argument later on.

Search the residence for signs of drug use. Whatever substance the child ingested had to be accessible to them. The smaller the child, the fewer places they can reach. If you can’t find signs of drug use, why is that? Could the child have overdosed somewhere else and been brought to a different house to contact 911 from? Did the caregivers take time to destroy/conceal evidence prior to calling 911? Keep in mind that if the caregiver’s focus was completely on getting help for the child, there should be evidence in plain view near where the child was found. If not, you could have a staged crime scene because someone took the time to clean up while the child was in distress.

Looks for signs of pill use. Many people abuse prescription medication thinking it is safer since it was made in a lab. Drug traffickers take advantage of this by creating fake prescription pills laced with fentanyl and other substances. The goal is to figure out exactly what the child took and in what form.

What else is going on in the home? If they can’t keep drugs away from the child, what are the odds that the child is being fed and cared for properly? Heavy drug use is also a risk factor for physical/sexual abuse and also needs to be considered.

To end with, children growing up in drug-infested homes are some of the most tragic cases a police officer will encounter in their career. With attention to detail and sound investigative practices, you can hopefully break the cycle and get that child on the path to a better life.

Detective Corporal Jim Twardesky has been in law enforcement since 1999, currently serving as a detective for the City of Warren Police Department in Michigan. He has a bachelor’s degree in criminal justice and a master’s in public administration, both from Wayne State University. Additionally, he teaches as an adjunct instructor for the Macomb Public Service Institute and regularly lectures on the subjects of child homicide, sex crimes and interviewing child molesters through his company Twardesky Consulting.