Even though chloral hydrate is used all the time in infants, chloral hydrate has many dangerous side effects when used in infants and children. Medical Research states that chloral hydrate has adverse side effects and clinical data shows it can even cause death.

Aidan Janssens was born on December 23, 2009 and had some minor birth defects, none of which were life threatening. Because of these defects, doctors wanted to perform an MRI (magnetic resource imaging) on him on the second day of his life. They sedated him with chloral hydrate for the procedure he was to undergo. The procedure went well, but when Aidan woke up from the procedure, he immediately experienced unrelenting obstructive apnea. His episodes of apnea required Aidan to be manually stimulated, so he would start breathing on his own. These episodes continually worsened, and the need for him to be manually bagged (a bagged placed over his nose and mouth that is manually pumped to give him air) were required. The onset of these episodes would continually worsen and become more frequent with each passing day. The doctors had a conference with Aidan’s parents requesting they sign a DNR (do not resuscitate) order for Aidan and told Aidan’s parents that they could not continually bag Aidan. Aidan’s parents refused and requested that they be able to bring Aidan home. Aidan lived at home for 4 days and ultimately on the 38th day of his life, he passed away from unrelenting obstructive apnea, bradycardia and cyanosis.

Chloral hydrate has been in use since the early 1800s, and as early as 1894 it has been used in infants and children (Buck ML. 2005). Chloral hydrate remains the most common choice for sedation even though newer agents with fewer side effects are available. Chloral hydrate has been used in infants and children undergoing procedures such as computed tomography scans, magnetic resource imaging of the brain and echocardiograms. Chloral hydrate has also been used in the treatment of insomnia and is rarely used in children for this sleeping disorder. It has been recommended it only be used for severe insomnia for short term use (Sennik, 2009).

According to the American Academy of Pediatrics “Replacement of chloral hydrate with other sedatives would represent a major change in practice because it is one of the drugs most widely employed to sedate young children undergoing dental and medical procedures as well as imaging studies” (American Association of Pediatrics, 2006, p.1). Although chloral hydrate has been known to have many adverse effects, we will only mention a few of the most dangerous side effects here, which include respiratory depression, prolonged drowsiness, disorientation, confusion and headache, induced obstructive apnea, bradycardia, cyanosis, acute laryngeal edema, and acute laryngospasm (Buck ML.2005; Pershad J.1999; Nichols M. 2004).

Marcia Buck (2005) of the University of Virginia Children’s Hospital reports, after evaluating 95 cases of adverse effects associated with chloral hydrate, seven cases resulted in death or neurologic injury and in five of these cases chloral hydrate was the only drug administered (Vol. 11 No. 9). Chloral hydrate can cause cardiac arrhythmias and cardiovascular compromise in severe overdose cases. Chloral hydrate is also known to cause severe central nervous system depression (Sing, 1996). Chloral hydrate was implicated in the death of four children after three of them were given overdoses and the fourth died after experiencing complications with his preexisting cardiopulmonary disease. In one of these cases, a five year old boy was given double the intended dose because the pharmacist that dispensed the drug dispensed it in the wrong concentration. (Cohen, 1993)

Chloral hydrate is also used in dentistry for the sedation of children undergoing dental surgery and it works very well in children. The cost of chloral hydrate is very minimal and for a 30 day supply the cost ranges from 10 dollars to 15 dollars. A one-time dose of chloral hydrate cost a little less than one dollar. Because it comes as flavored syrup, it is very easy to administer to children and it also comes as a suppository.

Chloral hydrate overdose is extremely hard to treat as choloral hydrate induced cardiac arrhythmias are resistant to most of the standard drugs given for overdose induced arrhythmias but improvement can be found with the use of propanolol. It is very important that emergency room physicians should be aware that choloral hydrate is a major culprit of drug induced cardiac- arrhythmias. (OF Wong, 2009)

Recently chloral hydrate has come under scrutiny for its potential for being a carcinogen and this has raised many concerns among physicians, dentist and parents. The basis for raising concern is the assumption that chloral hydrate is a reactive metabolite of trichloroethylene, an industrial solvent. Some studies have suggested that this drug causes cancer in some rats, but not all rats studied have developed cancer. There have been no known studies pertaining to chloral hydrate associated carcinogenicity in people. Chloral hydrate is also a by-product of chlorine and naturally occurring organic material produced during water treatment and the World Health Organization has had to set provisional guideline values on the level of chloral hydrate in drinking water, until adverse health effects and levels of chloral hydrate in drinking water can be established (Barrott, 2004).

In a study done by the Department of Pediatrics at the University Hospital Gasthuisberg, Germany it was revealed that the use of chloral hydrate in preterm infants caused a high increase in bradycardic events with some becoming life threatening (K, H, G, D, & H, 2005 ). In this case report in the Turkish Journal of Pediatrics, a four month old girl that was given a therapeutic dose of chloral hydrate, suffered life threatening central nervous system depression and respiratory depression. The little girl slowly recovered after supportive treatment including ventilation therapy (E, O, & A, 2009).

According to the American Academy of Pediatrics, chloral hydrate is known to damage chromosomes in selected mammalian test systems. They also agree that well designed studies need to be conducted that provide the necessary information for the safest and most efficacious use of sedatives in infants and children (American Academy of Pediatrics Committee, 1993).

It is concluded that the benefits of chloral hydrate do not outweigh the dangers associated with this drug. According to Alfred D. Steinberg chloral hydrate is a safe drug and the dangers associated with it are not good enough reason to have chloral hydrate banned (Steinberg, 1993). I do not agree with Mr. Steinberg and feel that chloral hydrate should in fact be banned or at least not allowed to be used on our children. Our children are our most precious resource and by giving them chloral hydrate because it is easier to administer or because the cost is low, is outrageous. It is time that health care providers take into consideration the dangers that our children are subjected to by giving them these types of dangerous drugs. We as a society are always acting as though we are so concerned with the protection of our children, but at the same time we allow health care providers to subject our children to extremely dangerous drugs. There are numerous case studies and reports that reveal that chloral hydrate possesses too many risk to continually use it on infants and children. These dangers include life threatening obstructive apnea, bradycardia, cyanosis, gastric lesions, neurologic injuries, lifetime airway support and even death. It is also surprising that this drug is consistently used in Neonatal Intensive Care Units throughout the United States. The American Association of Pediatrics warns that the chance of adverse effects is greater in children fewer than six months of age and that doctors and medical professionals should use extreme caution when administering this drug to young patients (American Association of Pediatrics, 2006).

American Academy of Pediatrics Committee. (1993). American Academy of Pediatrics Committee on Drugs and Committee on Environmental Health: Use of chloral hydrate for sedation in children. United States: American Academy of Pediatrics.

Asbury, H. (1942). The Gem of the Prairie. DeKalb, Ill.: Northern Illinois University Press.

Barrott, L. (2004). Chioral hydrate: Formation and removal by drinking water treatment. Buckinghanishire: Journal of Water Supply: Research & Technology-AQUA.

Buck, M. L. (2005). The use of Chloral Hydrate in infants and children. Charlottesville: University of Virginia Children's Hospital.

Cohen, M. R. (1993). CHLORAL HYDRATE OVERDOSES IMPLICATED IN DEATHS. Huntington Valley: Nursing.

Ceçen E, Uygur O, Tosun A. (2009). Severe central nervous and respiratory system depression after sedation with chloral hydrate: a case report. Turkey: The Turkish Journal Of Pediatrics.

Allegaert K; Daniels H; Naulaers G; Tibboel D; Devlieger H (2005 ). Pharmacodynamics of chloral hydrate in former preterm infants. Gasthuisberg: European Journal Of Pediatrics.

OF Wong, T. L. (2009, July). Two cases of choloral hydrate overdose. Hong Kong Journal of Emergency Medicane , pp. 161-167.

MALVIYA Shobha,VOEPEL-LEWIS Terri, TAIT Alan R.,EYNOLDS Paul I., GUJAR Sachin K.,GEBARSKI Stephen S., ELDEVIK O. Petter. (2004). Pentobarbital vs chloral hydrate for sedation of children undergoing MRI: efficacy and recovery characteristics. France: Paediatric Anaesthesia.

Sing, K. (1996). Chloral hydrate toxicity from oral and intravenous administration. Journal of Toxicology: Clinical Toxicology.