Nonfatal pediatric fentanyl exposures reported to US poison centers, 2015–2023

<i>Background:</i> The opioid crisis, driven by fentanyl use, continues to worsen in the US and there has been a lack of focus on nonfatal overdose and how pediatric populations are being affected.<i>Objectives:</i> We determined the prevalence of nonfatal pediatric fentanyl exposures and associated characteristics and delineated how such characteristics are associated with major (life-threatening) outcomes.<i>Methods:</i> This repeated cross-sectional study examined characteristics of pediatric nonfatal fentanyl exposures (aged 0-19 years) reported to poison centers in 49 US states from 2015 through 2023.<i>Results:</i> 3,009 nonfatal pediatric exposures (41.5% female) were reported to poison centers-58.9% aged 13-19 and 41.1% aged 0-12. The number of exposures increased overall from 69 in 2015 to 893 in 2023 (a 1,194.2% increase, <i>p</i> < .001). Exposures increased by 924.3% among those aged 0-12 (<i>p</i> < .001) and by 1,506.3% among those aged 13-19 (<i>p</i> < .001). Ingestion-only use was the most prevalent route of administration by those aged 0-12 (76.9%) and 13-19 (54.1%). Prevalence of ingestion-only use increased from 44.1% of exposures in 2015 to 67.9% in 2023 (<i>p</i> < .001). The majority of patients aged 0-12 were exposed unintentionally (81.7%, vs. 1.0% among patients aged 13-19) while the majority of patients aged 13-19 misused or "abused" fentanyl (65.7% vs. 1.8%). The plurality of exposures (41.0%) resulted in a major (life-threatening) effect.<i>Conclusions:</i> Pediatric exposures to fentanyl are increasing and over one-third of cases are unintentional and/or had documented life-threatening effects. Prevention and harm reduction efforts need to include efforts for youth, particularly as counterfeit pills containing fentanyl flood the illicit market.