The intentional poisoning of children is an uncommon but dangerous form of child abuse. It can occur as a form of extreme neglect, a bizarre means of discipline, or as Munchausen Syndrome by Proxy (MSBP). MSBP is an illness in a child that is caused or induced by a parent, usually the mother. In some cases, what is apparently an attempt to harm a child may instead be the well-intentioned use of a folk remedy the family is too embarrassed to discuss with the physician. The physician must rely on the medical history, the findings of a physical exam, and laboratory studies. Given the confusing history often involved in poisoning, the physician must be alert to the myriad signs and symptoms children can show after an ingestion of poison. The physical examination can differentiate drug-induced encephalopathy from the other common causes of coma in children, such as mass lesions and seizures. The physical examination can also lead to the identification of a specific toxicological syndrome that accounts for the patient's unexplained symptoms. Laboratory data that can help in a diagnosis include serum osmolality, electrolytes, glucose, blood urea nitrogen, and creatine. The routine toxicology screening test used by most hospitals can be valuable in the identification of the poisoning agent if the child has been poisoned with a drug included in the screen; however, in many recorded cases of intestinal poisoning, the drug was not part of the standard toxicology screen. Some examples of poisoning agents profiled in this chapter are salt; pepper aspiration; and alcohols, glycols, and hydrocarbons. 19 references