Abstract
Pediatric respiratory failure carries a wide differential diagnosis. Toxic ingestion should remain on the differential even at very young ages. There have been increasing reports of fentanyl overdoses among adults; however, this should be considered for accidental pediatric ingestion, especially considering its high potential for mortality. A nine-month-old female presented to the pediatric emergency department with respiratory failure. The patient was noted to be bradypneic with miotic pupils, and therefore, naloxone was given intravenously (IV) with a positive response. The patient required numerous boluses of intravenous naloxone, which ultimately saved her from intubation. The patient's laboratory results were later positive for fentanyl and cocaine. Fentanyl ingestion has a high mortality rate, especially in pediatrics. With increasing fentanyl use, there is a potential for exposure due to not only child abuse and intentional toxicity but also exploratory ingestions.