Cocaine-induced dystonic reaction: an unlikely presentation of child neglect.

Child neglect can be difficult to recognize. Parental substance abuse may place a child at increased risk of neglect. This report reviews 2 cases of dystonic reaction in children after accidental exposure to cocaine in their home environments. The reports are followed by a review of proposed physiologic mechanisms for cocaine-induced dystonia and a discussion on neurological symptoms that may develop after cocaine exposure. Pediatric emergency physicians should consider cocaine exposure when a child of any age presents with abnormal movements. Dystonic reaction is an uncommon, but reported, complication of cocaine exposure in the absence of other risk factors and may be the first presentation of child neglect.