Intentional childhood poisoning is an uncommon form of child abuse but has a very high risk of morbidity and mortality. Patients present with four main categories of illness: metabolic derangements (salt and water ingestion), gastrointestinal symptoms (laxative and ipecac poisoning), hemorrhagic disease (warfarin and superwarfarin exposures), and neurologic symptoms (central nervous system depression or excitation). While widely available, routine urine drug screens are of limited value so clinicians must have a high index of suspicion to make these diagnoses.