OBJECTIVES: Pediatric drug exposures and poisonings continue to be an important public health concern. Among different drugs involved, opioids are an important class due to a rise in their medical and nonmedical use. This study aims to examine the prevalence and characteristics of pediatric opioid exposures and poisonings. METHODS: Data from the American Association of Poison Control Centers’ (AAPCC) National Poison Data System (NPDS) from January 1, 2010 to December 31, 2014 were used. Closed cases of children <18 years with an exposure to any opioid-containing analgesic or non-analgesic were included. Opioids were identified using generic codes maintained by the AAPCC. Exposure comprised any suspected exposure whereas poisoning was operationalized as any exposure that resulted in clinical effects. Opioid exposures were characterized based on clinical factors such as intent, route, clinical effects and level of healthcare involved, and socio-demographics. Prevalence rates were calculated using the number of cases reported in NPDS, standardized by the age-adjusted U.S. Census population estimates. RESULTS: We identified 83,418 children exposed to an opioid and nearly half of them experienced poisoning. Over 90% of exposures occurred at home and involved ingestion, and 23.2% involved ≥2 products. About 73.4% of exposures were unintentional, 10.9% had a moderate-to-severe outcome and 8.5% involved critical care. The total prevalence rate of opioid exposures was found to be 22.6 per 100,000 children. Annual prevalence rate decreased from 2010 to 2014 (25.5 to 20 per 100,000 children, respectively), this decline was significant after controlling for random effects of states. Prevalence rate of opioid exposures was higher among children ≤5 years (42.4 per 100,000 children) compared to those 6-12 years and 13-17 years (6.1 and 22.2 per 100,000 children, respectively). CONCLUSIONS: Pediatric opioid exposures and poisonings continue to occur. Further analyses will identify the factors and economic burden associated with opioid exposures and poisonings in children.