We analyze 25 accidental childhood fentanyl exposures reported to FDA, 2004-2013. These exposures had a case-fatality rate = 48%; male:female ratio = 7.3; 76% were within the 2-4 age range. The ability of fentanyl to kill children so quickly is explained by fentanyl's ability to suppress respiration-as quantified by the antinociceptive potency per milligram, fentanyl far and away leads all narcotics. FDA recommends for fentanyl disposal: flush all forms of fentanyl down the toilet.