Nicotine poisonings soar in babies and toddlers
From 2010 through 2023, U.S. poison centers reported 134,663 cases of nicotine poisonings among kids under age 6, according to a study published Monday in Pediatrics, a journal of the American Academy of Pediatrics.
Nearly all occurred at home.
The cases included exposures to nicotine pouches, chewing tobacco, regular cigarettes, vapes and nicotine replacement products like gum and lozenges.
But it's nicotine pouches, like the wildly popular Zyn, that are behind the most significant rise in accidental nicotine poisonings among young kids.
The new research found that the rate of poisonings involving nicotine pouches among kids under 6 rose from 0.48 per 100,000 children in 2020 to 4.14 per 100,000 in 2023.
That's an increase of 763% in just three years — a startling finding that correlates with a surge in sales of nicotine pouches.
Nicotine pouches — which users tuck between their lip and gum and later discard — can contain as much as 6 milligrams of nicotine, a stimulant, and have been promoted as tobacco-free, spit-free and hands-free alternatives to cigarettes and chewing tobacco.
They are not, however, approved by the Food and Drug Administration as nicotine replacement products used to help quit smoking.
A 2021 study from the Centers for Disease Control and Prevention's Office on Smoking and Health (one of several public health groups dismantled under the Trump administration) found that sales of nicotine pouches rose dramatically in the past decade, from $709,000 in 2016 to $216 million by mid-2020.
'It was just a matter of time before they fell into the hands of younger kids,' said Dr. Molly O'Shea, a Michigan pediatrician and spokesperson for the American Academy of Pediatrics. 'It's unfortunate, but not shocking.'
Why is nicotine toxic to little kids?
Nicotine is a chemical that's highly toxic and could easily exceed a fatal dose in small children, according to a 2013 study.
The chemical increases heart rate and blood pressure, and could lead to nausea, vomiting or even coma, the study authors wrote.
Most cases included in the new research weren't serious enough to warrant medical attention. But 39 children had significant side effects, like trouble breathing and seizures, said Natalie Rine, an author of the new study and director of the Central Ohio Poison Center at Nationwide Children's Hospital in Columbus.
Most nicotine poisoning cases, 76%, were babies and toddlers under age 2.
Two children, a 1-year-old boy and another boy about a year and a half old, died after ingesting liquid nicotine used in vapes.
'It's good that the majority of kids in the study actually did pretty well. Most kids had either minor symptoms or no symptoms and didn't require any medical management,' Rine said. 'But two deaths is a lot, especially for something considered a preventable death.'
How to reduce nicotine poisonings in kids
Kids are curious by nature. Babies and toddlers in particular explore their worlds by putting things in their mouth.
And they're masters at breaking into drawers and cabinets to find new 'toys.' Canisters of nicotine pouches are not equipped with child-resistant packaging. They taste good, too. Mint and fruit flavors are almost always added.
O'Shea said it's critical that all nicotine products are placed far out of reach of children. 'That doesn't mean in your purse, in your back pocket or on the counter,' she said. 'It means locked away.'
It's not just parents and other adult caregivers who must be mindful of their nicotine products. An April study from the Keck School of Medicine of the University of Southern California found the use of nicotine pouches among high school students nearly doubled between 2023 and 2024.
'It's easy for a teenager to be using this product and have parents be unaware,' O'Shea said. 'It's important for parents to be talking with their teenagers about products like this and having open dialogue in a nonjudgmental way in order to ascertain any risk.'
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