As nicotine pouches grow in popularity, so do pediatric poisonings—raising alarm among health officials
Nicotine pouches, often marketed as a safer alternative to smoking, are landing more and more young children in emergency rooms across the U.S. These small, flavored products are easily mistaken for candy or gum by toddlers, leading to accidental ingestion and serious health risks. Poison control centers and pediatricians are raising the alarm.
Nicotine… it’s not just in cigarettes, anymore.
You’re probably familiar with the hazards associated with nicotine in cigarettes, cigars, chewing tobacco, snuff, and e-cigarettes (vapes). But you might be less familiar with nicotine pouches. These are small, discreet pouches that contain nicotine (along with flavoring and fillers). They’re used by placing a pouch between the lip and gum, which allows nicotine to be absorbed into the bloodstream.
Nicotine pouches have been on the market in Scandinavia since the early 2000s, but they became more popular in the US in 2014 under the brand name ZYN. A nicotine pouch does not contain tobacco, just nicotine and flavoring. Users like them because they can be used discreetly and offer nicotine without smoke or vapor, there’s no spitting, and they’re hands-free (unlike cigarettes or chewing tobacco). However, they’re not intended or approved by the FDA as a smoking cessation method, because they still contain nicotine.
Now, officials are sounding alarms over nicotine pouches because the number of children who’ve been sickened by accidentally ingesting nicotine has skyrocketed over the past few years.
A new study published by Pediatrics, a journal of the American Academy of Pediatrics, indicated that there were 134,663 reported cases of child nicotine poisoning between 2010 and 2013. This includes poisonings from nicotine pouches, chewing tobacco, cigarettes, vapes, and nicotine replacements like gum and lozenges.
However, the most significant increase was related to pouches like ZYN.
The dramatic increase correlates with an increase in sales of nicotine pouches.
How and why do children ingest nicotine pouches?
There are several reasons why children younger than six years old can easily accidentally ingest a nicotine pouch.
- Attractiveness. Some pouches are in colorful and eye-catching packaging, which might make them appear to children to be similar to candy or snacks typically marketed to kids.
- Accessibility. A parent or caregiver could leave nicotine pouches in a handbag or other spot that a child can reach, including unlocked cabinets or reachable countertops or other surfaces.
- Modeling. Young children mimic the behavior they observe of the adults around them. If they see a parent or caregiver using nicotine pouches, a child is more likely to try to put a pouch in their own mouth.
- Lack of awareness. A parent or caregiver might not understand the dangers of nicotine pouches to children. This could result in their taking insufficient or no precautions to prevent children from gaining access.
How nicotine pouches are hazardous to children
- Nicotine toxicity. Nicotine is highly toxic, even in small amounts, for children. A child who ingests just a few milligrams of nicotine could experience vomiting, rapid heart rate, headaches, dizziness, seizures, coma, or respiratory failure.
- Brain development. Nicotine can impair memory, attention, and learning, and can lead to long-term cognitive and behavioral problems, particularly for developing brains.
- Addiction. Nicotine is highly addictive, and a child can easily become addicted to nicotine if they use a pouch. This could have significant health and social consequences.
Most of the cases included in the recent study did not warrant medical attention. About 40 children did suffer breathing troubles and seizures, however. Of the studied cases of nicotine poisoning, 76% were under age two. Two children died after ingesting liquid nicotine from vapes.
Can we prevent child nicotine poisonings?
Yes. The easiest and most critical prevention is the most obvious: Keep your nicotine products out of reach of children. A spokesperson for the American Academy of Pediatrics specified that this doesn’t mean in your pocket or handbag—it means keeping them locked away. Far away.
It also means being aware of what your older children are doing. Teens can also be affected by nicotine, and they also might not understand the dangers and could leave pouches or other items in places where they’re accessible to younger siblings.
What to do if a child eats a nicotine pouch
?? ACT IMMEDIATELY. This is a medical emergency. ??
- Stay calm, but act quickly.
Remove any remaining nicotine pouch from the child’s mouth. Encourage them to spit out whatever they can, but do not induce vomiting.
- Call poison control.
The National Poison Control number is: 1-800-222-1222 (US). Follow their expert guidance.
- Seek emergency medical attention.
Go to the nearest emergency department or call 911 if the child:
- is under five years old;
- has ingested more than one pouch; or
- demonstrates any unusual symptoms or behavior
Do not wait for symptoms to appear or try to induce vomiting, unless specifically instructed by poison control or a medical professional. Call 911 immediately for guidance.
Symptoms of nicotine poisoning in children
- Vomiting
- Pale skin
- Increased heart rate
- Excessive drooling
- Agitation or restlessness
- Tremors or seizures
- Dizziness or weakness
- Difficulty breathing
- Confusion or lethargy
- Loss of consciousness
Importantly, be prepared with this information to provide to medical professionals:
- Child’s age and weight
- Exact product name and nicotine concentration
- Number of pouches ingested
- Time of ingestion
Following treatment, be sure to follow any medical advice carefully. Prompt treatment can significantly reduce the risk of severe complications from nicotine poisoning.
Can adults experience nicotine poisoning?
Yes, an adult can definitely experience nicotine poisoning. Children are at higher risk because of their small size, but an adult can suffer serious or fatal nicotine poisoning if they consume a large quantity or concentrated form of the substance.
For instance, adult nicotine poisoning could occur if a nicotine pouch is accidentally swallowed or used improperly. It can also happen from concentrated forms of liquid nicotine, typically used for vaping.
Adult nicotine poisoning can also occur from heavy smoking or vaping over a short period of time, improperly using nicotine-replacement therapies, or as occupational exposure to workers who handle tobacco or nicotine products without proper protection.
If you believe an adult is suffering from nicotine poisoning, follow the same steps as you would for a child, as listed above.
As nicotine products become more common and accessible, especially with the popularity of vaping and nicotine pouches, protecting children from accidental exposure is more important than ever. Increased awareness among parents, caregivers, and communities is essential, alongside stricter safety measures and clear labeling on nicotine-containing products. Ultimately, prevention through education, secure storage, and responsible practices is the best way to reverse the troubling trend of rising nicotine poisoning cases among children.
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