Liz Szabo | (TNS) KFF Health News
Hospitals toxicologist Ryan Marino has witnessed firsthand the severe reactions of children who have been poisoned by liquid nicotine found in electronic cigarettes. One young boy who arrived at his emergency room experienced intense symptoms such as nausea, diarrhea, and vomiting, and had to receive intravenous fluids to treat his dehydration. Other symptoms children may experience include dizziness, loss of consciousness, and dangerous drops in blood pressure. In the most extreme case Marino has witnessed, a boy had to be put on a ventilator in the intensive care unit because he couldn’t breathe. Marino is from the Case Western Reserve University School of Medicine.
Thousands of children are exposed to liquid nicotine from e-cigarettes every year. Even a few drops of liquid nicotine can be fatal for a toddler. Despite the 2016 Child Nicotine Poisoning Prevention Act, which requires child-resistant packaging on bottles of e-liquid, reported cases of children exposed to nicotine from vaping reached an all-time high in 2022. However, this law does not require protective packaging on the vaping devices themselves. Marino explains that refillable vapes, which hold liquid nicotine in a central reservoir, pose a danger to children. Even vapes that appear more child-resistant, where the nicotine is sealed inside a removable cartridge, can still be opened by children. Disposable e-cigarettes, which are currently the top-selling type on the market, can be used for thousands of puffs and contain as much nicotine as multiple packs of cigarettes.
Many e-cigarettes and e-liquids are designed to appeal to children, with attractive packaging in pastel colors, names like “Candy King,” and flavors such as bubble gum and blue raspberry. This makes vaping more tempting and dangerous for children compared to traditional cigarettes, which have lower nicotine doses and a bitter taste that causes children to spit them out quickly, says Diane Calello, a medical director from the New Jersey Poison Information and Education System.
Senator Richard Blumenthal (D-Conn.), who co-sponsored the 2016 legislation, plans to push for an expansion of childproof packaging requirements to include disposable and pod-based e-cigarettes. He emphasizes the need to remove flavored e-cigarette products from the market to protect children from these dangerous products.
The FDA reported that the number of vaping-related exposures reported to poison control centers has more than doubled since 2018. Between April 2022 and March 2023, poison control centers reported over 7,000 vaping-related exposures, with 43 resulting in hospitalization and an additional 582 requiring medical treatment. Nearly 90% of these exposures involved children under 5 years old. The authors of the report believe that their numbers underestimate the problem, as not all cases are reported to poison control centers. Tragically, a 1-year-old died from vaping-related nicotine poisoning in 2014. The report also mentioned a suicidal case involving an adult using an e-cigarette.
A spokesperson for the vaping industry claims that safety is taken seriously and that all e-liquid bottles manufactured in the United States conform to U.S. law. The bottles have child-resistant caps and restrict the flow of liquid to dispense only small amounts. However, many vaping products are made outside the U.S., and illegal e-cigarettes, primarily from China, have flooded the market.
The increasing number of nicotine exposures among children likely reflects the growing sales of e-cigarettes. State bans on flavored e-cigarettes, such as those in California, Massachusetts, New Jersey, New York, Rhode Island, and Washington, D.C., have been effective in reducing overall e-cigarette sales by 25% to 31%. However, some doctors argue that more needs to be done to protect children. Carl Baum, a professor of pediatrics and emergency medicine at Yale School of Medicine, believes that if the numbers are increasing, it indicates that the current laws are not effective.
Doctors emphasize that e-cigarette devices need child safety requirements. Refillable devices are easy for children to open, and disposable e-cigarettes, such as Elfbar, Puff Bar, and Pop Vape, were commonly mentioned in the FDA analysis. Expanding federal law to include devices and limiting the nicotine concentration in vape juices are crucial steps to protect children from the dangers of e-cigarettes, says pediatrician Gary Smith, president of the Child Injury Prevention Alliance.
Even if children don’t inhale the aerosol, sucking on a vape can expose their skin to nicotine, which can be absorbed into the bloodstream. E-cigarette liquids also contain harmful chemicals such as arsenic, lead, carcinogens, and volatile organic compounds. However, children who inhale nicotine generally receive a lower dose than those who ingest it, reducing the risk of serious harm.
Fortunately, the human body has protective mechanisms when it comes to toxic substances like nicotine. Children who ingest e-cigarette nicotine products typically vomit a lot, which keeps the mortality rate low. Regardless, these children often end up in emergency departments due to the associated nausea and vomiting.
To protect children, the FDA advises parents and guardians to keep e-cigarettes and vaping liquid out of reach and in their original containers. In case of emergencies, they can contact Poison Help at 800-222-1222 or visit poisonhelp.org for support and resources.
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