Nicotine intoxication increases in infants and young children, study shows

A new study published in the journal Pediatrics of the American Academy of Pediatrics reveals a worrisome 763.1% increase in nicotine poisonings in children younger than 6 years old between 2020 and 2023, attributed mainly to the rise of flavored nicotine pouches.

The analysis, based on data from the National Poison Data System, reported 134,663 cases of unintentional nicotine intake in this age group from 2010 to 2023, with 98.5% occurring in the home, predominantly in children younger than 2 years (76.2%) and boys (55.5%).

Nicotine puches, which contain between 3 and 12 milligrams of nicotine and are marketed as a non-tobacco alternative, have driven this increase due to their attractive taste and easy access.

It is a high-nicotine product and "taste good," said Dr. Natalie Rine, director of the Central Ohio Poison Control Center and co-author of the study.

In addition, Rine pointed out: "There’s nothing telling the kid, ‘this is bad, you should spit it out’ … and that’s where you get into trouble.”

What do the pouch contain?

These pouch, introduced to the U.S. market in 2014, combine synthetic or natural nicotine with flavorings and sweeteners, making them particularly appealing to children.

Although 81.3% of cases did not require medical attention and most had no (36.8%) or mild (19.6%) effects, such as nausea and vomiting, the study highlights that 1,600 children suffered serious consequences, including hypertension, tachycardia, seizures and respiratory failure.

Tragically, two one-year-old children died after ingesting liquid nicotine used for vapers.

Nicotine pouch showed an increased risk of serious medical outcomes and hospital admission compared with other nicotine products, such as vaporizers, chewing gum, or chewing tobacco.

The study also notes that, although liquid nicotine poisonings increased dramatically between 2010 and 2015 (450.0%), the overall trend in intakes decreased by 34.1% from 2015 to 2023, except for the spike in nicotine pouch.

Prevention

To prevent these incidents, the authors urge parents to avoid using these products in front of children, keep them out of reach, and discuss these precautions with other caregivers, such as babysitters or family members.

In the event of ingestion, they recommend immediately contacting the Poison Control Center at 1-800-222-1222, where trained personnel can assess symptoms and determine if emergency medical attention is necessary.

Dr. Molly O'Shea, a Michigan pediatrician and spokesperson for the American Academy of Pediatrics, stressed the need for vigilance: "It was just a matter of time before they fell into the hands of younger kids. It’s unfortunate, but not shocking.”