Nicotine exposures are skyrocketing among kids in N.J. and Pa. — especially those under 5

Nicotine exposures among children — especially in children under 5 years old — have doubled in New Jersey in recent years and are rising rapidly in eastern Pennsylvania.

There have been 89 cases of exposure to vaping liquids or e-cigarettes among children in eastern Pennsylvania in 2023 as of July 31, compared to 58 the same time last year, according to the Children’s Hospital of Philadelphia, which manages the regional poison control center. A total of 131 exposures were reported in 2022, up from 103 in 2021.

Between 2021 and 2023, 75% of reported vape liquid or e-cigarette exposures in eastern Pennsylvania were among children under 5 years old. Just 15% occurred among children between 6 and 19, and 10% were among people age 19 or older.

Nicotine exposures among New Jersey residents under 20 doubled between 2021 and 2022, from 42 to 86 cases. So far this year, New Jersey has logged 83 cases. All but six of those reported exposures in 2023 were in children under 5.

New Jersey’s data don’t distinguish between children who ingested nicotine through a traditional tobacco cigarette and those who smoked an e-cigarette or consumed vaping liquid. But as e-cigarettes and vapes have shot up in popularity over the past decade, poison control experts worry that the rise in poisonings is a sign that liquid nicotine products are too accessible to children, said Diane Calello, a physician who serves as the executive and medical director of the New Jersey Poison Information and Education System.

National nicotine exposures are rising as well. Reported cases of nicotine exposure related to vaping hit an all-time high in 2022, KFF Health News reported last week. (The term “exposure” refers to an incident where someone has ingested or is suspected to have ingested a substance. “Poisoning” refers to adverse health consequences as a result of ingesting a substance.)

Part of experts’ worry comes from the potency of vaping products available on the market. Disposable e-cigarettes, now the most popular type of vape on the market, can contain as much nicotine as multiple packs of cigarettes, KFF Health News reported, and aren’t required to have child-resistant packaging.

Children can also ingest nicotine by drinking the nicotine liquid intended for a refillable vape. A 2016 law does require child-resistant packaging on vape liquid, KFF Health News reported.

Another danger, experts say, is the flavors that some vape liquids and e-cigarettes come in — sweet, candy-like flavors that can appeal to young kids. Six states, including New Jersey, have banned flavored e-cigarettes. Philadelphia bans flavored vaping pods and vapes with high levels of nicotine at stores that children can enter.

A federal law bans flavored cartridge-based e-cigarettes, where the nicotine liquid is sealed in a removable cartridge. (Doctors warn that even those sealed cartridges can be pried apart, KFF Health News reported.)

“We hear a lot about the flavoring, and also the colorful packaging, across all our calls,” said Anthony Jaworski, a doctor of pharmacy and the clinical program manager at CHOP’s poison control center. And, even though certain states have banned flavored nicotine products, adults can cross state lines or order flavored products online, he said.

“Of course, people are purchasing products for themselves as adults, without realizing that the little kids can also be attracted to the way that these are packaged,” Jaworski said.

Exposures also aren’t limited to children drinking vape liquid, experts say. About half of the reported exposures in eastern Pennsylvania in the last two years involved ingestion of nicotine, and half involved inhaling nicotine.

Drinking the liquid is “certainly the most dangerous” because it could deliver the highest dose, Calello said.

But the poison control center has also seen cases of children as young as two years old inhaling vapes that belong to their parents. “They do what they see,” she said. “The childproof packaging doesn’t help when it’s loaded into a vape pen. They just have to take a puff.”

Calello and Jaworski aren’t surprised by the rise in reported nicotine exposures to children. The proliferation of vaping products on the market will naturally result in more exposures, they say.

“It comes down to the fact that these are more common in the household,” Jaworski said.

Still, he said, parents can take steps to mitigate risks related to nicotine exposure. Those who use e-cigarettes should consider avoiding flavored products to make them less appealing to children, and avoid vaping in front of kids to reduce the chance that they’ll puff on an e-cigarette, trying to imitate their parents.

Vaping products should be stored high up and locked away from children — “in a similar manner to medications or dangerous chemicals,” Jaworski said.

And parents can watch for signs of a nicotine exposure in their children. Vomiting, paleness, and sweating usually happen within 15 to 20 minutes after ingesting nicotine, he said. Parents should consider visiting a doctor if a child shows unusual tiredness or confusion.

More serious symptoms include dizziness, weakness, muscle twitching, seizures, and loss of consciousness. “That progression of symptoms — into neurologic findings — is when nicotine poisoning can become fatal,” Calello said. “It’s rare, but it does happen.”

Jaworski said his center has fielded no reports of fatalities, and most nicotine exposures in children in the area have resulted in mild symptoms, he said. Still, he said, the rise in cases is alarming, especially among young children.

In particular, he said, poison experts are concerned about vaping liquids, which can be heavily concentrated.

The national poison control hotline can be reached at 1-800-222-1222 and is staffed 24/7. Jaworksi said parents concerned about exposure to any substance shouldn’t hesitate to call. “We have nurses and pharmacists who are judgment-free, it’s all anonymous, and parents and caregivers won’t have to search through Google to find an answer,” he said.

KFF Health News contributed to this report.