Nicotine pouches pose growing danger to young children

A new study reveals that ingestions of nicotine pouches by young children have surged in recent years. Researchers at the Center for Injury Research and Policy of the Abigail Wexner Research Institute at Nationwide Children’s Hospital and the Central Ohio Poison Center analyzed calls to U.S. poison centers and found an alarming 763% increase in the rate of reported nicotine pouch ingestions among children younger than 6 years old from 2020 to 2023. Nicotine pouches were also more likely to be associated with serious medical outcomes or hospital admissions than other nicotine products like gum/lozenges, e-liquids, powder/granules, and tablets/capsules/caplets.

Nicotine pouches, which contain nicotine powder and are placed in the mouth, were not tracked in national poison center data until 2020. However, between 2020 and 2023 (the most recent year of data from the study), the rate of unintentional ingestion of nicotine pouches by young children increased at a fast rate – even as ingestion rates for other formulations of nicotine declined.

Nicotine pouches are a serious and growing toxic ingestion hazard among young children. The rapid increase in the number and comparative severity of nicotine pouch ingestions is a reminder of the public health challenges of the changing nicotine product market. This is why we need to continue ongoing surveillance and increase our efforts to prevent nicotine ingestions among young children.”

Hannah Hays, MD, co-author of the study and medical director of the Central Ohio Poison Center

The study, published in Pediatrics, also investigated other nicotine products and formulations. Researchers examined nearly 135,000 cases of nicotine ingestions among children younger than 6 years old that were reported to U.S. poison centers from 2010 through 2023. Most ingestions occurred at home and involved children under the age of 2 years. While most exposures resulted in minor or no effects, there were 39 cases with major medical outcomes and two deaths.

The overall rate of all nicotine ingestions increased 59% from 2010-2015 before decreasing 34% from 2015-2023. This rate was primarily driven by the ingestion rate for liquid nicotine and nicotine solid formulations such as tablets, capsules, and caplets. The ingestion rate for liquid nicotine increased by 450% from 2010-2015 and then decreased by 45% from 2015-2023.

“This abrupt change in the rate trend for liquid nicotine ingestions corresponded with the passage of both state and federal legislation, including the Child Nicotine Poisoning Prevention Act of 2015, which required child-resistant packaging of liquid nicotine,” said Gary Smith, MD, DrPH, senior author of the study and director of the Center for Injury Research and Policy at Nationwide Children’s. “This suggests that legislation can make a difference. However, despite this improvement, the ingestion rate for liquid nicotine remained higher than the rates for any other nicotine product, which clearly indicates that there are opportunities for further improvement.

“Many nicotine products are flavored and sold in colorful packaging that may be attractive to a young child,” said Dr. Smith. “Banning flavors in all nicotine products helps reduce unintentional ingestions by young children as well as discourage use among teens.”

Researchers also shared a few safety tips for parents and caregivers of young children. The safest choice is to keep all nicotine products out of the home. If you choose to have them in your home, you can lower the risk by following these steps:

• Store nicotine products safely. If these products are kept in the home, store them up, away from food, and out of sight-preferably in a locked cabinet, drawer or box. While storing these products in purses or backpacks is not recommended when you have young children that live in or visit your home, if you are going to keep them in these places, make sure to store the purse/backpack up, away, and out of sight of children. Ask that caregivers around your child do the same in their homes.
• Avoid using these products in front of children. It is helpful to not use these products in front of your children, especially if packaged to look like treats.
• Save the national Poison Help Line number (1-800-222-1222) in your phone and post it in a visible place in your home. The Poison Help Line provides free, confidential advice from experts, 24 hours per day, seven days per week.

Data for this study were obtained from the National Poison Data System (NPDS), which is maintained by America’s Poison Centers. Poison centers receive phone calls through the national Poison Help Line (1-800-222-1222) and document information about the exposure, which is reported to the NPDS..