Smoking cessation is one of the more difficult challenges a physician faces. It’s an unbelievably addictive habit with well-documented negative health effects. My adult medicine colleagues fight this battle every day, trying to reduce their patients’ risk for heart attacks, strokes, cancer, and innumerable other health problems. Fortunately, I’m in the field of pediatrics, and most of my patients don’t smoke. Unfortunately, many of their parents do. Secondhand smoke exposure increases a child’s risk for asthma, ear infections, Sudden Infant Death Syndrome (SIDS), and many other medical problems. It also increase a child’s own likelihood of picking up the habit.
I recently saw a patient (one of my favorites), who has fantastic parents. I’ve taken care of her since she was born. When I first met them, both of her parents smoked. After several conversations, I had convinced them both to stop. And then they split up, and the cravings were more than they could handle. But they both want the best for their daughter–so they have decided to come to appointments together, treat each other well (at least while she’s around), and make the switch to e-cigarettes.
If you’re somehow unaware of this fad, e-cigarettes (also known as “e-cigs” or “vapes”) are electronic devices that aerosolize a liquid containing nicotine along with any of several hundred flavorings. They are marketed as a safer alternative to smoking, or as a pathway to smoking cessation. They are widely available on the internet and in specialty shops that are popping up all over the country. These products are not regulated by the FDA, and in many states, can be sold to children. The liquid for these devices comes in small bottles—typically with brightly-colored labels and pictures of fruit or other food items. A typical bottle holds 30 mL of liquid, which is the equivalent of roughly 2.5 cartons of cigarettes.
When my patient’s parents asked what I thought of their decision, I congratulated them on their efforts to minimize her secondhand smoke exposure, but cautioned them about keeping this liquid locked away out of reach. I explained that if a child ingested enough of this liquid, it could be highly toxic and potentially even fatal. My warnings were based purely on knowledge of the effects of nicotine; honestly I hadn’t thought much about the topic before. When I got home that evening, I searched for any reports of child deaths caused by nicotine toxicity, but couldn’t find any. Three days later, one made the news.
Historically, nicotine toxicity hasn’t been a major problem–probably because most toddlers wouldn’t sit down and eat a whole carton of cigarettes. But I can certainly see how a brightly-colored bottle of “tutti fruiti” or “gummy bear” flavored vape juice could seem appetizing. I did some further reading and found that the number of nicotine exposures reported to US poison control centers has increased from 1 per month in 2010 to 215 per month in 2014.
To me, a 215-fold increase in toxic exposures to a potentially fatal substance is a big deal. Apparently, I wasn’t the only one concerned. The American Academy of Pediatrics recently issued a press release about these dangers, and there is currently a bill (The Child Nicotine Poisoning Prevention Act of 2014) in Congress to address some of these problems. Until there are major changes to make packaging child-proof and less visually appealing to children, these products pose a major health risk to our children.
In addition to the risk of accidental overdose by young children, e-cigarettes also contribute to increased nicotine addiction in adolescents. This was the topic of a recent article in Pediatrics, which reported that 29% of high school students interviewed in Hawaii reported using e-cigs (compared to 3% for traditional cigarettes alone). The article suggests that, instead of helping people stop smoking, these devices may actually be recruiting more adolescents to nicotine addiction. Perhaps the novelty, variety, and availability of e-cigarettes has become too appealing.
But, for those who are actually using them, are they safer? Maybe. There’s not enough evidence yet to say for sure. They do have lower levels of the carcinogens (cancer-causing toxins) than traditional cigarettes. But the nicotine itself also causes numerous health problems—hypertension and birth defects, to name two.
However, if they increase the number of young people that develop nicotine addictions, any health benefits are negated. And if they’re left within easy reach of a toddler, they can be more dangerous than any of us would care to imagine.
Click here for symptoms of nicotine overdose. If you are concerned that your child may have overdosed on nicotine, call your local poison control center, or go to the nearest emergency room. If you choose to use these products, please keep them locked away and out of reach of your children.
Thanks for reading–I encourage you to leave any comments below (even if you disagree). I’ll reply when I can. Follow me on Twitter @chadhayesmd for future posts.