Perry Rosen, BA, discusses steps to prevent pediatric nicotine exposure

This clinical discussion by Perry Rosen, BA, student physician at the New York Institute of Technology, explores the shifting landscape of pediatric nicotine exposure, specifically contrasting the risks of e-cigarette inhalation with traditional liquid nicotine ingestion.

The progression of nicotine poisoning in children ranges from mild to severe, with inhalation cases often presenting more mildly than ingestions. Common symptoms of e-cigarette inhalation include coughing, choking, nausea, and vomiting. However, inhalation is not without significant danger; cases of central nervous system depression have been documented.

The primary concern is the low threshold for toxicity, as 2 mg of nicotine can cause severe effects in a child. For context, a single puff from a high-end vape can deliver up to 0.5 mg of nicotine, meaning severe toxicity can be reached in as few as 4 puffs.

The data indicate a complex shift in exposure types. There has been a 7360% increase in inhalation-based e-cigarette exposures, while traditional nicotine ingestions have decreased by 34.1%. While it is noted that the odds of severe effects and health care facility admissions for e-cigarette poisonings have reduced since the introduction of cartridges and disposables compared with traditional products, these devices still maintain higher admission rates and severe effect odds than traditional nicotine products. This surge in preventable inhalation cases represents a significant strain on health care resources.

From a regulatory standpoint, the Poison Prevention Packaging Act was successful in reducing poisonings from refill bottles by requiring child-resistant packaging that 85% of children cannot open within 5 minutes. However, a major loophole remains: There are currently no childproofing restrictions on disposable e-cigarettes, cartridge-based vapes, or nicotine pouches.

Furthermore, disposable vapes often bypass current flavor restrictions and use candy-like colors and designs that are highly appealing to children. Advocacy efforts are currently focused on pushing for device-level safety regulations to address these design accessibility issues and prevent toxic pediatric exposures.

This video is part 2 of a 2-part series. Click here for part 1

No relevant disclosures.

Reference

Rosen PE, Bartsche DR, Leonard JB, Greller HA, Ruck BE, Calello DP. Pediatric nicotine exposures reported to US poison centers. JAMA Netw Open. 2026;9(3):e260479. doi:10.1001/jamanetworkopen.2026.0479