Perry Rosen, BA, highlights the surge of pediatrics e-cigarette inhalation exposures

In a recent interview with Contemporary Pediatrics, Perry Rosen, BA, student physician at the New York Institute of Technology, highlighted the need for updated parental guidance following the significant spike observed in pediatric e-cigarette exposures.

Since 2016, there has been a 7460% increase in pediatric inhalation exposures related to e-cigarettes. This surge is largely attributed to the introduction of cartridge-based devices such as Juul in July 2015. At the beginning of the study in 2016, there were only 70 reported e-cigarette-based exposures, but by 2023, that number had risen to 5292.

Children aged 2 years or less are the most vulnerable, representing nearly 50% of all poisoning exposures nationally each year. Their developmental stage makes them prone to these incidents as they are naturally exploratory and often oral-driven, especially when teething.

Furthermore, children frequently mimic adult behaviors; seeing a parent or caregiver use a vape encourages them to do the same. The design of these products also exacerbates the risk, as they often feature bright packaging, fruit icons similar to candy, sweet scents, and game-like features such as LED lights that flash star and moon patterns during use.

Pediatricians are encouraged to update their anticipatory guidance during well-child visits to address these hazards. While vapes may be used for smoking cessation or as a "safer" alternative to traditional cigarettes in some households, they remain a significant toxidrome risk for toddlers. Safe storage is critical because these devices are portable and often left in accessible places such as purses or low tables.

Additionally, research into pediatric opioid poisonings suggests that nicotine exposures may similarly originate from products belonging to visiting extended family members or friends. Clinicians should approach these conversations with an open mind, emphasizing that visitors or traveling to other homes can introduce unexpected dangers.

In clinical settings, it is vital to distinguish between inhalation and ingestion. Even used nicotine pouches or cigarette butts can cause delayed toxic effects. If exposure is suspected, providers should immediately contact the Poison Control Center at 1-800-222-1222 to determine if emergency department evaluation or treatments such as activated charcoal are necessary.

Nicotine poisoning presents as a biphasic toxidrome, starting with stimulatory signs such as nausea, vomiting, and tachycardia, followed by more severe symptoms such as parasympathetic and neuromuscular failure. Early identification of these signs, particularly the onset of a muscular blockade, is essential for specialized critical care.

This video is part 1 of a 2-part series. Check back Monday for part 2.

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