Study: Nicotine pouch ingestions in young children increased more than 760% from 2020 to 2023

Study: Nicotine pouch ingestions in young children increased more than 760% from 2020 to 2023 | Image Credit: © Анастасія Шатирова - stock.adobe.com.

Unintentional ingestions of nicotine-containing products by young children remain a significant health concern in the United States. A new study published in Pediatrics highlights a sharp rise in nicotine pouch ingestions among children younger than 6 years, with a 763% increase in reported cases from 2020 to 2023. Researchers from the Center for Injury Research and Policy at the Abigail Wexner Research Institute at Nationwide Children’s Hospital and the Central Ohio Poison Center conducted the analysis using data from the National Poison Data System (NPDS).^1,2

The retrospective study examined 134,663 unintentional, single-substance nicotine ingestions reported to US poison centers from 2010 through 2023. The majority of cases occurred among children younger than 2 years (76.2%) and took place in the home (98.5%). Most exposures involved nicotine tablets, capsules, or caplets (25.7%) and liquid nicotine (25.4%).

While overall nicotine ingestion rates rose 59.4% between 2010 and 2015 and then decreased by 34.1% through 2023, researchers noted a significant and concerning deviation in the trend associated with nicotine pouches. These products, which became trackable in the NPDS beginning in 2020, were found to be disproportionately linked to more severe clinical outcomes compared to other formulations. Specifically, nicotine pouch ingestions were 1.53 times more likely to result in a serious medical outcome and 2.03 times more likely to result in medical admission than other nicotine product types.

“Nicotine pouches are a serious and growing toxic ingestion hazard among young children,” said Hannah Hays, MD, co-author of the study and medical director of the Central Ohio Poison Center. “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.”

From 2020 to 2023, the rate of nicotine pouch ingestions among children younger than 6 years rose by 763.1%. In contrast, ingestion rates for nicotine liquids and other solid forms declined during this period. The sharp increase in pouch-related exposures coincides with the broader market availability of these products and the introduction of new product codes into NPDS.

“Many nicotine products are flavored and sold in colorful packaging that may be attractive to a young child,” said Gary Smith, MD, DrPH, senior author of the study and director of the Center for Injury Research and Policy at Nationwide Children’s. “Banning flavors in all nicotine products helps reduce unintentional ingestions by young children as well as discourage use among teens.”

Although most cases resulted in no or minor effects, the study identified 39 cases with major medical outcomes and 2 fatalities. One involved a 12-month-old boy who ingested liquid nicotine of unknown concentration and was found unresponsive. The second fatality involved a 17-month-old boy who was exposed to e-cigarette liquid with a known concentration of 18 mg/mL.

The authors noted a decline in ingestion rates for liquid nicotine products beginning in 2015, attributing the shift in part to the implementation of the Child Nicotine Poisoning Prevention Act, which mandated child-resistant packaging. Nevertheless, the rate of liquid nicotine ingestions remained higher than that of any other product category by 2023, suggesting continued risk despite regulatory progress.

To mitigate exposure risks, researchers recommend that parents and caregivers avoid storing nicotine products in the home. If present, they should be stored in locked, inaccessible locations and not kept in purses or backpacks. The national Poison Help Line (1-800-222-1222) should be saved and visibly posted in the home.

The authors conclude that ongoing surveillance, regulatory action, and public education are essential to addressing the evolving threat of nicotine exposures among young children.

References:

1. Olivas M, Hays HL, Kistamgari S, et al. Nicotine Ingestions Among Young Children: 2010–2023. Pediatrics. Published online July 14, 2025. doi:https://doi.org/10.1542/peds.2024-070522
2. Nationwide Children's Hospital. New Study Finds Sharp Increase in Nicotine Pouch Ingestions Among Young Children. Newswise. Newswise.com. July 11, 2025. Accessed July 15, 2025. https://www.newswise.com/articles/new-study-finds-sharp-increase-in-nicotine-pouch-ingestions-among-young-children/?sc=mwhr&xy=10023887