Recent research highlights a dramatic surge in cases where young children have accidentally ingested nicotine pouches. Experts from the Center for Injury Research and Policy at the Abigail Wexner Research Institute of Nationwide Children’s Hospital, in collaboration with the Central Ohio Poison Center, reviewed data from U.S. poison control centers. Their analysis uncovered a staggering 763% rise in the incidence of nicotine pouch ingestions reported for children under the age of 6 between 2020 and 2023. Compared to alternative nicotine delivery methods such as gums, lozenges, e-liquids, powders, granules, tablets, capsules, and caplets, these pouches showed a higher propensity for leading to severe health complications or requiring hospitalization.
Understanding Nicotine Pouches and Their Risks
These nicotine pouches consist of nicotine powder tucked between the lip and gum, mimicking the use of smokeless tobacco products. Prior to 2020, national poison center databases did not systematically record incidents involving them. Yet, from 2020 through 2023—the latest dataset available—the rate of accidental ingestions by toddlers and infants escalated rapidly. In contrast, ingestion rates for other nicotine variants actually dropped during the same timeframe.
“Nicotine pouches represent an escalating and significant poisoning risk for small children,” stated Hannah Hays, MD, who co-authored the study and serves as medical director at the Central Ohio Poison Center. “The swift escalation in both the volume and the gravity of these incidents underscores the public health dilemmas posed by evolving nicotine markets. It emphasizes the necessity for persistent monitoring and intensified prevention strategies to safeguard young children from nicotine exposure.”
Comprehensive Analysis of Nicotine Exposure Trends
Detailed in the journal Pediatrics, the study delved into a broad spectrum of nicotine products and their formulations. The team scrutinized approximately 135,000 reported nicotine exposure cases in children younger than 6 years, spanning from 2010 to 2023 across U.S. poison centers. The vast majority of these incidents took place in residential settings and predominantly affected children below 2 years old. Although most cases led to minimal or no symptoms, there were 39 instances of critical medical effects and tragically, two fatalities.
Looking at the bigger picture, the total rate of nicotine ingestions among young children climbed by 59% between 2010 and 2015, followed by a 34% decline from 2015 to 2023. This pattern was largely influenced by trends in liquid nicotine and solid forms like tablets, capsules, and caplets. Specifically, liquid nicotine ingestions skyrocketed by 450% from 2010 to 2015, then fell by 45% in the subsequent period from 2015 to 2023.
“This sharp shift in liquid nicotine ingestion trends aligns closely with the enactment of key state and federal laws, notably the Child Nicotine Poisoning Prevention Act of 2015, which mandated child-resistant packaging for liquid nicotine containers,” explained Gary A. Smith, MD, DrPH, the study’s senior author and director of the Center for Injury Research and Policy at Nationwide Children’s Hospital. “Such evidence demonstrates that regulatory measures can yield tangible benefits. Nevertheless, liquid nicotine ingestion rates continue to exceed those of other products, signaling ample room for additional advancements in safety protocols.”
Dr. Smith further noted, “A wide array of nicotine items come in enticing flavors and vibrant, eye-catching packaging that can easily appeal to curious toddlers.” He advocated, “Prohibiting flavors across all nicotine products would not only curb accidental ingestions in young children but also deter adolescent initiation into nicotine use.”
Practical Safety Recommendations for Families
To help mitigate these dangers, the researchers offered actionable guidance for parents and caregivers. The most effective strategy remains excluding all nicotine products from the household entirely. For those who opt to keep them, adhering to the following precautions can substantially reduce hazards:
- Secure storage practices. When nicotine products must be stored at home, place them high up, separated from food items, and completely out of children’s reach—ideally within a locked cabinet, drawer, or container. Avoid stashing them in purses or backpacks if young children are present or visiting; if unavoidable, ensure these bags are elevated, hidden, and inaccessible. Encourage all caregivers in your child’s circle to adopt identical precautions in their own spaces.
- Refrain from use around kids. It’s advisable to never use nicotine pouches or similar items in the presence of children, particularly those designed with packaging resembling candy or snacks.
- Keep emergency contacts handy. Program the national Poison Help Line number (1-800-222-1222) into your phone and display it prominently in your home. This service delivers round-the-clock, expert, confidential guidance every day of the week.
Data Sources and Methodology
The findings stem from the National Poison Data System (NPDS), managed by America’s Poison Centers. This comprehensive database compiles exposure reports from calls routed through the Poison Help Line (1-800-222-1222), where specialists meticulously record details of each incident for analysis and public health insights.
