In the midst of the investigation into the vaping epidemic, which has resulted in the hospitalization of more than 800 people and 12 confirmed deaths nationwide, there’s been a rush to point fingers at the potential culprit behind the epidemic, as well as generate concern about issues that may be tangentially related to vaping. The latest is a report from Kansas local ABC affiliate KMBC TV, which claims there’s been an increase in reports of very young children accidentally ingesting e-cigarette cartridges or liquid nicotine bottles.
According to officials at the University of Kansas Health System Poison Control Center, the center has received nine calls within the past three weeks from parents regarding toddlers and infants ingesting or touching e-cigarette juice or cartridges. ”Parents are calling saying, ‘Hey I found my kid holding the vaping product,’ or ‘I found the kid with the e-cigarette pod in their mouth.’ So we’re actually having a bit of an uptick in that, along with having reports of these vaping associated pulmonary illnesses,” Dr. Elizabeth Silver, clinical toxicologist with the University of Kansas Health System Poison Control Center, told the news station. “We’ve had kids ingest that and they get pretty bad toxicity from the nicotine because it’s very, very concentrated in those little pods.” (To be clear, this phenomenon is distinct from teenagers on YouTube purposefully drinking liquid nicotine for views — a thing that does apparently happen, but far less than media coverage of the subject would suggest.)
For adult readers, particularly adult readers who are parents, the story, which was picked up by a number of national news outlets, hits all of the requisite points to inspire panic; the fact that it incited fear about a product that is already the subject of national news media attention makes it all the more frightening. And according to data from the National Poison Data System, kids under 12 swallowing, eating, or smoking vaping pods or ingesting the liquid is indeed on the rise. Data from the National Poison Data System provided to Rolling Stone indicated that although the number of such reported incidents sharply fell between 2016 (which saw more than 2,014 reports of exposure from children under 12) and 2017 (which saw 1,619 such reports), the pendulum has swung back up again, with the system logging 1,913 reports of exposure in 2019.
This increase is extremely troubling, says Brian Jenssen, pediatrician at Children’s Hospital of Philadelphia and assistant professor at the Pearlman School of Medicine at the University of Pennsylvania. While some of these reports may be attributable to toddlers or young children simply having a habit of putting things in their mouths, some of it may well be attributable to imitation, he says: “If you see an older sibling or parent putting this in their mouth, you may see kids try to emulate them by vaping.”
Nicotine poisoning cases have a wide range of symptoms: in minor to moderate cases, symptoms can include sweating, nausea, vomiting, jitteriness, rapid heartbeat, and shortness of breath, while more extreme cases can lead to seizures or respiratory failure. While most adults can be exposed to a drop or two of juice and be fine, for a child exposure to a relatively small amount of fluid could contain enough concentrated liquid nicotine to be extremely dangerous. Because e-cigarettes are not regulated, Jenssen says, the levels of nicotine vary tremendously by product, with some products containing far more nicotine than actually advertised. But according to one 2018 study in the Journal Pediatrics, as little as 6.5 to 13.0 milligrams of concentrated nicotine per kilogram of body weight could be enough to prove fatal. And there is at least one documented instance of this happening, when a 15-month-old died from nicotine poisoning in December 2014.
In 2018, the journal Pediatrics reported that an estimated 8,269 children under the age of six had been exposed to liquid nicotine between 2012 and 2017, per data from the National Poison Data System, with the vast majority of these children (92.5%) ingesting the fluid. The study found that there was a tremendous spike in reports to poison control centers, with a 1,398% increase in such calls between 2012 and 2015 — a trend that coincided with the increasing use of e-cigarettes in the United States in general, according to Alex Clark, CEO of Consumer Advocates for Smoke-Free Alternatives Association (CASAA), who tells Rolling Stone 2013 was the year vaping became “more mainstream.”
In the years following, however, the number of calls starts to decrease significantly, with the rate decreasing 20 percent between 2015 and 2016. The authors of the Pediatrics study suggest that this may be attributable to the passage of the Child Nicotine Poisoning Prevention Act, a law signed by President Barack Obama requiring e-cigarette manufacturers to sell liquid nicotine bottles in child-resistant packaging. But that doesn’t quite explain why the number of calls to poison control swings back up again around 2018 and 2019, with 1,783 and 1,913 reports being placed in both years, respectively.
Jenssen, the pediatrician, attributes the increase in calls in part to the increased media attention over vaping-associated pulmonary injuries. “We’re seeing more of these products and hearing more about the safety risks, so people are calling in with concerns,” he says. Clark suggests that the fact that market trends have swung back in favor of smaller-form cartridges may also play a role: because they are smaller, they’re easier to misplace, so it “makes sense these products would be lying around and kids would be getting ahold of them.” But probably the biggest factor is the simple fact that until very recently, vaping has been on the rise among adults, with one market research firm estimating that the number of vapers worldwide will hit 55 million by 2021.
None of this is to say, however, that the prospect of toddlers sucking on vape pods or 6-year-olds becoming addicted to JUUL should be keeping all parents up at night. The risk of children being poisoned by vape pods is far lower than that posed by other products, according to the National Poison Data System. In one 2016 report, the most common product linked to reports of exposure for children under 5 years old was cosmetics or personal care products (13.3% of all reports concerning children under 5 years old), closely followed by household cleaning substances (11.1%) and painkillers like acetaminophen and ibuprofen (9.21%). The number of calls related to ingestion of e-cigarette juice pales in comparison.
Further, the authors of the Pediatrics study note that these numbers are based on self-reported data — presumably, calls from concerned parents to poison control centers. But that doesn’t necessarily mean that all of the children in these reports actually ingested e-cigarette juice. As the authors note, “exposures are not generally confirmed with definitive laboratory testing”; therefore, such reports “cannot be completely verified” by poison control centers. In other words, it’s possible that many of the parents who placed calls to poison control didn’t actually see their child ingest any liquid nicotine or put a cartridge in their mouth; they could’ve just seen them holding a cartridge or a bottle and assumed the worst, or called poison control just to be safe. (Jenssen says that mere skin-to-skin contact with a vape cartridge probably wouldn’t result in a child developing nicotine poisoning.)
That said, reports of very young children ingesting liquid nicotine are certainly worth taking seriously. Just as a parent would keep tobacco cigarettes concealed and out of reach from small children, they should do the same with e-cigarettes. But in the context of the vaping-related health crisis, it must be stated that the number of adolescents and teenagers who regularly use e-cigarettes is much, much higher than that of young children who may or may not have been exposed to e-cigarettes themselves. According to one recent survey of more than 44,000 high school students, more than 37.5% of high school seniors said they used flavored e-cigarettes, while 17.6% of eighth-graders reported using them as well. And some of these kids may actually be going out of their way to ingest nicotine in unsafe ways: Jenssen says that over the past six months, he has anecdotally heard reports of teenagers experiencing withdrawal symptoms from vaping and attempting to suck out the nicotine from used pods.
As more research emerges about the health effects of vaping and the factors that may be contributing to the recent reports of pulmonary issues, many legislators are taking steps to try to eradicate the e-cigarette industry altogether: both New York and Michigan have instituted flavored e-cigarette bans, and President Donald Trump has stated he is flirting with instituting a federal flavor ban as well. While these efforts have largely been applauded by public health experts, others have suggested such draconian measures may steer people back toward using traditional combustible cigarettes (though there’s some debate as to whether e-cigarettes are actually the lesser of these two evils, as many advocates have claimed). Either way, the fact remains that a generation of adolescents and teenagers hangs in the balance — and that’s the real crisis at hand here.