When I was teenager, parents only had a few substances to really worry about: cigarettes, alcohol and, for those whose children were a little more daring, maybe marijuana. But times have changed. Now there are many natural and synthetic substances available to teens, as well as some substances sold commercially that have been blamed for deaths from toddlerhood to the teenage years and beyond.
Liquid nicotine, nicotine pouches and powdered caffeine are readily available for purchase, and both have resulted in multiple deaths in the United States.
If you have children of any age, here is some important information that could save your child’s life:
Liquid Nicotine and Nicotine Pouches
Liquid nicotine is a liquid that comes in varying flavors — such as bubble gum, cotton candy, gummy bear and berry — and varying concentrations for use in e-cigarettes. Contents of liquid nicotine are unregulated and contain concentrations of 0-36 mg/ml when purchased in stores and even higher concentrations if purchased online.
Nicotine pouches are small, odorless packets that contain nicotine powder, fillers and flavorings. The user places a pouch between the lip and gum for fast nicotine absorption.
But why is this dangerous?
Nicotine is a highly toxic substance when either ingested or absorbed through the skin. In fact, historically nicotine was used as a pesticide. Even at volumes as small as a teaspoon, liquid nicotine can be fatal if ingested, especially by a small child or toddler. Currently, liquid nicotine is not regulated and is not required to be in childproof packaging. As a result, many children are having unintentional exposures to this potentially toxic substance.
The Center for Disease Control (CDC) found that from 2010 to 2014, the number of calls to poison control centers for e-cigarette exposures rose 41.7 percent, with exposures most likely to occur in children ages 0-5 years. Sadly, an 18-month-old child from New York died last year after ingesting liquid nicotine.
In 2016, Federal law required that liquid nicotine be sold in a childproof container (Child Nicotine Poisoning Prevention Act). Liquid nicotine ingestions peaked in 2019.
From 2020 to 2023, the rate of poisonings caused by nicotine pouches in children younger than 6 years increased by 763%.
Signs of nicotine toxicity include vomiting, increased heart rate, headache, agitation, nausea, low blood pressure, coma, muscle weakness, respiratory failure and death.
If there is liquid nicotine in your home, or a home where your child visits, be aware of the dangers of ingestion or absorption through the skin. Keep liquid nicotine bottles secured and out of the reach of children.
Powdered Caffeine
Powdered caffeine is sold as a supplement, so it is not regulated, but the warning was issued after two U.S. citizens, including an Ohio teen, died after ingesting toxic amounts of caffeine.
Caffeine is a stimulant, and pure caffeine ingested in very small doses can be enough to cause a fatal overdose: single teaspoon of pure caffeine is approximately equivalent to the amount of caffeine in 25 cups of coffee. Powdered caffeine is inexpensive and readily available online and could be especially dangerous to those with a heart condition.
The instructions for appropriate use of some brands of powdered caffeine suggest that an appropriate amount is 1/16 teaspoon — a measurement not possible with standard kitchen utensils.
Signs of caffeine overdose include rapid or erratic heartbeat, vomiting, diarrhea, altered mental status, seizures and death. If caffeine overdose is suspected, seek medical attention immediately, then report it directly to the Poison Help Line at (800) 222-1222.
Parent of teens should discuss the risk of powdered caffeine, just as they would talk to their children about the risks of drugs and alcohol.
Talking With Your Kids About Drugs
As with anything, the key is to be aware and have open discussions with your children before they are faced with these decisions.
Talk about the risks associated with liquid nicotine, powdered caffeine, powdered alcohol and other drugs. Problem-solve with them about what they can do in a situation where they are faced with peer pressure associated with high-risk behaviors.
You can also employ a few tips from the American Academy of Pediatrics:
Leave no doubt as to where you stand about drug and alcohol use.
Be clear on expectations and consequences.
Emphasize the immediate consequences — such as impaired decision making or potential arrest for intoxication.
Sarah Denny, MD, FAAP, works as an attending physician in the Division of Primary Care Pediatrics at Nationwide Children’s Hospital and as a Professor of Pediatrics at The Ohio State University College of Medicine.
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