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 and powdered caffeine are readily available for purchase and both have resulted in multiple deaths in the United States. Powdered alcohol has recently been approved for sale in the United States and may be on the market as soon as this summer.
If you have children of any age, here is some important information that could save your child’s life:
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.
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.
Currently, most states prohibit sale of liquid nicotine to minors, but only a few states require childproof packaging. Ohio currently has legislation introduced that would require vendors to sell liquid nicotine in childproof packaging.
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.
The Food and Drug Administration (FDA) has recently put out a warning statement about the dangers of powdered caffeine. Powdered caffeine is sold as a supplement, so it is not regulated by the FDA, 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. The FDA states that a 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 FDA at (240)402-2405.
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.
While not yet on the market in the United States, powdered alcohol has been approved by the Alcohol and Tobacco Tax and Trade Bureau. Lipsmark, the manufacturer of “Palcohol,” states that the product will come in many varieties, including vodka, rum, Cosmopolitan and lemon drop.
Many states have already preemptively passed or introduced legislation banning the sale of powdered alcohol, since alcohol is regulated at the state level. While the future of powdered alcohol is up in the air, the reality is that kids will probably be able to get their hands on this product or something similar in the near future. It is worth discussing this along with the discussions on traditional alcohol products.
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 Section of Emergency Medicine at Nationwide Children’s Hospital and as an associate clinical professor of pediatrics at The Ohio State University College of Medicine.
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