New Study Finds Child E-Cigarette Exposures up 1,500%

May 9, 2016

As the household presence of e-cigarettes and liquid nicotine has increased, so have exposures among young children. A new study conducted by the Center for Injury Research and Policy of the Research Institute and the Central Ohio Poison Center, both at Nationwide Children’s Hospital, found that exposure to e-cigarettes increased by nearly 1,500 percent over a 40-month period.

The study, published online today in Pediatrics, found that from January 2012 through April 2015, Poison Control Centers in the U.S. received more than 29,000 calls related to e-cigarette, nicotine, and tobacco product exposures among children younger than 6 years old. The study found that cigarettes accounted for about 60 percent of exposures, followed by other tobacco products (16 percent) and e-cigarettes (14 percent). Children under two years old accounted for nearly all cigarette and other tobacco exposures (92 percent and 75 percent, respectively), and almost half of e-cigarette exposures (44 percent).

Incidents related to e-cigarette and liquid nicotine exposure saw a dramatic 1,500 percent increase during the study period. Data from April 2015 show that on average, every 3 hours a poison center receives a call about a young child exposed to an e-cigarette or liquid nicotine. That’s more than 7 children each day. Children exposed to liquid nicotine were more than five times more likely to be admitted to the hospital and two-and-one-half times more likely to have a severe medical outcome than children exposed to traditional cigarettes. The one child death in this study was associated with exposure to liquid nicotine accessed from an open refill container.

“This is an epidemic by any definition,” said Gary Smith, MD, DrPH, the senior author of the study and director of the Center for Injury Research and Policy at Nationwide Children’s Hospital. “This is another example of a highly toxic product being introduced to the market without regard to child safety.”

A recently passed federal law will become effective in July of this year that requires child-resistant closures for liquid nicotine containers. “This is a good first step,” said Dr. Smith, “but further swift action is needed by the Food and Drug Administration, industry, and others to adequately protect kids from nicotine poisoning associated with e-cigarette use.”

Experts say other prevention steps include prohibiting the use of flavors (as was done for cigarettes since 2009), restricting the use of packaging and labeling attractive to children, ensuring that liquid nicotine compartments on e-cigarettes are child-resistant, and limiting the concentration and/or quantity of nicotine in refill products.

“Families and caregivers of children younger than 6 years old who vape should take precautions to keep kids safer. Liquid nicotine needs to be treated like any other poison in your home,” said Henry Spiller, MS, D.ABAT, a co-author of the study, and director of the Central Ohio Poison Center at Nationwide Children’s. “If you vape, store vaping supplies – especially refill containers – up, away, and out of sight, preferably in a locked location. Don’t leave them lying around on the coffee table, in the cup holder in your car, or in your purse. Kids are curious and can get into trouble quickly with liquid nicotine.”

Parents and child caregivers can help children stay safer by following these tips:

  • Store e-cigarettes and refill products where children cannot see or reach them – in a locked location is best. Do not store them in a purse, which children can easily access.
  • Use and refill alone. Do not use e-cigarettes around children. Because children want to imitate adults, using e-cigarettes and refilling them with children nearby could lead to a dangerous exposure. The images, smells, and colors may attract children.
  • Refill, clean, and dispose of products safely. Wear rubber or latex gloves when handling liquid nicotine. Clean up spills right away with paper towels. Get rid of leftover liquid by pouring it into a bag of kitty litter or coffee grounds. Put empty liquid nicotine containers, papers towels, and any other waste into the bag, and throw it away in a trash can kids can’t open. Once everything is in the trash, wash your hands.
  • Adults in households with children younger than 6 years old should be counseled on vaping cessation. If adults with young children continue to use e-cigarettes, they are strongly encouraged not to use or store e-cigarettes, liquid nicotine, and related products in the home.
  • Save the national Poison Help Line number (1-800-222-1222) in your cell phone and post it near your home phones.

Data for this study were obtained from the National Poison Data System, which is maintained by the American Association of Poison Control Centers (AAPCC). The AAPCC receives data on calls to participating poison control centers that serve the US and its territories. Poison control centers receive phone calls through the Poison Help Line and document information about the product, route of exposure, individual exposed, exposure scenario, and other data.

The Central Ohio Poison Center provides state-of-the-art poison prevention, assessment and treatment to residents in 64 of Ohio’s 88 counties. The center services are available to the public, medical professionals, industry, and human service agencies. The Poison Center handles more than 42,000 poison exposure calls annually, and confidential, free emergency poisoning treatment advice is available 24/7. To learn more about the Poison Center, visit

The Center for Injury Research and Policy (CIRP) of The Research Institute at Nationwide Children’s Hospital works globally to reduce injury-related pediatric death and disabilities. With innovative research at its core, CIRP works to continually improve the scientific understanding of the epidemiology, biomechanics, prevention, acute treatment and rehabilitation of injuries. CIRP serves as a pioneer by translating cutting edge injury research into education, policy, and advances in clinical care. For related injury prevention materials or to learn more about CIRP, visit

About Nationwide Children's Hospital

Named to the Top 10 Honor Roll on U.S. News & World Report’s 2023-24 list of “Best Children’s Hospitals,” Nationwide Children’s Hospital is one of America’s largest not-for-profit free-standing pediatric health care systems providing unique expertise in pediatric population health, behavioral health, genomics and health equity as the next frontiers in pediatric medicine, leading to best outcomes for the health of the whole child. Integrated clinical and research programs, as well as prioritizing quality and safety, are part of what allows Nationwide Children’s to advance its unique model of care. Nationwide Children’s has a staff of more than 14,000 that provides state-of-the-art wellness, preventive and rehabilitative care and diagnostic treatment during more than 1.7 million patient visits annually. As home to the Department of Pediatrics of The Ohio State University College of Medicine, Nationwide Children’s physicians train the next generation of pediatricians and pediatric specialists. The Abigail Wexner Research Institute at Nationwide Children’s Hospital is one of the Top 10 National Institutes of Health-funded free-standing pediatric research facilities. More information is available at