Unravelling the Risk of Poisoning From Nicotine-Containing Tobacco Products in Children Less Than Five Years of Age

Introduction:
This text provides an in-depth analysis of the risk of poisoning from nicotine-containing tobacco products in children under five years old. Using toxicological principles of human health risk assessment and published data, the author estimates the acute toxicological risk from exposure to various types and quantities of tobacco products. The text also discusses potential measures to protect children from future acute exposures to tobacco products.

Key Points:

* The text uses toxicological principles of human health risk assessment, published data, and information about the content and characteristics of specific products to estimate the acute toxicological risk from exposure to various types and quantities of tobacco products for children under five years old.
* Approximate reference levels for a non-lethal oral dose of nicotine are derived, with a higher level potentially requiring medical care (0.2 mg per kg) and a lower level not potentially requiring medical care (0.04 mg per kg).
* A weight-based oral lowest lethal dose (LDLO) of 1-14 mg per kg in children under five years old is estimated from cited LDLOs in adults.
* The text provides tables relating e-liquid concentration and volume to the oral LDLO in children under five years old and describes the amount of other tobacco products expected to result in lethality.
* Communications about safe storage practices should focus on the benefits of keeping any nicotine-containing product out of the reach of young children, and adults can be reminded to always reengage child-resistant closures on packages and call a poison center for accidental exposures.
* Healthcare providers, families, or any member of the public can also make reports about unexpected health or safety concerns related to tobacco products to the FDA using its online Safety Reporting Portal.
* Tobacco products, particularly electronic nicotine delivery system (ENDS) liquids, are highly toxic to children under five years old in small amounts.
* Features such as flow restrictors, child-resistant closures, and communication of safe storage practices to parents can help to lessen the morbidity and mortality from poisoning.

Main Message:
The text highlights the significant risk of poisoning from nicotine-containing tobacco products, particularly electronic nicotine delivery system (ENDS) liquids, in children under five years old. Using toxicological principles and published data, the author estimates the acute toxicological risk from exposure to various types and quantities of tobacco products. The text emphasizes the importance of safe storage practices, including keeping nicotine-containing products out of the reach of young children and always reengaging child-resistant closures on packages. Additionally, the text encourages healthcare providers, families, and the public to report any unexpected health or safety concerns related to tobacco products to the FDA using its online Safety Reporting Portal. Overall, the text underscores the need for continued vigilance in protecting children from the harmful effects of nicotine-containing tobacco products.

Lynn M Crosby, Unravelling the Risk of Poisoning From Nicotine-Containing Tobacco Products in Children Less Than Five Years of Age, Nicotine & Tobacco Research, Volume 27, Issue 3, March 2025, Pages 378–386, https://doi.org/10.1093/ntr/ntae044