A new study found that there were more than 8,200 calls to US poison centres regarding exposures to liquid nicotine and e-cigarettes among children younger than 6 years of age from January 2012 through April 2017, averaging 129 calls each month or more than 4 a day

Children younger than three years accounted for most (84%) exposures, and ingestion was the most common (93%) way children were exposed to liquid nicotine. More than one-third of exposed children were treated/evaluated and released, while 1.4% were admitted to the hospital.

A quarter of children exposed to liquid nicotine experienced one or more related clinical effects. Severe clinical effects were rare and included coma, seizure, respiratory arrest, and cardiac arrest.

"These exposures are concerning because a very small amount of concentrated nicotine solution could easily deliver a lethal dose to a young child," said Henry Spiller, MS, D.ABAT, study author. Increased concern about the risks of liquid nicotine exposures led to state and federal legislation requiring child-resistant packaging for liquid nicotine containers in recent years.

The annual rate of exposure to liquid nicotine and e-cigarettes increased by almost 1400% from 2012 to 2015 and then decreased by about 20% from 2015 to 2016. The observed decline in exposures since January 2015 may, in part, be attributable to legislation requiring child-resistant packaging and greater public awareness of the dangers of e-cigarette products to young children.

"Although the observed decrease in exposures is encouraging, the number of young children still being exposed to liquid nicotine is unacceptably high," said Gary Smith, MD, DrPH, senior author of the study. "Additional regulation is needed."

The authors recommend adding flow restrictors to liquid nicotine refill bottles, similar to those used for children's fever medications, to limit young children's ability to empty the contents of the bottles, and child-resistant chambers on e-cigarette devices to help prevent liquid nicotine exposure to young children.

Additionally, the volume and concentration of liquid nicotine in refill bottles should be limited to a sub-lethal dose for an average young child. This approach has been used for decades for products like children's aspirin. To decrease exposure among young children, the authors also call on the US Food and Drug Administration to prohibit the use of flavours and attractive labelling of liquid nicotine as was done for cigarettes.

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 centres that serve the US and its territories. Poison centres receive phone calls through the Poison Help Line and document information about the product, route of exposure, individual exposed, exposure scenario, and other data.