Rutgers Health researchers reported on Apr. 3 that exposures to electronic nicotine products are increasing among toddlers and infants, even as traditional cigarette-related incidents decline. The findings were published in JAMA Network Open and highlight new risks for young children from modern nicotine delivery devices.
The issue is significant because it shows a shift in how children are being exposed to nicotine. While past efforts have focused on preventing ingestion of liquid nicotine, the study suggests that inhalation of vapors from e-cigarettes is now a growing concern for this age group.
Researchers at the New Jersey Poison Control Center, based at Rutgers New Jersey Medical School, analyzed more than 92,000 reported cases of nicotine exposure in children five years old and younger between 2016 and 2023. They found a 43% decrease in exposures from conventional tobacco products such as cigarettes but observed a 243% increase in incidents related to electronic cigarettes over the same period. These cases often involved direct inhalation by the child and resulted more frequently in visits to health care facilities compared with cigarette exposures.
"This significant spike in children breathing in these substances tells us the risk has changed: It's no longer just about a toddler swallowing something they found on the floor," said Perry Rosen, lead author who conducted the research at the New Jersey Poison Control Center before becoming a medical student at New York Institute of Technology College of Osteopathic Medicine. "Many recent cases involve children actively using e-cigarette devices after gaining access to them."
Diane Calello, executive and medical director of the New Jersey Poison Control Center, said that when young children see adults or older family members vaping, they may imitate this behavior without understanding its dangers: "When children see caregivers or older family members vaping, they may copy that behavior-bringing the device to their mouth and inhaling-without any understanding they are exposing themselves to a harmful substance." She also noted that unlike cigarettes, many vaping devices are brightly colored and resemble toys.
Current laws require child-resistant packaging for liquid nicotine both federally under the Child Nicotine Poisoning Prevention Act of 2015 and statewide through legislation like New Jersey's Liquid Nicotine Child-Resistant Container Act (N.J.S.A. 2A:170‑51.9). However, these protections do not address behavioral imitation or device accessibility by young children.
Rosen said existing regulations focus mainly on preventing ingestion rather than use: "Child-resistant packaging may prevent a toddler from swallowing liquid nicotine, but it does nothing to stop a child from copying what they see an adult do," adding that safety standards should also cover device design itself.
Calello concluded by saying: "Current laws which focus on child-resistant packaging for nicotine liquids, are no longer enough. This study underscores the need for safety regulations at the device level. For example, manufacturers should be required to include flow restrictors or designs that make it more difficult for a child to activate a device."
