During the past four months, Maryland's poison control centers have received 16 calls regarding an unlikely exposure source: the liquid nicotine used to refill e-cigarettes. Most of those calls involved children under the age of 5 who unintentionally ingested the toxic liquid nicotine, which can be brightly colored and come in flavors like grape and gummi bear that appeal to young children. Of the children who came into contact with this dangerous substance, 60 percent were seen and evaluated in the emergency department.
Nicotine is a highly toxic substance when ingested or absorbed through the skin, and it quickly produces serious or even fatal effects in children. Liquid nicotine comes in a variety of strengths, containing upward of 36 mg of nicotine per milliliter of liquid. At this concentration, a standard-sized eye dropper bottle of liquid nicotine would be enough to kill four toddlers. One teaspoon of liquid nicotine at this strength would be enough to kill one toddler. These are small bottles that can easily roll around in a purse or bag and are often within easy reach of children when left unattended inside the home. Curiosity is a natural part of child development, but with lethal substances like bottles of liquid nicotine, the consequences of such curiosity can be fatal. Sadly, last December, an 18-month-old boy in New York died after ingesting liquid nicotine found at home.
I have spent a lot of time as a pediatrician in the emergency department, and a brief period of time rotating through the local poison center, witnessing firsthand the unfortunate perils of children who accidentally ingest toxins. My first experience with the death of a patient, during my medical training, involved a child who accidentally ingested mint-flavored rubbing alcohol. The biggest takeaway I learned from these experiences is that all too often these encounters are preventable. This is certainly the case with liquid nicotine poisoning.
Currently, liquid nicotine containers are not required to have the same child-resistant packaging that pediatricians and parents depend on to keep their children safe from products like household cleaners and prescription drugs. And many parents are not aware of how lethal liquid nicotine can be. A bipartisan piece of legislation moving through Congress right now, The Child Nicotine Poisoning Prevention Act, would give the U.S. Consumer Product Safety Commission the power to require child-resistant packaging on liquid nicotine containers sold to consumers. Maryland's Sen. Ben Cardin is a co-sponsor of this important bill that can make a real difference for children in Maryland and across the country.
The American Association of Poison Control Centers recently reported nearly 4,000 adverse incidents related to e-cigarette exposures in 2014, which amounts to a more than 250 percent increase from 2013. With the rising popularity of e-cigarettes, liquid nicotine refills for these products are becoming increasingly common in households across the country. Parental supervision is not enough, and we have an easy solution — used for other poisonous household substances like bleach — in child-resistant packaging. We must act quickly to prevent more children from being injured or killed by these dangerous products.
I urge Congress to pass the Child Nicotine Poisoning Prevention Act without delay. We cannot wait another day to keep our children safe.
Dr. Sylvia Owusu-Ansah is a member of the American Academy of Pediatrics and a pediatric emergency medicine fellow at Johns Hopkins Children's Center. Her email is sowusua1@jhmi.edu.