It is likely that many people who use e-cigarettes do not realize the hazards of leaving their products such as nicotine liquid refills within reach of small children.
In December 2014, the first such death was reported in the United States. A 1-year-old child in Fort Plain, NY, died after ingesting liquid nicotine accessed from an open refill container.
Neighbors interviewed at the time said they had no idea the substance could have such deadly consequences.
This is probably true of most people who might be amazed to learn the e-liquid they can buy in different flavors and colored bottles at the supermarket kiosk contains a toxic chemical that was once used in the U.S. as an insecticide and fumigant.
According to a new study published in the journal Pediatrics, in the 40 months up to April 2015, the National Poison Data System (NPDS) in the U.S. saw a 1,500 percent rise in the number of monthly calls relating to e-cigarette exposure in young children.
E-cigarette exposure up 1,500 percent in young children
From January 2012 through April 2015, the NPDS received 29,141 calls reporting children younger than 6 years exposed to nicotine and tobacco products - an average rate of 729 child exposures a month.
"Exposed to" means the substance was ingested, inhaled, or absorbed by the skin or eyes.
While tobacco products accounted for the vast majority of the exposures, e-cigarettes were responsible for 14 percent of them.
But what is most alarming is the rate at which exposures associated with e-cigarettes in young children are growing, and the severity of the cases relative to tobacco product exposures.
Month on month, exposures associated with e-cigarettes in young children increased by 1,493 percent during the study period, with children under the age of 2 accounting for 44 percent of them.
Further analysis revealed that children exposed to e-cigarettes had a 5.2 times higher chance of being admitted to hospital and a 2.6 higher chance of having a severe outcome than children exposed to cigarettes.
Senior author Dr. Gary Smith, director of the Center for Injury Research and Policy at Nationwide Children's Hospital in Columbus, OH, describes the situation as "an epidemic by any definition" and "another example of a highly toxic product being introduced to the market without regard to child safety."
Youth use of e-cigarettes rising rapidly
Nicotine is a stimulant that occurs naturally in tobacco plants. It affects the nervous system and the heart. However, exposure to relatively small amounts can rapidly be fatal (resource no longer available at www.cdc.gov).
According to the Centers for Disease Control and Prevention (CDC), youth use of Electronic Nicotine Delivery Systems (ENDS) is rising rapidly (resource no longer available at www.cdc.gov).
From 2011-2014, there was a ninefold increase (from 1.5 to 13.4 percent) in e-cigarette use (measured as past 30-day use) among high school students, and a more than sixfold increase (0.6-3.9 percent) among middle school students.
In 2014, there were nearly 2.5 million middle and high school students using e-cigarettes, including about 1 in 7 high school students.
If awareness of the dangers of nicotine liquid and the importance of keeping it out of reach of little hands is not reaching adults, what hope is there that teens will take heed?
Public education, prevention strategies urgently needed
So perhaps it will be down to regulators to enforce strict guidelines around availability, packaging, and labeling. As a minimum, all liquid nicotine containers should have childproof caps - at least that law will become effective in the U.S. in July this year.
However, while that is a good first step, it is not enough, says Dr. Smith. He urges the Food and Drug Administration (FDA) and other bodies to take further swift action "to adequately protect kids from nicotine poisoning associated with e-cigarette use."
He and his colleagues conclude:
"Prevention strategies include public education; appropriate product storage and use away from children; warning labels; and modifications of e-cigarette devices, e-liquid, and e-liquid containers and packaging to make them less appealing and less accessible to children."
The team also offers the following advice for parents and caregivers to keep their children safe:
- Do not keep e-cigarettes and refill products in a purse or where children can easily see and reach them: Keep them in a locked location, out of sight
- Do not use e-cigarettes around children, and do not refill in front of them; children like to imitate adults and are likely to be attracted by the images, smells, enticing little bottles, and colors
- When you refill with liquid nicotine, remember you are handling a toxic product, so wear protective gloves
- Clean up spills right away, and dispose of leftover liquid nicotine by pouring into a bag of kitty litter or coffee grounds
- Put empty liquid nicotine bottles, and any other waste, such as paper towels, into the bag and throw them away in a trash can that kids cannot open - then wash your hands
- Make a note of the national Poison Help Line number (1-800-222-1222) - put it in your cell phone and post it next to any phones around the home.
They also suggest that adults who live with children under the age of 6 should received advice and counseling about vaping cessation. If they continue to vape, they are strongly advised to keep any e-cigarettes, liquid nicotine, refills, and related products in a separate location and not in the family home.
"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."
Study co-author Henry Spiller, director of the Central Ohio Poison Center at Nationwide Children's
Some experts are also calling for prohibiting the use of flavors (as was done for tobacco cigarettes from 2009), restricting the use of packages and labels that appeal to children, and limiting the concentration or amount of nicotine in refill products.