Nicotine Poisonings Among Kids Surge 763%, New Study Finds

Nicotine pouches are a growing ingestion hazard for young kids. A new study published in Pediatrics found that ingestion of these pouches by young children has surged in recent years.

“We analyzed calls to U.S. poison centers and found a 763% increase in the rate of reported nicotine pouch ingestions among children younger than 6 years old from 2020 to 2023,” says Gary A. Smith, MD, DrPH, senior author of the study and director of the Center for Injury Research and Policy at Nationwide Children’s Hospital.

Researchers also found that nicotine pouches were more likely to be associated with serious medical issues or hospital admissions than other nicotine product formulations, such as gum, lozenges, liquids, and powder. And though the rate of unintentional ingestion increased rapidly, the ingestion rates for different formulations of nicotine declined, says Dr. Smith, who points out that nicotine pouches were not tracked in national poison center data until 2020.

Here’s why nicotine pouch poisonings are occurring and how to keep kids safe.

Why Nicotine Pouch Poisonings Are Happening

Typically, nicotine pouches are placed between the gums and the lip or cheek. But, to young kids, these pouches, which are about the size of a piece of Chiclet gum, can look like candy and can be swallowed or chewed. When this happens, it can lead to a quicker intake of nicotine.

“Nicotine pouches are small and can easily fit in a child’s mouth,” says Antonia Nemanich, MD, toxicologist and assistant professor of emergency medicine at Rush University System for Health. “Toddlers and infants old enough to crawl often explore their environment by putting items in their mouths. If they encounter a nicotine pouch on the floor, they are very likely to suck or chew on it and possibly swallow it.”

Older children may put nicotine pouches in their mouths because they have seen adults do it or because they are curious about what it tastes like or what the effects may be, Dr. Nemanich adds.

“Some nicotine pouches are packaged to look like candy, making exploratory ingestions by children more likely,” says Dr. Nemanich. “Their appealing flavors make it more likely a child will keep sucking on it or swallow it.”

And nicotine pouches, which were first introduced in the United States in 2014, have become increasingly popular, meaning it’s not unlikely to be found in homes. That’s especially true among teens. Dr. Nemanich says a study published this year in the Journal of the American Medical Association found that nicotine use among 10th- and 12th-graders increased from 3.0% to 5.4% from 2023 to 2024, with a subset of these teenagers reporting regular use.

What Are the Risks of Nicotine Poisoning?

Nicotine pouches contain nicotine, and that is a neurotoxin, says Suchitra Krishnan-Sarin, PhD, a substance use researcher and professor of psychiatry and chronic disease epidemiology at Yale Cancer Center. Depending on the age and body mass of the child, and depending on how many pouches they ingest, this could lead to nicotine poisoning, says Dr. Krishnan-Sarin. 

Plus, nicotine pouches are not intended to be swallowed. “Doing so greatly increases the absorption of nicotine, making the symptoms of toxicity more likely to develop,” says Dr. Nemanich. “Early symptoms of nicotine poisoning include fast heart rate, nausea, vomiting, headache, increased respiratory rate, anxiety, and drooling.”

Mild toxicity may be limited to these symptoms, while severe toxicity starts with those same symptoms and then progresses to symptoms like confusion, tremors, seizures, and generalized weakness, she says.

“As with any poisoning, the severity of symptoms depends on the dose ingested,” adds Dr. Nemanich. “In rare cases, nicotine poisoning can be fatal due to the development of paralysis, respiratory arrest, or cardiac arrhythmias.”

What To Do if You Suspect an Accidental Ingestion

Nicotine is quite dangerous to young children, says Todd Zimmerman, DO, a pediatric emergency medicine physician at Pediatrix Medical Group in Las Vegas. If you find your young child with a nicotine pouch in their mouth, remove it immediately, he says.

“You also want to try and determine how many pouches may have been consumed as a significant ingestion could be potentially life-threatening in younger children,” says Dr. Zimmerman. “If you find your child with a nicotine pouch, whether you think they ingested one or not, you should seek immediate medical care.”

If they have already swallowed the pouch, do not try to induce vomiting, adds Dr. Nemanich. Call the Poison Center at 1-800-222-1222 for instructions on what to expect and whether you can observe them at home or a trip to the emergency department is needed. 

“Poison control centers are a wonderful resource for parents,” she says. “The phone is answered by nurses and pharmacists with specialized training in poisonings, and they have physician toxicologists for backup as needed. A child who is already experiencing symptoms of nicotine poisoning should be evaluated in an emergency department.”

How To Prevent Accidental Ingestions

Nicotine pouch packaging is sleek and colorful, sometimes resembling gum or breath mint containers, says Jennifer Pearson, PhD, MPH, associate professor of public health, University of Nevada, Reno.

“If a child comes across one—especially if it smells fruity or sweet—they might not hesitate to pop it in their mouth,” continues Dr. Pearson. “It’s not that they’re seeking out nicotine; they’re responding to the sensory cues that make the product seem harmless or even appealing.”

For this reason, it’s important to take steps to prevent accidental ingestions and to discourage use. Here are some ways you can keep your kids safe.

• Store nicotine products away from food and out of sight. Preferably, store them in a locked cabinet, drawer, or box, suggests Dr. Smith.
• Think about how behavior is modeled at home. Using nicotine pouches—or any nicotine or tobacco product—in front of children can inadvertently normalize the behavior. “Kids are observant, and seeing a parent use a product can make it seem acceptable, even expected,” says Dr. Pearson. “Being mindful of that influence can go a long way in preventing uptake in the next generation.”
• Talk openly about nicotine and tobacco use with older kids. That includes what these products are, why they’re used, and why they come with health risks, says Dr. Pearson. “If a parent is using nicotine pouches as a tool to quit smoking or vaping, framing them that way—as a quit aid, not a recreational product—can help shape how kids understand them,” adds Dr. Pearson.
• Save the poison control number in your phone and post it in a visible place in your home. Kids may still get their hands on nicotine pouches despite your best efforts for safety. That’s why it’s important to know how to call poison control. The help line (1-800-222-1222) provides free, confidential advice from experts, 24 hours per day, seven days per week.