The growing popularity of e-cigarettes has had an unintended consequence, with more young children swallowing or being exposed to the liquid nicotine that can be contained within the devices, according to a new study.
Exposures among children under the age of 6 increased dramatically from January 2012 to April 2015, according to a report published today in the medical journal Pediatrics. Researchers from the Nationwide Children's Hospital in Columbus, Ohio, studied data from the National Poison Data System to understand how often children were exposed to tobacco, nicotine and e-cigarette products.
There were 29,141 calls during that study period to poison control centers about children 6 years or under who had been exposed to these products, according to the study, which noted that while most of the exposures involved cigarettes or other tobacco products, the rates of e-cigarette exposure increased rapidly.
Calls about e-cigarette exposure made up 14.2 percent of the total number, but rose from 14 in January 2012 to 223 in April 2015 -- a nearly 16-fold increase. Researchers found that children who were exposed to liquid nicotine often ingested the substance and were 2.6 times as likely to have a severe health outcome as children who were exposed to cigarettes. One death was reported during the study when a toddler ingested liquid nicotine.
Dr. Gary Smith, co-author of the study and director of the Center of Injury, Research and Policy at Nationwide Children’s Hospital, said young children are particularly at risk because of their small size and the high concentrations of liquid nicotine in e-cigarette fluids.
"We have known for decades how toxic liquid nicotine can be for kids," Smith told ABC News. "Unfortunately, this study has findings that bore this out. We saw kids that had coma, children with seizures and even death within this 40 month period."
Smith pointed out that children who were exposed to liquid nicotine were five times as likely to end up in the hospital compared to children who were exposed to cigarettes.
"We shouldn’t put a poison that’s been known for decades to cause harm among children in homes across the country in non child-resistant containers that have flavors and labels," Smith said.
Toddlers "explore their environment by putting things in their mouth" and may mistake flavored liquid nicotine for candy, Smith said, noting that creating child-resistant containers and educating parents about the dangers of these substances is key to keeping children safe.
Ray Story, founder and CEO of the e-cigarette industry group Tobacco Vapor Electronic Cigarette Association, said that the product is intended for adults and that it is not up to the industry to keep these products out of the reach of children. He pointed out that liquid nicotine is not the only potentially harmful substance found in a typical home and that the FDA could have issued guidelines earlier to require child-resistant packaging.
"If you look at some of the commercials currently, it says lock up your laundry detergent because these things look like candy," Story told ABC News. "It becomes the responsible parental thing to do," to keep potentially harmful substances from kids.
Story pointed out that far more calls are made about cigarettes and other traditional tobacco products than e-cigarettes.
"We are trying to serve the adult population and provide them with a [more] healthy alternative" to cigarettes, Story said. "We expect the adult population to handle this product with care."
The study comes as the e-cigarette industry faces new regulations. The U.S. Food and Drug Administration issued its first regulations last week that will affect labeling, manufacturing and sales of e-cigarettes. All products that came on the market after Feb. 15, 2007, will have two years to apply for an FDA review. If a product is not approved, it will no longer be allowed on the market. In January, Congress passed a bill to require more child-resistant containers for liquid nicotine that was signed into law and is set to take effect later this year.
Dr. Hilary Tindle, director of ViTAL, the Vanderbilt Center for Tobacco, Addictions and Lifestyle, told ABC News that the amount of liquid nicotine contained in the liquid used in e-cigarettes varies widely from extremely concentrated to almost nonexistent. The new FDA regulations will likely help safeguard the products by regulating the amount of liquid nicotine in the products so it's more uniform across the industry, Tindle said.
"Some of these products with the e-liquid, they have four times a lethal dose for a child in a fifth of a teaspoon," Tindle said. "It’s really scary when you think about how many people are using these products. If you’re using these products, put them away," so children can't get to them.
She said it would make sense for pediatricians to bring up e-cigarette safety with parents to encourage them to put the liquid out of sight and out of reach of young children.
"We have these household products like ammonia or bleach that typically we keep in cabinets at higher levels," Tindle said. "It’s kind of the same principle."