As nicotine pouches’ popularity soars, they’re also responsible for more poisonings in young kids, study finds

A new study found that children's accidental nicotine ingestion from nicotine pouches rose more than 760% between 2020 and 2023. ( Peter Dazeley/Getty Images via CNN Newsource)

Nicotine pouches are a fast-growing source of nicotine poisoning in young children, according to a new study.

Researchers at Nationwide Children’s Hospital in Ohio analyzed more than a decade’s worth of data, examining over 134,000 cases of children under 6 who accidentally ingested nicotine through products like vapes, gums, and lozenges. Most types of exposures fell after 2016. But one delivery method — nicotine pouches — shot up, rising more than 760% between 2020 and 2023.

“It’s a high-concentration nicotine product, and it tastes good,” said Dr. Natalie Rine, director of the Central Ohio Poison Center at Nationwide Children’s Hospital and co-author of the study, published Monday in the journal Pediatrics. “There’s nothing telling the kid, ‘this is bad, you should spit it out’ … and that’s where you get into trouble.”

The miniature white packets that users tuck between their lip and gum hit US shelves in 2014. They don’t contain tobacco but are instead filled with nicotine, either synthetically or naturally derived, along with flavorings and sweeteners.

The discreet, sweet and smokeless nature of nicotine pouches has raised concerns among public health advocates, who are closely watching their rising popularity among teens and young adults. They’ve become the second most-used nicotine product among young people, according to the US Centers for Disease Control and Prevention. The National Youth Tobacco Survey found that nicotine pouch use among teens doubled between 2021 and 2024.

Still, the overall user base remains small. Just 0.5% of Americans use nicotine pouches, compared with 9% who smoke cigarettes and 3% who vape or use e-cigarettes, according to US Census Bureau data.

Levels of nicotine in pouches can vary from 3 to 12 milligrams per pouch. At their lowest doses, they deliver more of the stimulant than a cigarette, and even small amounts of nicotine can be dangerous for small children. Ingesting just 1 to 2 milligrams — less than what’s inside a single regular-strength pouch — can cause nausea, vomiting and tremors, among other serious symptoms, according to the National Library of Medicine.

The study found that nicotine pouches were associated with a 150% greater risk of serious medical effects and were twice as likely to lead to hospitalization than other smokeless nicotine products swallowed by children, like gums, lozenges, e-liquids, tablets and powders.

Although the vast majority of pediatric nicotine ingestions resulted in little to no harm, more than 1,600 children had serious medical outcomes, the study found. Two children died after ingesting liquid nicotine.

Rine recommends that parents avoid using nicotine pouches in front of children to keep them from imitating potentially risky adult behaviors. She also suggests keeping nicotine products physically out of kids’ reach and to have conversations with other caretakers, like babysitters and extended family, about doing the same.

If a child may have ingested a nicotine pouch, Rine says, the best first step is to call Poison Control at 1-800-222-1222. Trained staff can guide caregivers based on a child’s symptoms and help them decide if emergency care is needed.

Jeffrey Kopp, CNN