Nicotine pouches like Zyn have exploded in popularity in the U.S. With that growth comes a steep increase in the risk of young children accidentally eating the pouches, with potentially serious consequences, according to a new study.
Overall, the study found 134,663 cases of young children inadvertently ingesting nicotine between 2010 and 2023, whether in the form of pouches, gum, tablets, or the liquid used in e-cigarettes. (The study was based on calls to America’s Poison Centers about children under age 6.) In most cases, the children were fine, though they may have experienced symptoms like nausea or vomiting. But the consequences can be severe: 1.2% had serious medical outcomes like seizures or respiratory failure, and two children, both under age 2, died after consuming liquid nicotine.
“We don’t want parents and caregivers to be led to a false sense of security that they aren’t that harmful if most don’t have a bad outcome,” said Natalie Rine, a study co-author and managing director of Central Ohio Poison Center. The study was published Monday in the journal Pediatrics.
Nicotine pouches made up just 1.4% of the accidents. But they were 1.5 times as likely to lead to a serious health outcome compared to other nicotine product formulations, and twice as likely to prompt admission to a medical facility. Overall, the number of nicotine pouch accidents soared by 763% between 2020, when the data first started tracking those specific products, and 2023. (Nicotine pouches’ popularity increased dramatically during that period and in subsequent years.)
“The pouches are highly concentrated products,” said Rine. “The flavors are attractive too. So when you have something like that — it’s easy to access, it tastes good, kids don’t really know the difference — that could lead to more serious outcomes because they’re getting a large dose very quickly.”
Philip Morris International’s Zyn can contain up to 6 milligrams of nicotine per pouch, while competitors offer varieties with up to 15 mg per pouch. The danger of nicotine poisoning increases if kids eat multiple pouches. A tin of 6 mg-strength Zyn would contain 15 pouches, or a total of 90 mg of nicotine. For comparison, people inhale an average of 22-36 mg of nicotine in a pack of cigarettes, though cigarettes also contain many toxic chemicals and pose much greater health risks.
Nicotine tablets or capsules and liquid cartridges used in e-cigarettes were the most common products that young children ingested, though rates of liquid nicotine accidents fell after the enactment of a 2015 law requiring childproof packaging on those products.
The study points to another policy change that could help further reduce accidental poisonings — a federal ban on all flavored nicotine products. Right now, Zyn is available in 10 flavors in the U.S., including citrus and cinnamon. Lucy pouches, founded by the team behind Silicon Valley’s favorite meal replacement drink, Soylent, come in mango and apple ice, while its sub-brand Breaker (“for the Montauk season”) has additional flavors like Berry Citrus. (Also housed under Lucy is the Excel nicotine pouch, which comes in mint for the rise-and-grind “productivity pioneer.”) On!, owned by tobacco giant Altria, has kid-friendly flavors like berry and citrus, too.
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In 2020, the U.S. banned most flavored e-cigarette cartridges, allowing only tobacco and mint varieties. The goal was to limit the products’ appeal to kids and teens, though a surge in illegal disposable flavored vapes imported from China means that fruit and candy-flavored vapes are still widely available.
The study’s authors also suggest that design changes like restricting the flow of liquid from e-cigarette cartridges could help further curb accidental poisonings. Parents and other adults should also keep nicotine products in locked cabinets rather than in backpacks or purses, Rine added.
“For younger kids, when they see fun, brightly-colored packaging, they want to take a look and see what that is,” she said. “Storage can help keep kids safe.”
