Nicotine replacement products: poisoning in children

Nicotine is widely used in smoking cessation aids. They are marketed in many forms, including: chewing gum, sublingual tablets, lozenges, transdermal patches, cartridges for oral inhalation, and mouth spray. French poison control and toxico-vigilance centres identified 318 cases of exposure to nicotine replacement products in children under the age of 10 years between 2000 and 2010. The exposure provoked symptoms in 62 of these children, about two-thirds of whom were under the age of 4 years. A U.S. analysis identified 1768 cases of poisoning in children under the age of 6 years involving smokeless tobacco products, reported between 2006 and 2008.84% of these cases occurred in children under the age of 3 years. The first signs of nicotine poisoning are gastrointestinal (vomiting, diarrhoea), cardiovascular (tachycardia, hypertension) and neuropsychological (tremor of the extremities). With higher doses, these effects are rapidly followed by loss of consciousness, convulsions or respiratory failure. In children, poisoning can occur after ingestion of 1 mg of nicotine per kilogram of body weight. A dose of this magnitude is sometimes fatal in adults. Most cases of poisoning involving transdermal patches occur when a child finds an unused patch, or a used patch that an adult has discarded in a bin without taking proper precautions. Sometimes they involve patches that have become detached from an adult's skin. In practice, it is important to warn adults using smoking cessation aids containing nicotine that these products are dangerous