ENDS Liquid Nicotine Exposure in Children Aged <5 Years Presenting to U.S. Emergency Departments, 2019-2024.

Abstract

ENDSs have become widely popular, inadvertently increasing the risk of pediatric liquid nicotine exposures. Even small amounts of concentrated nicotine can result in severe toxicity in young children. This study aimed to quantify emergency department visits for liquid nicotine poisoning among children aged <5 years from 2019 to 2024. Data from the National Electronic Injury Surveillance System from 2019 to 2024 were analyzed using a cross-sectional approach. Cases were identified by extracting records with poisoning diagnoses and filtering narratives using keywords associated with ENDS poisonings. Two independent reviewers confirmed each case involving exposure to ENDS liquid nicotine. National Electronic Injury Surveillance System sample weights were applied to produce national estimates with 95% CIs. An estimated 3,952 emergency department visits nationally (95% CI=2,600; 5,305) were attributed to liquid nicotine poisoning among children aged <5 years from 2019 to 2024. Children aged <2 years accounted for 2,921 cases (73.9%). Males represented 2,345 cases (59.3%), and females represented 1,607 cases (40.7%). White children comprised 2,345 cases (59.3%). Most children (88.3%) were treated and released, whereas 165 cases (4.2%) required hospital admission. No fatalities were reported. Liquid nicotine poisoning remains a significant pediatric health concern, with over 3,900 emergency department visits nationally during 2019-2024. Children aged <2 years are at highest risk owing to developmental factors and exploratory behaviors. Although most cases did not require hospitalization, the potential for serious outcomes underscores the need for enhanced prevention strategies, including improved product packaging and public education about safe storage practices.