Paediatric poisoning due to nicotine replacement therapy products: An emerging hazard

Authors


  • Funding source: No external funding was secured for this study.
  • Financial disclosure: The authors have no financial relationships relevant to this article to disclose.
  • Conflict of interest: The authors have no conflicts of interest to disclose.
  • Submission statements: There are no prior publications or submissions with any overlapping information, including studies and patients. The manuscript is being submitted only to the Journal of Paediatrics and Child Health, is not being submitted elsewhere while under consideration, and has not been published elsewhere. No author has received an honorarium, grant or other form of payment to produce the manuscript. All authors have participated in the concept and design, analysis and interpretation of data, and drafting or revising of the manuscript. All authors have approved the manuscript as submitted and take full responsibility for the manuscript.

Dear Editor,

Nicotine replacement therapy (NRT) products are used as aids in smoking cessation[1] and are available without a prescription in New Zealand. As they become increasingly popular, incidents of poisoning, particularly among young children, will theoretically become more common. Consequently, it is anticipated that poison information centres may be contacted with increasing frequency regarding inadvertent exposures. We retrospectively reviewed data from the New Zealand National Poisons Centre (NZNPC) call collection database to investigate the epidemiology of acute paediatric NRT exposures reported between 2003 and 2011 and compared this with New Zealand NRT sales data.

For these years, the NZNPC received 185 enquiries associated with NRT exposures in children 6 years of age or less. From 2003 to 2007, enquiries were relatively steady with a mean of 8 (standard deviation (SD) + 2.5, range 4–10) calls per year. The following 4 years demonstrated a constant increase in enquiries per year, culminating in 59 for 2011 (Fig. 1). The mean age was 29 months (SD + 13, range 2 months to 6 years), and the most common site of exposure was at the child's own home (99.5%). NRT sales data for New Zealand were obtained for the period 2007 to 2011 from Novartis Consumer Health Australasia and Johnson & Johnson Pacific, the sole suppliers of NRT products in New Zealand. Sales data (Fig. 1) demonstrated an increase in sales of NRT products; total single units sold increased from 32 551 108 in 2007 to 87 680 044 in 2011.

Figure 1.

Paediatric nicotine replacement therapy (NRT) product exposures per year (left axis) and combined sales data for NRT products sold in New Zealand each year (right axis). NPC, National Poisons Centre.

Paediatric NRT exposures reported to the NZNPC are occurring with increasing frequency and while these exposures have increased in association with increased sales volumes, the increase in exposures has been disproportionately larger. Because of the risk of nicotine poisoning producing marked signs and symptoms,[2, 3] steps should be taken to minimise paediatric exposures to these products. As most exposures were in the child's home, parents must be informed of the hazard and of appropriate actions to prevent such exposures; NRT products need to be stored out of the reach of children and used products need to be disposed of appropriately. Additionally, NRT products in New Zealand are not sold in child-resistant packaging; such containers are effective in reducing accidental poisoning in children,[4] and implementation of safety packaging could potentially help to reduce paediatric NRT exposures.

Ancillary