Electronic cigarettes (e-cigs) are battery powered devices that heat a cartridge containing liquid nicotine to produce a nicotine vapor. These devices have been available in the US since 2007 and are now a multibillion dollar industry. Many companies market flavored nicotine liquids for e. cigs such as bubble gum, cotton candy and grape which certainly seems to be aiming at a younger crowd. One of the biggest issues with e-cigs are what we don’t know about them. We have no idea the long term effects of smoking vaporized nicotine on both those who smoke the devices as well as the secondhand effects.


The e-cig industry is not regulated by anyone at this time which presents two major problems. First, without regulation there are no quality standards for the companies who produce the nicotine liquid vials. Therefore, there is no way to really know the composition of the liquids being sold. Several studies have shown that even those products claiming to be nicotine free, actually contain nicotine as well as other carcinogens such as formaldehyde. The second issue with regards to a lack of regulation is that e-cig devices can legally be sold to those under 18 years of age as well as in vending machines and online, and free samples can be distributed to anyone interested. In late April, the FDA proposed a ban on the sale of these devices to minors, and luckily, 28 states have already imposed age restrictions on the sale of the devices. Here in Louisiana, the house has approved a ban on the sale of e-cigs to children under 18, and there is a bill awaiting a vote in the Senate for the same purpose.


As a pediatrician there are several things that really worry me with regards to e-cigs. First and foremost, the liquid nicotine cartridges are generally not child-proof. Many of these liquids are bright red, pink or yellow in color again with flavors like bubble gum or cotton candy, all of which are certainly enticing to children. As little as 1 teaspoon of this liquid if ingested by a child can be fatal. Calls to poison control centers in regards to e-cig liquids has risen from 1 per month in 2010 to more than 200 each month this year. Therefore, these liquid vials must be treated as you would treat any other poison. Parents should also know that toxicity in children can result from the liquid being absorbed through the skin.


My second concern it that e-cigs will serve as a gateway drug for children and young adults. It is one thing for an adult who has smoked traditional cigarettes for years to use e-cigs to try to quit smoking. However, children and teens are being introduced to smoking through the use of these devices. It is my worry that e-cigs will lead them down a path to conventional tobacco products as well as other drugs and high risk behaviors.


So here is yet another “danger” that parents should be aware of and add to the list of important topics to discuss with your children before someone else introduces them to it first.