Conference Paper 1)
A review of calls to the New Zealand National Poisons Centre to determine if there is an increased incidence of children ingesting oral nicotine replacement therapies (NRTs).
Call data was extracted from the National Poisons Centre calls database (NPCPhone) using the following parameters: Age : 0–16 years, date range : 1 January 2003 to 31 December 2011, substance name : nicotine, route of exposure : ingestion. To capture exposures by buccal absorption, calls where the product was chewed then discarded were also included. The data were then filtered to only include nicotine gum, lozenges and dissolvable microtabs. A total of 142 records were retrieved.
Calls relating to children ingesting oral NRTs from 2003–2008 were low with an average of 6.6 calls per year. In 2009, there was a 122% increase in the number of calls from the previous year with calls dramatically increasing to a total of 45 in 2011. The age range of children ingesting NRTs was 6 months to 16 years. The highest recorded exposures were 15 pieces of gum and 20 lozenges. Since 2010, the New Zealand government has placed significant yearly tax increases on tobacco products, which has resulted in an increased uptake of subsidised nicotine replacement therapies to assist with smoking cessation. These products are provided by the government funded national stop-smoking support service ‘Quitline’.
An increase in the number of consumers using NRTs creates a greater risk of nicotine exposures in children.
Oral nicotine products can quickly produce toxicity in children with a rapid onset of symptoms which may include nausea, vomiting, abdominal pain, and diarrhoea. Tremor, sweating and salivation are also early signs of intoxication. Large exposures can produce more serious neurological and cardiovascular effects.
Children are not able to visually differentiate between therapeutic gum and lozenges and confectionary gum and lozenges.
Oral NRT products should be clearly labelled as medicines and consumers should be educated to keep them well out of the reach of children.