NEW YORK, May 05 (Reuters) -- Nicotine patches, used by adults to help quit smoking, are potentially dangerous in the hands of young children, a new study shows.
A two-year survey of U.S. poison control centers found three dozen cases in which youngsters had either bitten, chewed, or swallowed part of a patch, or had placed one on their skin. The children experienced symptoms such as nausea, vomiting, diarrhea, abdominal pain, dizziness, weakness, and rash. The exposures involved children younger than 16 years old (average age 3 years) and involved either new or used patches, including some that were discarded.
"Even one of these used patches will have somewhere between six to eight cigarettes-worth of nicotine in it," says Dr. Alan Woolf, attending physician at Children's Hospital in Boston and director of the Massachusetts Poison Center. "We wanted to see if these patches posed a risk to young children that we, as poison specialists -- as well as the manufacturers of the patches themselves -- needed to be concerned about."
The researcher and his colleagues were surprised by the variety of exposure circumstances. In four cases, the patch had fallen off the adult's skin without his or her knowledge. In three instances, the parents were unaware that the youngsters had removed the patch. A 5-week-old child went unnoticed while sucking on a patch attached to the father's upper arm.
"We had a couple of incidents where the child was co-sleeping with the parent, and the patch somehow became unattached during the night and then rolled onto the child's head or back," Woolf says.
"Two and three year olds love Band-Aids. They don't see a transdermal nicotine patch as a drug. They see a Band-Aid, and they're going to fish it out of the garbage can and put it on themselves," he explains.
The researchers found that most of the children studied were exposed to used patches for only a short time -- under 20 minutes -- and this resulted in few symptoms. They also found that children who had the patch applied to their skin were more likely to develop symptoms than those who bit or sucked briefly on a patch. But symptoms of nicotine poisoning were seen in children exposed to new or used patches for over an hour.
"In this study, all the children recovered -- there were a couple of hospitalizations, but only for observation. Nevertheless, nicotine is a drug and parents should treat these patches as medications -- to keep out of reach of kids, and to make sure they affix it to their skin securely," Woolf advises.
"We certainly don't want to discourage people from using these patches. We want people to quit smoking. Second-hand smoke is a real hazard to children," he adds.
Study co-author Dr. Keith Burkhart, medical director of the Central Pennsylvania Poison Center, in Hershey, Pennsylvania, echoes Woolf's advice. But he also notes that the study was conducted in 1993 and 1994, during a time when transdermal nicotine patches were available only by prescription.
"Now that they're over-the-counter, there's a potential for more exposures (in children and adolescents )," he says. "The cases reported here were not very toxic. But if young children get some new (unused) patches and treat them as Band-Aids -- putting on more than one at a time -- the toxicity will be greater."
Burkhart says it is important to keep a close watch on this potentially increased risk. He and his colleagues also recommend that parents follow manufacturers' labeling instructions and "take appropriate precautions in homes where there are young children."
When dealing with a child who has been exposed to a nicotine patch, the researchers advise parents to seek medical attention. They advise physicians to consider the child's weight, whether the patch is new or used, and the duration of the exposure. If there is only a brief exposure to a used patch, they say to remove the patch, wash the skin, and be aware that gastrointestinal upset is likely. If a patch has been chewed or swallowed, giving activated charcoal can help. They advise urgent medical attention if the estimated nicotine dose is high -- as in a new patch, and/or a small child -- if there is significant gastrointestinal upset, or if the child develops marked central nervous system symptoms such as irritability, headache, "fussiness," or fatigue.
SOURCE: Pediatrics Electronic Pages (1997;99(5):e4)
