A disturbing new study reveals a staggering 760% increase in nicotine poisoning cases among children under 6 years old due to accidental ingestion of nicotine pouches between 2020 and 2023.

The research, published in Pediatrics, highlights a growing public health crisis as these smoke-free nicotine products—some recently approved by the FDA—prove five times more likely to cause serious medical outcomes than other nicotine products. Tragically, two children died from nicotine pouch poisoning, underscoring the lethal risks posed by these seemingly innocuous products marketed as alternatives for adult smokers.

A hidden epidemic of child poisonings

Nicotine pouches, often flavored and sweetened, are designed to dissolve in the mouth when placed between the lip and gum. Brands like Zyn, Velo, and Rush have gained popularity among adults seeking smokeless nicotine alternatives. However, their appealing flavors and discreet packaging make them dangerously enticing to young children, who mistake them for candy or mints. According to the study, nicotine pouches accounted for only 1.4% of nicotine ingestions but were disproportionately linked to severe outcomes, including hospitalization and death.

Dr. Hannah Hays, medical director of the Central Ohio Poison Center and coauthor of the study, warned, "Nicotine pouches are a serious and growing toxic ingestion hazard among young children." The study analyzed over 134,000 cases of nicotine ingestion reported to U.S. poison control centers from 2010 to 2023, revealing an alarming spike in pouch-related incidents despite an overall decline in nicotine poisonings since 2016.

FDA approval sparks controversy

In January 2025, the FDA granted marketing authorization to Philip Morris International's Zyn nicotine pouches, approving 10 flavors—including coffee, mint, and menthol—as a "modified risk" product for adult smokers. Regulators argued that Zyn contained fewer harmful ingredients than cigarettes and could help smokers quit. However, anti-smoking advocates slammed the decision, accusing the FDA of enabling a new generation of nicotine addiction.

Yolonda Richardson, president of the Campaign for Tobacco-Free Kids, stated, "The FDA should not be authorizing the sale of any flavored tobacco products given the tobacco industry's well-documented history of using flavored products to appeal to and addict kids." While the FDA noted that youth use of pouches remains low (1.8% of middle and high school students), the rapid rise in child poisonings suggests insufficient safeguards.

Why nicotine pouches are especially dangerous

Nicotine pouches contain concentrated nicotine doses ranging from 3 to 12 milligrams per pouch, far exceeding the amount in a single cigarette. For small children, ingesting even 1 to 2 milligrams can trigger vomiting, seizures, or fatal respiratory failure. The study found that 1.2% of nicotine pouch ingestions led to "major effects," including the two fatalities. By comparison, other nicotine products like gum or e-liquids were less likely to cause severe harm.

Dr. Natalie Rine, coauthor of the study, explained, "There's nothing telling the kid, 'this is bad, you should spit it out' … and that's where you get into trouble." The pouches' candy-like flavors and lack of bitter deterrents increase the risk of prolonged exposure, allowing more nicotine to absorb into a child's bloodstream.