Calls to US poison control centers for young children exposed to liquid nicotine peaked in 2015 and then began to decline, according to new research in the May 2018 Pediatrics. Authors of the study, “E-Cigarette and Liquid Nicotine Exposures among Young Children” (published online April 23), said that legislation enacted in 2015 requiring child-resistant packaging for liquid nicotine and growing awareness of exposure danger may have contributed to the decline.

But, they emphasized that liquid nicotine, which is sold in a variety of candy-like flavors, continues to pose a serious risk for young children that warrants additional regulatory action. There were 8,269 liquid nicotine exposures among children age 5 and younger reported to the National Poison Data System between January 2012 and April 2017, according to the study.

Children under age 3 accounted for the majority (84%) of exposures. The annual exposure rate per 100,000 children increased by 1,398% between 2012 and 2015, before decreasing by 20% between 2015 and 2016. Among states without pre-existing laws requiring child-resistant packaging for liquid nicotine containers, there was a significant decrease in the number of exposures during the 9 months before compared with the 9 months after the federal child-resistant packaging law went into effect.

Study authors said additional protections, such as child-resistant e-cigarette devices, use of flow restrictors on liquid nicotine containers, and regulations limiting refill containers to sublethal doses and prohibiting e-liquid flavoring and attractive labeling, could further reduce child exposures and the likelihood of serious harm when they do occur.