Tobacco Smoke Exposure and Children

Harold J. Farber, MD, MSPH, FAAP, and Marianna M. Sockrider, MD, DrPH, FAAP

Introduction

•Children can be harmed from tobacco smoke by direct inhalation of exhaled and sidestream smoke (secondhand smoke) and from the dermal absorption, ingestion, and inhalation of smoke that has been absorbed into surfaces (thirdhand smoke).

•Children can be exposed to tobacco smoke from many sources, including active use and involuntary exposure, both inside and outside of the home.

•There is no safe level of tobacco smoke exposure.

•In the United States, the largest source of a child’s exposure to tobacco smoke is often the mother and other caregivers.

Adverse Effects

In Utero Tobacco Smoke Exposure

•Harms lung growth and development

—Reduces airway size and lung function

—Increases risk for wheezing as an infant and young child

—Increases risk for more severe asthma as an older child

•Harms brain development

—Increases risk for learning disabilities and attention-deficit disorder and attention-deficit/hyperactivity disorder

—Increases risk for sudden infant death syndrome

• Increases risk for adverse outcomes of pregnancy

—Stillbirth

—Lower birth weight

—Premature birth

—Placental abruption

•Is associated with other health problems

—Increased risk for orofacial clefts

—Increased risk for being overweight in childhood

Postnatal Tobacco Smoke Exposure

•Increases asthma prevalence and severity

•Decreases effectiveness of inhaled corticosteroids for asthma control

•Increases severity of viral respiratory illness, including bronchiolitis

•Increases risk for pneumonia

•Increases risk for cough

•Lowers lung function

Other Harms of Tobacco Smoke Exposure in Children

•Increases risk for middle ear disease

•Higher rate of preclinical atherosclerosis

•Increased risk for childhood cancers

Electronic Nicotine Delivery Systems

•The emissions of electronic nicotine delivery systems, such as e-cigarettes, e-hookahs, and vape pens, are not safe to breathe.

•Besides nicotine, the emissions (technically an aerosol, but often incorrectly called vapor