Exposure to electronic cigarette (e-cigarette) aerosol, often incorrectly called “vape smoke,” is a recognized concern for infants and young children. E-cigarettes, or electronic nicotine delivery systems (ENDS), generate an aerosol by heating a liquid, which is far from harmless water vapor. Health professionals agree that exposure to the components of this aerosol presents a risk to developing lungs and brains. Minimizing infant exposure to these substances is an important public health objective.
What Is In Vape Aerosol?
The liquid used in e-cigarettes, known as e-liquid, primarily contains propylene glycol (PG) and vegetable glycerin (VG). These solvents create the visible aerosol when heated by the device’s coil. Most e-liquids contain nicotine, a highly addictive chemical, and even products labeled “nicotine-free” may contain trace amounts.
The heating process generates harmful byproducts, including aldehydes like formaldehyde and acrolein. Acrolein is a hazardous air pollutant created when glycerin is heated. The device’s metal heating coil can also leach heavy metals, such as nickel, lead, and chromium, into the aerosol. Furthermore, thousands of flavorings are used; while many are safe to consume orally, their safety when inhaled is largely unknown, and some studies suggest they cause lung irritation.
Specific Health Impacts on Infants
Infants are particularly vulnerable to these airborne chemicals because their respiratory systems are still developing and their airways are smaller than those of adults. Exposure to nicotine, a known neurotoxin, is especially concerning for the developing brain. This exposure can alter brain development, potentially impacting memory, learning ability, attention span, and mood. Animal studies also demonstrate that nicotine exposure can impair lung growth and reduce alveolar development.
The lung tissue of infants exposed to e-cigarette aerosol shows signs of inflammation and oxidative stress. This can lead to increased respiratory resistance and a reduced ability to clear toxins. Exposure is associated with an increased risk for respiratory issues like asthma, bronchiolitis, and a heightened susceptibility to infections later in life.
Nicotine exposure during the perinatal period is associated with an increased risk of Sudden Infant Death Syndrome (SIDS). Nicotine affects the baby’s central nervous system, which controls cardiorespiratory function, potentially damaging the ability to recover from oxygen deprivation. Infants who die from SIDS have been found to have higher levels of nicotine in their lungs, which can be absorbed either prenatally or from the post-birth environment.
Mechanisms of Exposure: Secondhand vs. Thirdhand
Infants are exposed to the harmful components of e-cigarette use through two primary mechanisms: secondhand and thirdhand exposure.
Secondhand exposure occurs when the infant inhales the aerosol directly from the air after it has been exhaled by the user. This airborne exposure deposits fine particulate matter and chemicals, including nicotine and volatile organic compounds, directly into the infant’s lungs.
Thirdhand exposure refers to the residue that settles onto surfaces after the aerosol dissipates. Chemical components, such as nicotine and heavy metals, cling to clothing, furniture, carpets, and toys. Since infants spend time on the floor and frequently engage in hand-to-mouth behavior, they can ingest, inhale, or absorb this residue through their skin. This residue can also off-gas into the air and react with surrounding chemicals to form new pollutants.
Minimizing Infant Exposure
The most effective way to protect an infant is to maintain a completely vape-free environment. This requires a strict policy of no vaping inside the home or family car, even when the infant is absent, as chemicals linger on surfaces and in the air. Opening a window or blowing the aerosol away from the child is insufficient to remove the risk.
If a caregiver vapes, hygiene measures are recommended to minimize the transfer of thirdhand residue. Vaping should only occur outdoors, and the user should change clothes immediately after returning inside. It is also important to wash hands thoroughly with soap and water before handling the baby to remove residual nicotine and other particles.