Federal regulators warned 13 e-cigarette liquid makers and sellers Tuesday that they need to change packaging after children accidentally drank liquid nicotine.
Several of the online retailers were cited for illegally selling the products to minors. The e-cigarettes had labeling or advertising that looked like kid-friendly food products, such as juice boxes, candy or cookies, and some included cartoon images.
There were more than 8,200 e-cigarette and liquid nicotine exposures among children younger than 6 from January 2012 to April 2017, according to an analysis of National Poison Data System data.
For children, exposure to the nicotine in e-liquid products, even in small amounts, could lead to death from cardiac arrest, as well as seizure, coma and respiratory failure.
“No child should be using any tobacco product, and no tobacco products should be marketed in a way that endangers kids — especially by using imagery that misleads them into thinking the products are things they’d eat or drink," said FDA Commissioner Scott Gottlieb, a physician. "Looking at these side-to-side comparisons is alarming."
Products targeted include the One Mad Hit Juice Box, which resembles children’s apple juice boxes; Vape Heads Sour Smurf Sauce, which resembles War Heads candy; V'Nilla Cookies & Milk, which resembles Nilla Wafer and Golden Oreo cookies; Whip’d Strawberry, which looks like Reddi-wip dairy whipped topping; and Twirly Pop, which "not only resembles a Unicorn Pop lollipop but is shipped with one," the FDA said.
The federal action follows a crackdown on sales of the Juul brand to underage teens in 7-Eleven stores, Shell gas stations and vape retailers. The e-cigarette brand is popular among high-schoolers and has flavors such as fruit medley, cool mint and creme.
More than 2 million middle and high school students used e-cigarettes and other "electronic nicotine delivery systems" (ENDS) in 2016.
“Nicotine is highly toxic, and these letters make clear that marketing methods that put kids at risk of nicotine poisoning are unacceptable,” said acting FTC chairman Maureen Ohlhausen.
The FDA's Gottlieb said, "Companies selling these products have a responsibility to ensure they aren’t putting children in harm’s way or enticing youth use." He vowed to "continue to take action against those who sell tobacco products to youth and market products in this egregious fashion."
The FDA said it might file injunctions or seize products if the companies don't take action to address regulators' concerns.