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Nicotine Use Disorder in Children



  • Nicotine use disorder is a pattern of using nicotine that leads to serious personal, family, and health problems. Nicotine is a chemical in cigarettes, pipe tobacco, cigars, snuff, and smokeless (chewing) tobacco. It is both a stimulant, which increases energy, and a sedative, which is calming.
  • For any treatment to be successful, your child must want to stop using nicotine. If your child is abusing or dependent on nicotine and wants to quit, get help from your healthcare provider.


What is nicotine use disorder?

Nicotine is a chemical in cigarettes, pipe tobacco, cigars, snuff, and smokeless (chewing) tobacco. It is both a stimulant, which increases energy, and a sedative, which calms your child down.

Nicotine use disorder is a pattern of using tobacco that leads to serious personal, family, and health problems. The more of these statements that apply to your child, the more severe his nicotine use disorder is.

  1. Your child uses more or uses nicotine for longer than planned.
  2. Your child wants to cut down or quit but is not able to do so.
  3. Your child spends a lot of time and energy getting nicotine, using nicotine, and getting over the effects.
  4. Your child craves nicotine so much that your child has trouble thinking about anything else.
  5. Your child has problems at work, school, or at home.
  6. Your child has relationship problems because your child doesn’t keep promises or argues or gets violent with other people.
  7. Your child stops doing things that used to matter such as sports, hobbies, or spending time with friends or family, because of the nicotine use.
  8. Your child uses nicotine even when it is dangerous such as while driving or operating machinery.
  9. Your child keeps using nicotine even though your child knows that it is hurting his or her physical or mental health.
  10. Your child needs to use more and more of the drug or use it more often to get the same effects. This is called tolerance.
  11. Your child has withdrawal symptoms when your child stops using.

Nicotine use disorder may also be called dependence or addiction.

What is the cause?

At first your child may use tobacco because it makes him feel good or because he wants to change something about his life. He may start smoking to fit in with friends who smoke. He may want to look cool, older, or rebellious. Or he may think it will help him relax and feel better.

The brain makes chemicals that affect thoughts, emotions, and actions. Nicotine changes the balance of these chemicals in your child’s brain. When your child uses nicotine regularly, his brain starts to get used to it. As a result, he doesn't feel right unless he uses nicotine. When he stops using nicotine, the balance of chemicals in his brain changes, which causes the symptoms of withdrawal.

Your child has a higher risk of becoming dependent on nicotine if he:

  • Has a family history of tobacco, drug, or alcohol abuse
  • Has abused tobacco, alcohol, or drugs in the past
  • Is easily frustrated, has trouble dealing with stress, or feels like you aren’t good enough
  • Is regularly around people who use tobacco, alcohol, or drugs
  • Has a mental health problem

Your child may like the feel, smell, and sight of a cigarette and the ritual of handling, lighting, and smoking cigarettes. If your child tries to quit smoking, giving up these rituals may make withdrawal symptoms and cravings worse.

Most people who use tobacco start before age 18. Children who start smoking at a young age are less likely to quit when they become adults.

What are the symptoms?

Signs of smoking may include:

  • Fast heartbeat
  • Smelling like smoke and having bad breath
  • Sinus congestion and constant cough
  • Trouble breathing when doing activities such as running or swimming
  • Sore throat or hoarse voice
  • Tooth decay, stained teeth, and gum problems
  • Trouble sleeping
  • Getting frequent colds or other infections

If you notice these signs, it does not mean that your child is smoking regularly, but you should talk with your child.

When your child tries to quit using tobacco, he may have withdrawal that can be mild to severe. Symptoms your child may experience when he stops using nicotine include:

  • Restlessness and irritability
  • Depression or anxiety
  • Trouble paying attention
  • Trouble sleeping
  • Increased appetite
  • Headaches
  • Cravings for tobacco

The symptoms of withdrawal may be very strong, especially during the first 72 hours after your child stops using tobacco. After the first 2 or 3 days the symptoms improve.

How is it treated?

Nicotine use disorder can be treated. Your child must stop all use of tobacco, including smoking cigarettes or pipes, and chewing tobacco.

Your child’s healthcare provider may recommend nicotine replacements that can almost double the chances of quitting for good. You can buy nicotine gum, patches, or lozenges without a prescription. Nicotine replacement therapy lets your child slowly decrease the amount of nicotine in his system over time. Using a nicotine replacement may reduce cravings and ease physical symptoms. The dose of nicotine is slowly decreased over several weeks or months.

Electronic cigarettes, also called e-cigs, are battery-operated devices that look like a cigarette or cigar. They make a smokeless vapor that the user inhales. The vapor contains many chemicals, and often contains nicotine. E-cigs are not a good way to quit smoking because:

  • They have not been proven to be safe. Some of the chemicals are harmful. E-cigs affect lungs and breathing in some of the same ways that tobacco cigarettes do.
  • There is no proof that e-cigs help with quitting smoking. E-cigs deliver nicotine in a way that can continue nicotine and smoking addiction.

Your child is more likely to succeed if he works to change his behavior as well as take medicine. Your child may want to join self-help groups such as Nicotine Anonymous or organized quit-smoking programs, or try individual therapy. Cognitive-behavioral therapy (CBT) helps your child look at thoughts, beliefs, and actions, and understand which ones cause problems for him. Then your child learns to change unhealthy ways of thinking and acting.

How can I help my child?

If you use tobacco, get the support you need to quit. Nothing you say about tobacco will be as powerful as the example you set for your child.

If your child is using tobacco:

  • Talk to your child. Ask what he likes about smoking or using tobacco. Also ask what he doesn’t like or what concerns him about smoking. Try to find a healthy substitute for tobacco. For example, if your child is smoking to "fit in," help him find another activity, such as sports or drama, where he can fit in and feel good about himself.
  • Point out that it causes bad breath, stained teeth, and stinky clothing.
  • Although the immediate problems caused by tobacco will mean more to most children than long-term risks, it is still important to tell your child that people who smoke often die at an earlier age than nonsmokers. Smokers are more likely to die from problems caused by smoking, such as cancer, heart disease, or lung disease. Using smokeless tobacco causes gum disease, mouth cancer, and heart disease.
  • Let your child know that you don’t approve of smoking and you will not allow it in the home. Make your statement without anger if you can. Let your child know what will happen if he breaks the rules, such as loss of cell phone, TV, computer or game time. Make sure that you do what you say you will do.

If your child is ready to quit, help him:

  • Make a plan:
    • Set a quit date and tell his family and friends. Some people gradually use less tobacco in the days leading up to their quit date. Others use the same amount of tobacco right up to their quit date.
    • It may also help to chew sugarless gum or eat hard candy, beef jerky, or sunflower instead of smoking or chewing tobacco.
    • Throw out all tobacco products and anything used with the tobacco such as lighters and ashtrays.
    • Have your child write down his reasons for not wanting to smoke and review them whenever he feels tempted to use tobacco.
    • Make a list of the situations, places, or emotions that make him more likely to use tobacco. These things are called triggers. Being aware of these triggers can help him avoid them or be ready for them. For example, if he always uses tobacco after an argument, he can make a plan to take a walk the next time he has an argument.
  • Help your child change his daily routines and take on new activities that don't include smoking. He could join an exercise group or take up a sport. He might want to try drawing, making models, or other activities to keep his hands busy.
  • Encourage him to spend time with people who don't smoke. It is also helpful to learn ways to relax and manage stress. Talk about what he could buy with the money he would have spent on tobacco.
  • Encourage your child to keep trying. Many people try more than once to quit smoking before they finally succeed. If your child fails in his attempt to stop, praise his effort and support another attempt.
  • For more information, contact:
Developed by Change Healthcare.
Pediatric Advisor 2019.4 published by Change Healthcare.
Last modified: 2019-09-06
Last reviewed: 2018-04-02
This content is reviewed periodically and is subject to change as new health information becomes available. The information is intended to inform and educate and is not a replacement for medical evaluation, advice, diagnosis or treatment by a healthcare professional.
© 2018 Change Healthcare LLC and/or one of its subsidiaries
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