While youth cigarette smoking rates continue to drop, other forms of nicotine use are on the rise. Nicotine pouches are one of the newer products on the market, and they are growing in popularity among teenagers and young adults.

What are nicotine pouches?

Oral nicotine pouches are an emerging class of smokeless tobacco products that look like a small white pouch that contains nicotine mixed with flavorings, artificial sweeteners and other ingredients. They are sometimes referred to as a “lip pillow” or “upper decky.” As the powder inside the pouch dissolves, nicotine is released into the bloodstream. In the United States, they are only available for purchase for adults 21 and older.

Why are nicotine pouches becoming more popular?

These products are often marketed as a “tobacco‑free,” “clean” way to quit smoking or vaping — which can make them seem safer than they actually are. The packaging is usually colorful and playful, almost like a candy tin, and the flavors — mint, fruit and other sweet options — can be appealing to teens. They’ve become a trending topic for teenagers on social media in recent years. Common brands of nicotine pouches include ZYN, on! and VELO.

How do nicotine pouches differ from vaping and other nicotine products?

Nicotine pouches are more discrete than cigarettes or vapes because they tuck underneath the upper lip, lower lip or cheek. They are also harder to notice since they don’t have smoke or vapor. The nicotine in these products is absorbed through the mouth lining and directly into the blood stream, rather than being inhaled. While the strength of nicotine can vary from product to product, they are all highly addicting and can be harmful, especially if they are found by children. Because young children have a smaller body, they are at a higher risk of nicotine poisoning, which includes symptoms such as vomiting, rapid heartbeat and unsteadiness. It’s safest to keep nicotine products locked away and out of the reach of children. If you suspect nicotine poisoning, contact Poison Control immediately at 1-800-222-1222. If your child has difficulty breathing, has a seizure, is difficult to wake up or collapses, call 911 immediately.

Are nicotine pouches safer?

No, oral nicotine pouches are not safer for teens than products such as vapes and cigarettes, since they contain addictive nicotine.

Can oral nicotine pouches lead to nicotine addiction or health risks in teens?

Yes, nicotine is a highly addictive and toxic substance. Use of nicotine pouches can lead to addiction concerns, especially in teens. Nicotine pouches and other tobacco products have long-term health effects and negative impacts on brain development and heart health and can increase cancer risk.

What are the signs my teen is using a nicotine product?

Here are some signs that someone might be using a nicotine product or could be having withdrawal symptoms: 

• Changes in mood, behavior or increased irritability that are difficult to understand
• Finding small, round containers or used pouches
• Frequent trips to the bathroom or private spaces
• Increased use of gum or mints to mask breath
• Noticing their money missing that you can’t account for
• Increase in cavities or mouth sores
• Sadness, depression or irritability
• Anxiety
• Nausea
• Difficulty sleeping
• Change in appetite

How can parents talk with their children about nicotine use in a supportive, nonjudgmental way?

If you are caught off guard by finding a nicotine pouch or vape into your child’s backpack or room, our experts recommend pausing and focusing on your child’s immediate safety before reacting. While it’s natural to feel upset or worried, approaching the conversation with curiosity rather than judgement can create a trusting environment that supports honest and open communication.

• Ask open-ended questions.
• Listen to your teen’s perspective.
• Try to understand what may have led to their nicotine use.

Use the conversation as an opportunity to share your concerns, reinforce your support and work together on next steps. Actively listening and keeping communication open helps your teen feel more comfortable coming to you when they need help, especially in times of crisis or when they’re struggling with a difficult situation. This creates space to set appropriate boundaries and consequences without making punishment the immediate focus of the conversation.

When should you start having conversations about drug use?

You want to start by creating an environment where your teen doesn’t feel judged and can have an open conversation with you. It is best to approach these conversations proactively, and you can start as young as elementary school. Begin by discussing the risks of drug use, how drugs can impact their lives and help them practices what they can say if they are offered alcohol, nicotine or other drug.

“I’m a really big advocate for starting developmentally appropriate conversations about alcohol and drugs from a very young age to normalize those conversations so that your child feels comfortable talking to you about these things,” Dr. Sandhu says. “You want your child to know that they can come to you when they have questions or concern, even when they worry that they’ve made a mistake. Keeping the door open for these types of conversations is important, especially as they get older and will be navigating more complex situations.”

Here are ways to approach the conversation with each age group:

Preschool and elementary: Focus on safety and building healthy habits.

• Talk to them about making health choices, such as eating healthy foods and encouraging them to make their own decisions to help build confidence.
• Advise your child to only take medication from a trusted adult and reinforce that nicotine, alcohol and other substances are not safe for children. Consider saying: :if you ever see something that is interesting or you don’t know what it is, you can always ask me. You won’t get in trouble for asking questions.” Or “you may see adults using vapes or drinking alcohol. Those things aren’t safe for kids. If you have any questions about them you can always ask me.”

Middle school: Focus on curiosity and peer influence.

• Children may encounter vaping, nicotine pouches, alcohol, and cannabis through friends, social media, television/movies, or at school. Ask them about what they’re hearing, what friends may be engaging in, how they respond to pressure, and help them practice how to say no without feeling embarrassed. Consider: “ Have you heard people at school talking about vaping? What do you think about it? What would you say if someone offered you their vape?”

High school: Focus on decision-making, mental health and real-world situations.

• At this age, you can have more direct conversations about substances impact brain development, mental health, driving ability, relationships, and future goals.
• Discuss the role of stress, peers, and social situations can influence their choices. Consider saying: “When life gets stressful, sometimes people use nicotine, alcohol or other drugs. What helps you when you’re feeling overwhelmed? If you’re struggling with feeling overwhelmed or stressed, how can I help you?” Or “if you ever try something or you’re worried about friend using drugs you can always come to me to talk about it. My priority is to keep you safe, and we can figure out what to do next together.”

Conversations don’t have to be perfect. Use it as an opportunity to listen to your child’s perspective. Stay curious and revisit the topic over time so that it normalizes conversations early and helps your child build the skills to seek guidance from a trusted adult when they need help.

What should I do if I need help navigating my child’s substance use?

You don’t have to navigate your child’s substance use issues on your own. If you are concerned about your child’s substance use, start by talking with their pediatrician or another healthcare professional who can help you with identifying the appropriate next steps. Depending on your child’s need, this may include seeing a mental health professional or a clinician specialized in addiction treatment.

Even with your best efforts, some kids need support from trusted adults outside the home to confront substance use. Whether it’s a relative, teacher, family friend or faith leader, a bit of distance can make tough conversations easier. Professional help — from a pediatrician, psychiatrist or mental health counselor — is also an important part of getting your teen the support they need. Use your network to help connect them to the right care. If your child struggles with substance use, don’t wait to seek help. Early support is essential in preventing it from becoming a more serious problem. Asking for help is an important part of helping support your child.