If you're alone, perform CPR for two minutes, then call 911. Toxicity Levels are color-coded base on the chemical levels.. Usually Nontoxic Minimally toxic Toxic Possible Symptoms tells you what potential symptoms and side effects may feel, if ingested. Place your cat on IV fluids. Unauthorized use of these marks is strictly prohibited. Children with significant symptoms should be admitted and eventually treated by supportive care. In fact, a 2015 study of 315 mother-baby pairs in Boston, Massachusetts, found that 15.2 percent of the mothers were letting their toddlers consume some coffee by the time they reached their second birthday. If you dont know what plants you have in your garden and how toxic they could be, invite a gardener friend round to identify them. My husband Andy mows the grass really short as soon as the weathers good enough for the kids to play outside and that way we can pick up any poo as soon as we spot it. It's not likely you'll overdose on nicotine just from smoking cigarettes. Epub 2010 Apr 19. When after vomiting other symptoms persist activated charcoal can be given via a nasogastric tube. I'm compelled to write to inform people that cigarette butts contain highly toxic poisons. Chewing tobacco is also known as tobacco, nicotine, smokeless tobacco, snuff and spit tobacco. Try to make her spit out anything left in her mouth. MeSH Sometimes it comes in colorful packages or smells like candy, so it's not surprising that kids will drink it. Abstract Accidental ingestion of cigarettes (and butts) is mainly seen in young children. official website and that any information you provide is encrypted Low blood pressure (hypotension) and slow heart rate (bradycardia). This call is free and confidential. If your child is not having symptoms, give them a few sips of water and watch for vomiting or diarrhea. You'll most likely vomit before all the nicotine is absorbed, so there won't be any lasting effects, however. Serkalem Mekonnen, RN, BSN, MPH ", American Lung Association: "Nicotine," "E-cigarettes and Lung Health. In fact, the AAPs Committee on Nutrition and the Council on Sports Medicine and Fitness concluded in 2018 that caffeine has no place in the diet of children and adolescents.. Is it OK to drink coffee while breastfeeding? You'll get early symptoms within the first 15 minutes to an hour. American Academy of Pediatrics. Ipecac causes a child to vomit, which isn't an effective treatment for poisoning and may severely injure a child who has ingested a caustic substance. Your babys body cant handle it quite as easily, and a smaller amount can affect their functioning. up to 400 milligrams of caffeine on a daily basis. Symptoms typically last an hour or two after a mild overdose and up to 24 hours for severe poisoning. If your child develops any symptoms, call IPC now at 1-800-222-1222. Many of us can have a cup of coffee without any trouble at all, other than perhaps keeping us awake at night if we drink it in the evening. They use batteries to heat liquid nicotine -- usually in a cartridge or container -- into a gas or vapor so you can inhale it. Caffeine might make you feel more alert refreshed, even and ready to tackle your lengthy to-do list. Outlook. Should I monitor my home for carbon monoxide? A healthcare professional may administer activated charcoal, the standard treatment for poisoning in children. Another option: Have a pretend tea party. The more teenagers and adults use tobacco products, the more likely it is that infants and children will find and swallow them. Late-phase symptoms are more like winding down. What if your baby or toddler accidentally has coffee? A drink of water can take away any nasty tastes. Add the Poison Control Center's help line number (800-222-1222) to your phone contacts and post it at home for emergencies. Is it harmful for a baby to eat a cigarette - The Q&A wiki what if your baby eats tobacco My 8 month . In severe cases, it can lead to serious complications such as respiratory distress, seizures, and even death. Lock up liquid nicotine containers, and buy only refills that use child-resistant packaging. PMC As with all poison questions, dosage is critical.. Call 911 if someone is unconscious or is having difficulty breathing. Here, the short answer is probably not. 2007 Oct-Nov;45(7):737-52. doi: 10.1080/15563650701665175. The amount of nicotine that can be toxic to a baby depends on the age, weight, and overall health of the baby. Careers. An older child experimenting with chewing tobacco can also overdose. Most poison emergencies can be resolved quickly over the phone. Late phase symptoms include: Diarrhea. You need ALL of those, not one. The amount that causes overdose depends on things like your body weight and where the nicotine came from. Required fields are marked *, Baby Sleep Problems After Travel? Twigs, soil, worms and more what your child could be eating this summer and whether its dangerous. These are the most common things your tot is likely to pick up and what you should do if he swallows them. Im a firm believer that exposure to some germs makes your immune system stronger.. Firstly, I hope that the child that ate the cigarette butt is fine and well. Methylphenidate poisoning: an evidence-based consensus guideline for out-of-hospital management. Nicotine gums, patches, and lozenges have it, too. Most of them are drinking soda, but some of them love coffee or coffee-based drinks, too. Epub 2011 Jul 29. Unable to load your collection due to an error, Unable to load your delegates due to an error. You may be right to be concerned. Seizures can begin in as little as 20 - 30 minutes. Headache, dizziness. Luckily, you have a couple of options when it comes to toddlers over the age of 1. Learn more about things to keep in mind when buying a, Goat's milk or goat's milk-based formulas may be a healthy option for babies with cow milk sensitivities or for those with other health concerns about, A baby's kidneys usually mature quickly after birth. Ingestion of cigarettes and cigarette butts by children--Rhode Island, January 1994-July 1996. In extreme cases, low birth weight can cause the death of the newborn. Color-coded charts help you quickly understand toxicity and what you should do next. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). If your child already owns a play tea set, dust it off, set it out on the table, and just pretend to be drinking coffee or tea. Crayons are also known as brand names like Crayola. Children most often ingest lead in paint chips or inhale lead dust during renovations. Were still learning more about how caffeine affects children and what amount is considered safe, and more research is needed. The amount in only one cigarette butt is enough to poison a child. They need to explore to learn, says psychologist and child behaviour expert Corrine Sweet (www.corrinesweet.com). Gas space heaters, ovens, stoves, or water heaters, Liquid nicotine a small amount of liquid nicotine, used to fill e-cigarettes, can be fatal to a child if swallowed or spilled on the skin, Windshield washer solution and antifreeze, Hydrocarbons (gasoline, kerosene, motor oil, furniture polish, paint thinner). Are there babies and toddlers who are drinking coffee? The safety of ingested caffeine: A comprehensive review. There is a risk of toxocariasis or toxoplasmosis from eating cat poo (see later for a note on that). Here's a list of kid-friendly snacks that are healthy and, The terrible twos can start before your child is 2 years old, and they can extend well into their third year. or. If your child splattered the substance on other body parts as well, get into the shower with her instead. CNS depression in an infant after the ingestion of tobacco: a case report. Child and wellbeing psychologist Dr Maggie Redshaw from the Pampers Village Parenting Panel advises: Sadie is putting everything in her mouth at the moment and we have to keep a very close eye on her. How much nicotine is toxic to a baby? And the numbers go up as the kids get older. If your child has eaten some grass, or a twig less than 6cm long, it probably isnt anything to worry about, says Dr Arabella Sargent. This is about 19% of all adults 18 years or older. For example, a very small amount of liquid nicotine can kill a child. Fortunately she hasnt eaten any berries yet. 2005-2023 Healthline Media a Red Ventures Company. https://www.healthychildren.org/English/safety-prevention/at-home/Pages/Liquid-Nicotine-Used-in-E-Cigarettes-Can-Kill-Children.aspx [Accessed August 2020], AAP. Do not do this at home. Tip: Put the poison control telephone number in your cell phone and post it by every phone and on your emergency numbers list at home. Many sodas, teas, and energy drinks also contain caffeine. So, when is a good age to finally allow your child to have coffee? This aids in the elimination of nicotine from your cat's system. Her favorite gig of all is being "Mama Karen" to four grown children and "Nana" to nine grandkids. The inside of your tots stomach is extremely acidic and very good at killing off anything he eats, adds Dr Sargent. Dont fret if they like to taste your drink, but dont go out of your way to offer them caffeinated beverages, either. Even extremely small amounts of nicotine can be harmful to a baby. Clin Toxicol (Phila). Our guts are designed to cope with eating bacteria and once its eaten its eaten, says Dr Arabella Sargent. What if my child is exposed to toxic fumes? Usually, someone who gets quick, proper care will recover fully. Check it out at https://www.SleepBaby.org highly recommended! Call 911 if someone is unconscious or is having difficulty breathing. See below for more details about what to do if your child: No. An infant with severe MAS may need more treatment, such as: surfactant to help open lungs inhaled nitric oxide. Ingesting even a small amount of e-liquid can cause serious health problems in a 1-year-old. The combined poison of only 20-30 cigarette butts would be sufficient to kill an adult male. ( I have a 2 yr. old and 5 mo. Muscle twitching. Experts used to tell parents to keep syrup of ipecac on hand for poisoning emergencies, but the American Academy of Pediatrics (AAP) no longer recommends it. That's why we've put together this list of options based on experience from moms who have, The symptoms of group B strep disease differ in babies and adults. You can learn more about how we ensure our content is accurate and current by reading our. If you're going to smoke or use other nicotine products, take some basic precautions. Alcohol: A Dangerous Poison for Children (The Poison Post). Keep up-to-date with the latest from Illinois Poison Center. They happen 30 minutes to 4 hours later. Parents need see that their babies and toddlers are eating a healthy diet on a regular basis. The concentration, however, is very low. American Academy of Pediatrics. Your child has plenty of time later in life to develop a taste for coffee. Keep a sample (or what's left in the container, if there is one) in case it's needed to identify the poison. People with the disorder feel compelled to eat non-food items. That includes making sure they get the appropriate amount of milk. Theres also a danger that your child might have inhaled the berry into his lungs rather than swallowed it, which can cause breathing problems, says Arabella Sargent, a GP specialising in paediatrics. drooling. HHS Vulnerability Disclosure, Help After three days in the hospital, her symptoms resolved and she was released. Most poison emergencies can be resolved quickly over the phone. Although cigarettes are potentially toxic, their ingestion by children is generally benign. children will see things at their level you might have missed. According to the American Cancer Society, women who quit smoking before getting . Try offering a substitute beverage without caffeine in a favorite kid-appropriate coffee mug. "Babies and children have a psychological desire to explore. They happen 30 minutes to 4 hours later. Best time is 45 seconds from awake to asleep! Don't try to make someone who's swallowed nicotine throw up or give them antacids to settle their stomach. If your child swallows a piece of a cigarette or butt, cigar, chewing tobacco or any other nicotine products, use the webPOISONCONTROLonline tool for guidance or callPoison Controlright away at 1-800-222-1222. If your child is having symptoms or you don't know the exact substance or amount swallowed, call the Poison Center Hotline at 1-800-222-1222. Seizures. If you have ipecac, dispose of it properly. Contact POISON CONTROL as soon as possible!!! If you're alone, wrap your child tightly in a towel or blanket and hold her under one arm. Centers for Disease Control and Prevention (CDC). You need to wash his hands as soon as possible to minimise the risk of infection. Please enable it to take advantage of the complete set of features! ", National Cancer Institute: "Smokeless Tobacco and Cancer. Give your cat activated charcoal. Yes, it's a good idea to install a carbon monoxide detector in your home and to test it regularly, along with your smoke detectors. This includes "smoke juice", liquid nicotine for electronic cigarettes. If another adult is present, ask for help holding your child. government site. An 8-month-old child swallowed two old cigarette butts while in the care of a sitter. My Child Ate Crayons. Learn more about our editorial and medical review policies. Thirteen (14%) of the children had been taken to a health-care facility. (So cute, right?). Unintentional child poisonings through ingestion of conventional and novel tobacco products. Connolly GN, Richter P, Aleguas A Jr, Pechacek TF, Stanfill SB, Alpert HR. Accidental ingestion of cigarettes (and butts) is mainly seen in young children. Keep up-to-date with the latest from Illinois Poison Center. They will need to know as much information about the poisonous substance he was exposed to as possible, including: Nine out of 10 poisonings happen at home. After rinsing the eye, call poison control at (800) 222-1222. #3. If she plays in a sandpit and puts her hand in her mouth I always wash her hands afterwards and give her a drink. 2011 May;20 Suppl 1(Suppl_1):i17-20. You might have given up coffee or at least switched to decaf while you were pregnant. Gastric lavage was performed to help wash out her stomach and she was given activated charcoal; these were used to reduce the amount of nicotine absorbed by her bloodstream. Here is what you, You may have heard that you should wait to feed a baby eggs until their first birthday, but is this true? But what happens after the babys here, and youre really craving a hot cup of the good stuff? ", American Cancer Society: "Nicotine Replacement Therapy to Quit Smoking.". To prevent nicotine poisoning: sharing sensitive information, make sure youre on a federal Eating a small amount of gum usually does not cause any symptoms. What if something toxic splashes into my child's eye? Temple JL. Never drop a cigarette butt onto the street, for example, or toss products into open trash cans. 2020. If I do see her looking at them I divert her attention away by tickling her. Symptoms are caused by the nicotine component and usually develop rapidly (< 4 hours). In severe cases, hospitalization is necessary and the dog is put under surveillance. Poison Control is frequently called about children who swallow discarded cigarette butts. The best way, of course, is to simply not have it around. Ingesting small amounts can be managed at home with IPCs help, but ingesting large amounts can be life-threatening. This is his way of finding out. Thats fine when the object is soft and safe, but what about when its something that could be dangerous? Poison. How much should they eat? 2019. In severe cases, the filter can become lodged in the babys digestive system, causing an intestinal blockage that can lead to serious complications and require surgical intervention. MMWR Morb Mortal Wkly Rep. 1997 Feb 14;46(6):125-8. Committee on Nutrition and the Council on Sports Medicine and Fitness. The site is secure. doi: 10.1136/tc.2011.043489. The doctor will ask for the details and direct you to take any further steps. If your child has been exposed to toxic fumes but doesn't seem to be affected by it, talk with his doctor. below. Karen Miles is a writer and an expert on pregnancy and parenting who has contributed to BabyCenter for more than 20 years. Tips for Smoking Parents: If Your Child Eats a Cigarette, What Do. Answers.com > Wiki Answers > Categories > Health > Addictions > Smoking and Tobacco Use >. Our website services, content, and products are for informational purposes only. The filters of cigarettes contain cellulose acetate, which is not easily digested and can cause blockages in the digestive system. One more thing to remember: Dont just trade the coffee for a soda. Diarrhea Shallow breathing Slower heartbeat Lower blood pressure Lethargy. Her breathing was slow and she was very drowsy. Atypical antipsychotic medication poisoning: an evidence-based consensus guideline for out-of-hospital management. Ingesting a cigarette filter can be harmful to a babys health and should be taken seriously. An infusion to eliminate the toxic . I've also see cured tobacco (from a cigarette, in fact) used in at least one fine kitchen as a garnish on a coffee-based ice cream. This call is free and confidential. Include your child's age and weight and your street address, so a babysitter can quickly give this information to an emergency dispatcher. We avoid using tertiary references. Liquid nicotine used in e-cigarettes can kill children. If your child has swallowed a strong acid, such as toilet bowl cleaner, or a strong alkali, such as drain or oven cleaner, vomiting could further injure her by bringing the burning substance back up through her throat and mouth. Certified Specialist in Poison Information, Call American Association of Poison Control Centers, the most helpful and trustworthy pregnancy and parenting information. If a baby ingests a cigarette filter, it can cause symptoms such as nausea, vomiting, abdominal pain, and diarrhea. Keep your home and car nicotine-free. Even call if your dog has vomited up to nicotine just to be on the safe side. If he is, head to A&E. Call 1-800-222-1222 if you are concerned that you or someone else has been exposed to a potentially harmful substance. In fact, a healthy adult can probably consume up to 400 milligrams of caffeine on a daily basis without any adverse effects. Call 911 immediately if your child has any of the following symptoms: Call (800) 222-1222 right away if your child doesn't have any of the serious symptoms listed above. NEVER store cigarettes and other nicotine products where children can see or reach them. (2011). Ingesting any part of a cigarette, including the tobacco or the filter, can cause symptoms such as nausea, vomiting, abdominal pain, and diarrhea. Signs and symptoms of nicotine poisoning, along with treatment information, Alcohol: A Dangerous Poison for Children (The Poison Post. To help flush out the nicotine in your cat's system, the vet will place your cat on an IV. You could even let your child pick out a new coffee mug to drink out of. Will they ever be on a schedule? What information will 911 or poison control need about my child? If your baby has ingested any part of a cigarette, it is a potentially serious situation and you should seek immediate medical attention. May 29, 2011. E-cigarettes pose a bigger risk. For a list of common poisons, see "What are common poisonous substances in the home?" Burnham L, et al. You must keep any product that contains nicotine out of the reach of children and pets. My child swallowed chewing tobacco. Common and dangerous poisons. Put the poison control number in your mobile phone and post it next to all phones at home. 2. Do not try to make your child vomit. Ensure your child gets all the good stuff in their cups and on their plates each day, and forego the caffeinated drinks. FOIA There's enough in a cigarette butt to harm your little one if they decide to eat one off the floor, for example. Its possible for a child to consume whats considered to be a toxic amount of caffeine, but research suggests that its much more likely to happen with highly caffeinated energy drinks and medications containing caffeine than with coffee. All rights reserved. Its only a small amount, true, but your babys body cant process the caffeine as quickly and efficiently as your adult body can. Crayons may cause irritation if exposed to eyes. Complications. If your child is choking on a crayon, call 911 immediately. You might choose to allow them to have a coffee drink or a soda on a special occasion, or perhaps on the weekend. Read more about how to protect your child from lead poisoning. It will connect you to your local poison control center anywhere in the U.S. National Institute for Occupational Safety and Health: "Nicotine: Systemic Agent," "Nicotine. Caffeine might make you feel more alert refreshed, even and ready to tackle your lengthy to-do list. As little as 1 milligram (mg) of nicotine, a very small amount, can cause symptoms in an infant. I think you're safe. In severe cases, the filter can become lodged in the baby's digestive system, causing an intestinal blockage that can lead to serious complications and require surgical intervention. Ingestion of a mouthful or less is expected to cause a mild laxative effect at worst. Unintentional child poisonings through ingestion of conventional and novel tobacco products. What To Do will provide immediate next steps and determine whether or not more immediate action is needed. As well as being a choking hazard cigarette ends can be poisonous to your child, too. Its easy to forget that coffees not the only drink that contains caffeine. Ahluwalia N, et al. Flavored tobacco, usually smoked through a hookah, is a growing trend. Caffeine: Is it a problem for kids? Where liquid nicotine has gotten onto skin, wash the area well with soap and water (either warm or cool) and rinse for at least 15 minutes. Regul Toxicol Pharmacol. How often should they eat? Symptoms are caused by the nicotine component and usually develop rapidly (< 4 hours). In addition to the immediate effects of nicotine toxicity, exposure to nicotine at a young age can also have long-term effects on a childs health, including an increased risk of addiction, behavioral problems, and learning difficulties. Its hard to resist a chubby-cheeked toddler who wants to be just like Mom or Dad. This gas is added to oxygen to open blood vessels and improve oxygen delivery. This is a potentially life-threatening emergency . If youre in any doubt, seek medical help. 2005 - 2023 WebMD LLC. cerebral palsy. The American Academy of Pediatrics (AAP) maintains that children and adolescents should try to abstain from drinks containing caffeine. My baby never slept well (especially through the night) until I started using https://www.SleepBaby.org by far one of the best things Ive ever got my hands on to get him to fall asleep quickly. Diagnosis. Pipes & Cigars: Less Harmful Than Cigarettes? If your child needs emergency treatment, the poison specialist will let you know right away. Cigarette smoke contains toxic chemicals that can be harmful to a babys health, even in small amounts. Malizia et al 9 described four children who ingested two cigarettes each and developed salivation, vomiting, diarrhoea, tachypnoea, tachycardia and hypotension within 30 minutes, and depressed respiration and cardiac arrhythmias within 40 minutes. Simply put, nicotine poisoning happens when you have too much of it in your body. In symptomatic children or children with a reliable history of ingestion of large quantities who have not vomited gastric lavage with administration of activated charcoal has to be performed. As a parent, you have to decide what kind of limit to place on your child, based on their health and their specific needs. Disclaimer. Nicotine in tobacco products is easily absorbed by the oral mucosa and intestines; absorption depends on nicotine content and pH of tobacco. Crayons can be a choking hazard. Do not assume that he is fine. Chewing tobacco may cause irritation if exposed to eyes. Be sure to read the labels to make sure you know the score. Induction of emesis is not advised. If you suspect your baby has ingested any part of a cigarette, dont wait for symptoms to develop call poison control or seek medical attention right away. Call IPC at 1-800-222-1222 if symptoms develop. Check his mouth and that hes not in pain. What to Do. Call 911 or 800-222-1222 (poison control) if your child has been exposed to something poisonous. What should I do if my child is exposed to something poisonous? My son's perfectly protected, organic, cage-free mouth was happily chewing on a cigarette he had found in the grass. If a 1-year-old gets ahold of a vape, it can be a dangerous and potentially life-threatening situation. (2019). Novotny TE, Hardin SN, Hovda LR, Novotny DJ, McLean MK, Khan S. Tob Control. But if your healthy toddler snatches your (hopefully not scalding) coffee mug out of your hands and takes a gulp, youre more likely to wind up with a stain on your clothes than with a health problem. 28 Suzette Booth Former Self Employed (2010-2015) Author has 1.9K answers and 440.7K answer views 3 y OMG! Abnormal heart rhythms. As little as 1 teaspoon of liquid nicotine can be fatal for the average 26-pound toddler. (Some examples are Camel Orb, Ariva, and Stonewall.) If your child is having symptoms or you don't know the exact substance or amount swallowed, call the Poison Center Hotline at 1-800-222-1222. This article helps explain why coffee can make you poop. Summarized from: Borys DJ, Setzer SC, and Ling LJ. Undated. Location: USA. Gastric lavage is not needed in asymptomatic patients (with an unreliable history) or after vomiting. [3] 3. She's passionate about bringing up-to-date, useful information to parents so they can make good decisions for their families. These infections affect 20 children a year and in general cause flu-like symptoms. Learn when its safe for babies to eat eggs, Snack time is a great opportunity to sneak some extra nutrients into your childs diet. Symptoms were reported in 30 (33.3%) of the children and included spontaneous vomiting (up to four episodes) (26 {87%}), nausea (two {7%}), pale or flushed appearance (two {7%}), lethargy (one {3%}), and gagging (one {3%}). If your child swallowed a large amount of gum, they may experience vomiting, constipation, abdominal bloating and pain or changes in bowel habits. When children swallow cigarettes or other types of tobacco products, their symptoms will be directly related to the dose of nicotine they received. Carbon monoxide is a colorless, odorless gas that can seep through your home from an appliance that's malfunctioning or that isn't properly installed. 02/10/2009 at 6:08 pm. While I'm not advocating eating cigarettes, a little nibble of tobacco is not likely to be lethal, or even harmful. Rinse eyes splashed with nicotine well with a lot of warm water for at least 15 minutes. Flush the eye by pouring lukewarm water gently into the inner corner. But then the question becomes whether or not those young children need to be drinking coffee. If your child ate any amount of chewing tobacco or saliva that contains chewing tobacco residue, call IPC immediately at 1-800-222-1222. https://www.uptodate.com/contents/prevention-of-poisoning-in-children [Accessed August 2020]. Poisoning prevention Centers for Disease Control and Prevention. Eating something like creepy crawlies is just natural curiosity, says Corrine Sweet. Call 911 if someone is unconscious or is having difficulty breathing. Posts: 24. 2020. Vet Hum Toxicol. Nicotine in tobacco products is easily absorbed by the oral mucosa and intestines; absorption depends on nicotine content and pH of tobacco. Children are not just little adults, though. Get the rest of whatever your child has swallowed away from her. ALWAYS store cigarettes and other nicotine products where children cannot see or reach them. Tips for what to do if your toddler wants to be just like Mom or Dad, Age when its OK for your kiddo to have coffee, According to a 2019 review of research literature, aacap.org/AACAP/Families_and_Youth/Facts_for_Families/FFF-Guide/Caffeine_and_Children-131.aspx, healthychildren.org/English/news/Pages/Caffeine-Sources-for-Children-and-Teens-More-Varied-Than-Before.aspx, cdc.gov/breastfeeding/breastfeeding-special-circumstances/diet-and-micronutrients/maternal-diet.html, mayoclinic.org/healthy-lifestyle/nutrition-and-healthy-eating/in-depth/caffeine/art-20045678, ncbi.nlm.nih.gov/pmc/articles/PMC5445139/, cdc.gov/healthyschools/nutrition/energy.htm, Baby Feeding Schedule: A Guide to the First Year. She hasn't had any symptoms of poisening and it was an hour and a half ago so not sure if she did but need some advice. The most common cause of nicotine poisoning in young children is ingestion of cigarette butts. That doesnt mean you should deliberately give your baby or toddler coffee, of course. It's in all cigars, smokeless tobacco (such as chew or snuff), and most electronic cigarettes, or e-cigarettes.