Where There’s Smoke, There’s Crying
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Linda S. Nield, MD
I vividly remember the awful feeling of riding in a smoke-filled car when I was a kid. Besides hating the smell, I experienced claustrophobia, nausea, and motion-sickness simultaneously. It was particularly miserable in the middle of winter, 15 degrees outside, and I couldn’t roll down the car window for fresh air. Yes, the car windows had to be rolled down back then. A study by King and colleagues1 published last month showed that the percentage of middle and high school students exposed to secondhand smoke in cars decreased from 2000 to 2009; however, one-fifth of that population was still exposed. That one-fifth probably experienced the claustrophobia, nausea, and motion-sickness like I did. That’s still too many.
As pediatric providers, we have to be sympathetic toward the parent who smokes and acknowledge the difficulty in trying to quit. We also have to reiterate the potential harmful effects for the child, which are plentiful. Among the risks associated with prenatal exposure to tobacco smoke is also the risk of the development of colic. I know I have felt cranky and irritable when exposed to smoke, it’s no wonder that babies exposed to smoke would have colic. Whether the nicotine is to blame for the development of colic is unknown. Milidou and colleagues2 report that nicotine replacement therapy during pregnancy is also a risk factor. However, the mother on nicotine replacement therapy is trying to quit, and she should be given kudos for that.
It may be awkward at first for medical students and some residents to ask, “Does anyone smoke in the home?” (or “So who smokes?” when it is obvious on entering an examination room and smelling smoke in the air). But this is a question that we all must learn to ask tactfully. Perhaps you have heard the response, yes but … “not in the house,” or “not in the same room as Billy,” or “I change my clothes after I smoke.” Even if these measures were true, do they occur 100% of the time? And do they make any difference when it comes to the effects of secondhand smoke? In contrast are the parents with a child who is exposed to smoke from a caregiver, such as a grandparent, who provides perfect care in every other way. It takes a delicate conversation between parent and caregiver to address that issue.
Although it may be hard to believe, some parents and caregivers have not been told about the dangers of secondhand smoke. For those who have been told, we shouldn’t presume that they are aware of all the available information on this topic. There are also those parents who know the risks and have been told before and who may get angry at you for once again bringing up this bad habit. That shouldn’t stop us from bringing it up.
I think that most pediatric practitioners cannot take on the responsibility of helping a parent quit smoking. However, we can discuss the dangers of secondhand smoke and recommend that a parent quit smoking. At minimum, we should have a list of available smoking cessation options3 and provide names of local adult health care professionals who may be able to help. All of this has to be done in a respectful manner to avoid driving away the parent.