Smoking and Your Child

I remember a Family Circus cartoon once that said, "Children do often do as you say, but they nearly always do as you do." Dr. Rudloff

The biggest predictor of whether a child will smoke is whether a parent smokes.

Look at your baby or young child. Picture him or her with a cigarette. If you don't want to see this when your child is older, stop now.

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One of the biggest things parents can do to improve their child's health is to protect him or her from exposure to tobacco smoke.

The adverse effects of this are so great that they almost nullify the benefits of breast feeding in a mother who smokes.

We all know smoking is bad.

Look at the picture to the left. This poster is almost 20 years old. Despite many years of knowing how bad smoking is, many parents still smoke.

Almost everyone knows and believes that smoking can cause lung cancer and emphysema. Some people know that smoking is a main contributor to strokes, paralysis, heart attacks, and can greatly worsen the prognosis of someone who already has cancer. For example, women with breast cancer who continue to smoke have a much bleaker outlook than those who do not. Smoking accounts for an average of 434,000 deaths per year in the United States. To put this in perspective, about one half the population in the St. Louis area dies every year with smoke related deaths. Another way to look at it, back in the days when "everyone got measles," there were about 300-500,000 cases of measles in the United States each year. As many or more people die from tobacco usage every year than contracted one childhood illness that "everybody got."

Despite this, many people smoke. About 35% of the general population smoke. Unfortunately, about 40% of women of childbearing age smoke. Almost 20% of high school students smoke and surprisingly, about half of all preschoolers think they will smoke as adults. Why people smoke isn't hard to fathom. For a long time we knew that smoking was psychologically addicting. Recently, we discovered that nicotine is one of the most physically addictive substances we know. However, it is still a conscious decision to begin smoking and a conscious decision to continue to do so. No longer can we claim ignorance about the effects of smoking as an excuse. There is another group of people who do not make conscious decisions, are not informed and do not have control over whether or not they smoke. These are children who are exposed to second-hand smoke.

About a million babies are born each year to mothers who smoke. Another half a million or so are born to mothers exposed to secondhand smoke. Smoking is bad for babies. Most expectant mothers who smoke know this. They probably know that it causes low birth weight, but they may not know the entire story of what smoking during pregnancy does to the baby. Nicotine from cigarettes decreases blood flow to the placenta. Carbon monoxide in the mother's blood is transferred to the baby's blood, and decreases the capacity of the blood to carry oxygen. Therefore nicotine and carbon monoxide have the effect of robbing the developing baby of nourishment and oxygen. This decreased nourishment results in a lower birth weight. Many other complications can also be attributed to smoking.

Before the baby is born, smoking mothers have a higher incidence of miscarriage, abruption (tearing away of the placenta), and placenta previa (bleeding due to a low lying placenta). Infants born to smoking mothers have a higher incidence of low birth weight and often are small for their gestational age. Low birth weight and being small for gestational age are two leading risk factors for cerebral palsy. The effect on birth weight is not limited to mothers who smoke. When expectant mothers are exposed to second-hand smoke from fathers, these infants also have a lower weight that is directly correlated to the amount the father smokes. When mothers smoke during one pregnancy and not the other, the baby exposed to maternal smoking has a lower IQ than the one not exposed. This effect on IQ has even been found in children only exposed to smoke after birth and in one subset, a mother smoking only 10 cigarettes a day led to an average of 4 IQ points lower. Smoking not only lowers the IQ but mothers who smoke during pregnancy have a 50% greater chance of having a child with mental retardation. If the mother smokes over a pack of cigarettes a day, this risk increases by 75%.

The effects of smoking are not limited to problems in newborns. There is a higher incidence of infants dying in the perinatal period (period around the birth and first few weeks of life) and this is directly due to the increased incidence of SIDS (crib death). This increased incidence of SIDS can also be found in infants exposed to tobacco smoke only after birth and, in fact, if a breast-feeding mother smokes, the negative effects of the maternal smoking may outweigh the positive effects of breast-feeding. Nicotine-a highly addictive substance-is not only found in breast milk, but concentrated in breast milk. Finally, there is a higher incidence of apnea in mothers who smoke and the length and frequency of the apneic episodes tend to be worse than non-smoking mothers.

Second-hand exposure to smoke is also bad for older kids. In older children, researchers can tell how great of an exposure children have to second-hand smoke by the amount of a nicotine by-product in their urine. Those children have more episodes of bronchiolitis and pneumonia. There is a direct relationship between the amount of these by-products in the child's urine and hospitalization. It is estimated by some that possibly 20% of all ear infections are directly caused by exposure to tobacco smoke. Children with smoking parents are more likely to have behavior problems, lower IQ's, be retained in grades, have decreased attention span, more aggressive behavior, bronchitis, and pneumonia. Asthma is also worsened by tobacco usage and there is a direct correlation between exposure to nicotine, as measured by substance in the child's urine, and the severity of the asthma. Children raised in smoking environments are 1-2 centimeters shorter than a sibling who is not exposed. Their lung function is at least 10% less than non-exposed siblings. Finally, children raised in smoking environments are found to have abnormal pulmonary (lung function) tests at 12 years of age.

In the late 1970's, a sign hung in St. Louis Children's Hospital that said "For the sake of the children, please don't smoke." At that time, that sign was there in part because of the use of oxygen in the hospital, in part because of patients with cystic fibrosis (chronic lung disease) and at that time we knew that tobacco smoke was a trigger for asthma. That was 25 years ago. Now we know a lot more and the message behind that sign becomes truer each day.

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