From the Guidelines
Smoking cessation in children should focus primarily on prevention and behavioral interventions rather than pharmacotherapy. Children and adolescents who smoke should be encouraged to quit through counseling, motivational interviewing, and family-based interventions. The "5 A's" approach (Ask about tobacco use, Advise to quit, Assess willingness, Assist in quitting, and Arrange follow-up) is effective for healthcare providers working with young smokers, as recommended by the U.S. Preventive Services Task Force 1.
Key Interventions
- Counseling from a health care provider reduces the risk for smoking initiation, and pediatricians should include tobacco use prevention as part of anticipatory guidance 1.
- School-based programs that teach refusal skills and address peer pressure show better outcomes than simply providing information about health risks.
- Parental involvement is crucial, as children whose parents smoke are more likely to become smokers themselves, and addressing parent/caregiver tobacco dependence is important to protect the health of the child 1.
- Digital interventions including text messaging programs and mobile apps designed specifically for youth can provide age-appropriate support.
Medications and Nicotine Replacement Therapy
While nicotine replacement therapy (NRT) like patches or gum may be considered for heavily dependent adolescents, it should be used cautiously and is generally not recommended for children under 12, as no medications are currently approved by the U.S. Food and Drug Administration for tobacco cessation in children and adolescents 1.
Prevention and Early Intervention
The developing brain is particularly vulnerable to nicotine addiction, making early intervention critical to prevent lifelong tobacco dependence and associated health consequences. Pediatricians should inquire about tobacco use and tobacco smoke exposure as part of health supervision visits and visits for diseases that may be caused or exacerbated by tobacco smoke exposure, and recommend tobacco dependence treatment of tobacco-dependent parents and caregivers 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Smoking Cessation in Children
- Smoking cessation is a critical aspect of preventing tobacco-related illnesses in children and adolescents, as tobacco use is a leading cause of preventable death in the US 2.
- Primary care-feasible behavioral interventions, including education or brief counseling, have been shown to have a moderate net benefit in preventing tobacco use in school-aged children and adolescents 2.
- The US Preventive Services Task Force recommends that primary care clinicians provide interventions, including education or brief counseling, to prevent initiation of tobacco use among school-aged children and adolescents 2.
Interventions for Smoking Cessation
- Behavioral interventions have been associated with decreased likelihood of cigarette smoking initiation compared with control interventions in children and adolescents 3.
- However, there is insufficient evidence to determine the balance of benefits and harms of primary care interventions for tobacco cessation among school-aged children and adolescents who already smoke 2.
- Pharmacological interventions, such as nicotine replacement therapy and bupropion, have been shown to be effective in smoking cessation in adults, but there is limited evidence on their effectiveness in children and adolescents 4, 3.
Parental Smoking Cessation
- Interventions that encourage parental cessation for the benefit of their children have been shown to be effective in increasing parental quit rates 5.
- Subgroups with significant intervention benefits include children aged 4 to 17 years, interventions whose primary goal is cessation, interventions that offer medications, and interventions with high follow-up rates (>80%) 5.
- Parental smoking cessation can help protect vulnerable children from harm due to tobacco smoke exposure, and can be a worthwhile addition to the arsenal of cessation approaches 5.