Is your child smoking? Children who grow up in homes in which people smoke may be permanently handicapped in breathing fitness.

Children who grow up in homes in which people smoke may be permanently handicapped in breathing fitness.

Most people know by now that cigarette smoking causes many health dangers to the smoker. But more than 20 years of research were necessary, following the landmark 1964 Surgeon General's Report on Health Consequences of Smoking, before the public became aware of the dangers of passive or secondhand smoking. Secondhand smoking, sometimes called involuntary smoking, is the inhalation of smoke from two sources: mainstream smoke, which is exhaled by the person smoking a cigarette; and sidestream smoke, which goes directly into the air from the end of a cigarette, pipe, or cigar.

Mainstream smoke is exhaled by the smoker for about 24 seconds per cigarette, while sidestream smoke pollutes the air during the entire cigarette's burning, about 12 minutes. Such smoke lingers in the air long after the cigarette is finished. Because sidestream smoke is unfiltered by the lungs of the smoker, it has the highest concentration of toxic materials. Notice that for most components, the sidestream to mainstream smoke ratio is in excess of 1, as shown in Table 1.

Secondhand smoke can pollute a room with carbon monoxide levels well above federal air standards. The 1986 Surgeon General's Report on Health Consequences of Involuntary Smoking reported that such secondhand smoke can cause lung cancer in nonsmokers and increase significantly the respiratory illnesses of children whose parents smoke. Children are at special risk. Although less than 30 percent of adult Americans smoke, more than 60 percent of households with small children have at least one smoker. Women of childbearing age represent the group with the highest smoking rate in America. In addition, at least half of these mothers work outside the home and utilize baby-sitters or childcare centers in which passive smoking may also be present. It is estimated that between 9 and 12 million children under the age of 5 are daily exposed to second hand smoke in the U.S.

The health risks imposed on children around adults who smoke are sobering. At a time when young lungs are growing and developing, children in a room with a smoking adult can inhale two to three times as much toxic material per pound as adults do. This is because they have a more rapid breathing rate. And the infant or very young child may literally be trapped in this poisonous environment. Even if the adult smoker leaves the room, the young child must continue to breathe the residual second hand smoke that remains. Depending on climate and time of year, infants may be trapped indoors in smoke-contaminated areas for 60 to 80 percent of each 24 hours. As a pediatrician and allergist, I frequently encounter small children whose misery from frequent colds, asthma, and middle-ear infections might be avoided entirely if their parents didn't smoke. How my heart goes out to these young patients whose parents' tobacco addiction is the cause of their troubles. Harmful effects of passive smoking on children. What is the effect of involuntary smoking on little lungs, ears, noses, and throats? Many studies have now shown increased risks of bronchiolitis, tracheitis, bronchitis, and pneumonia in children from smoking families. Inflammation of the lower respiratory tract's bronchioles (bronchiolitis) has been found to be nearly four times higher in children who live in a passive smoking environment than in children from smoke-free homes. in a study of 1,265 children, those from smoking families had twice the risk of bronchitis and pneumonia compared to those in nonsmoking families. In a similar study with more than 2,000 children, the risk was 1.73 times greater for bronchitis and pneumonia if there was one smoking parent, and 2.6 times greater if both parents smoked.

In the case of asthma, numerous studies have connected symptoms and severity of asthma in young children with parental smoking. In families with a history of asthma, one study showed that nearly two thirds of smoking parents had children who developed asthma before age 5, compared to only 37 percent in families in which parents did not smoke. Asthmatic children placed in a controlled environment in which passive smoke is present show a 21 percent decrease in the amount of air they can exhale and a 20 percent decrease in the lung capacity. Among severely asthmatic children, the risk of fixed-chest deformity, a sign of severe prolonged asthma, was six times greater if they came from smoking homes. Research over a seven-year period on children in Boston showed that maternal smoking stunted the lung growth from 4 to 7 percent. If such smoking continued, the researchers projected that by age 20 there would be a significantly decreased lung capacity.

From all these studies one cannot escape the conclusion that children who grow up in homes in which people smoke may be permanently handicapped in breathing fitness.

Asthma is the most common reason for children to be hospitalized in pediatric hospitals. But chronic middle-ear effusions, also known as "glue ears," is the most common reason for surgical admission. The forerunner of glue ears is otitis media, or middle-ear infection. Recurring incidents of otitis media result in the need to do a tympanostomy and insert ventilation tubes into the child's middle ear.

Children from smoking families have a greater incidence of otitis media. The risk of needing tube surgery is twice as high in children living in a home in which one pack per day is smoked. if three packs a day are smoked, the risk climbs fourfold. Exposing young children to such surgery to correct the consequences of parental smoking seems to me to be a form of child abuse, particularly if repeated surgeries have occurred.

A French study of 4,000 children found that 28 percent of children in nonsmoking homes needed tonsillectomies; if one parent smoked, then 41 percent of the children needed such surgery; if both parents smoked, 51 percent of the children required tonsillectomies.

When sickness or bedfast days are studied, once again children in smoking homes are at a disadvantage. In a study of 37,000 households with children ages birth to 16, children from nonsmoking families had fewer bedfast days than children from smoking families.

Children of smokers also have increased risk of developing cancerous tumors, compared to children from nonsmoking homes. The risk is one and a half times as great for all types of tumors and two times as great for leukemia and Hodgkin's disease.

Problems begin during pregnancy. Infants whose mother smoked during pregnancy are known to be affected. The newly described fetal smoking syndrome affects more children than does the better known fetal alcohol syndrome. At least 13,700 neonatal deaths per year are estimated to be smoking related. Fetal smoking syndrome (FSS) causes babies to be lower birth weight for the date: the differential is approximately 9.2 grams per cigarette smoked per day by the mother, and 6.1 grams lower per cigarette smoked per day by the father. Infants who experience smoking-related growth retardation also appear to have reduced adult height.

Infantile colic occurs in 7 percent of babies born to nonsmokers, but is as high as 61 percent in babies whose parents both smoke.

What can be done? Smoking imposed on infants and children results in a terrible waste of life and health. How can we help innocent, unprotected children who cannot help themselves?

On every visit, physicians and other health workers should urge every smoker with children to stop smoking. Smoking patients should be referred to local smoking cessation programs. Social workers or protective service workers should make special efforts to encourage smoking mothers to stop smoking if children are hospitalized because of smoking-related illnesses.

Legislation that limits smoking or tobacco advertising should be supported and promoted. Smoking bans should be enforced in all schools and day-care centers; licensing for infant and child day care should include the requirement that the caretakers be nonsmokers.

Finally, if parents appear unable or unwilling to quit their smoking, they should be urged to take the following minimal precautions to protect their children:

1. Don't smoke while a child is in the car.

2. Don't smoke while a child is in the same room.

3. Don't smoke when nursing, feeding, or holding an infant.

4. Don't allow family or friends to smoke while children are present.