A 1993 survey reported that one in every six (17%) eighth graders had abused inhalants. Inhalants are rapidly becoming the springboard for young children, often preadolescents, who progress to other so-called harder drugs such as marijuana, heroin and cocaine. One of the reasons for this is the ready availability of inhalants on the store shelves or even in the household pantry-such items as paint thinner, lighter fluid, nail polish remover, varnish, and butane. Children and adolescents may abuse such substances as a method of coping with our increasingly mobile society, double income families, and the pressures of adolescence.
Entry into the sixth grade is reported by many parents to be a difficult transitional event, both in the life of the young child and also for the family as a unit. Often mothers remark, "Where did my sweet little boy (or girl) go who helped in the kitchen and who asked me dozens of questions about school? Now they are so somber and sometimes talk back in a tone that is unfamiliar." Parents need to be reassured that their child is undergoing a difficult transition during this period, which is often accentuated by fears about failing in school, not being accepted by others at school, and concerns over body image which are unparalleled at any other time in life.
It is no longer safe to say that children who abuse inhalants are the school troublemakers. Initially, there may be no signs of problems, such as school truancy or emotional problems, which are often ascribed to substance abusers. The family may not be aware of a problem. Early clues to inhalant abuse include chemical odors on the breath and clothes, stained skin or clothing, and possibly reports of empty solvent containers around the house. The sniffing, or "huffing" as it is often called, gives the user an inexpensive but suitable euphoric or "high" feeling. Children who abuse inhalants may do so alone or in a group of huffers. Unless the person is caught with a solvent in hand during a state of euphoria, there is little evidence of huffing in many cases. However, long-term abuse of inhalants may result in cognitive impairment, difficulty in concentration, anxiety, apathy, mood swings, depression, hostility, and ultimately severe brain damage or death. From the aforementioned list there are perhaps only a couple of signs which might not be attributed to any given teenager or preadolescent during a given time of difficulty. It is interesting to note that many adolescents in school and in the neighborhood know who is or is not abusing inhalants yet it is not "cool" to discuss with parents. Therefore, it is imperative that parents and healthcare workers be able to discuss with children and adolescents problems of daily living such as coping with pimples, bad hair, and rejection. In many cases a passive, nonjudgemental healthcare worker might lend an ear to a teen who is having a bad day and is having difficulty coping.
Perhaps most important is the fact that many adolescents are unaware of the inherent dangers of huffing. Many household and industrial cleaners used as inhalants are CNS depressants; children not aware of the cumulative effects during huffing can suffer respiratory or cardiac arrest, resulting in death.
The most frequently observed manifestations of inhalant abuse involve the respiratory system and include a sore throat, cough and runny nose. Since inhalants cause bronchial constriction, a variety of respiratory conditions including bronchitis, pneumonia, and bacterial and viral infections may be seen. Sores in the mouth and nose may be observed with chronic huffing, as well as freezing of the lips and mouth which may occur when the substance is inhaled directly from the container. Long term neurological effects of inhalant abuse may include disorientation, sluggishness, poor coordination, and cognitive impairment. Electrolyte and acid base imbalance is common when toluene is used as an inhalant. Some huffers may show other signs which are nonspecific including restlessness and hyperactivity. Chronic weight loss and anorexia are common gastrointestinal signs of inhalant abuse as well as nausea, vomiting and abdominal cramping. From this it is evident that all systems are at risk for possible damage beyond repair.
For children who are identified as being abusers it is important to detoxify them initially if there are no life-threatening complications. There is no current available treatment to shorten the effects of inhalant toxicity; exposure to fresh air and oxygen administration may be helpful, but the treatment is primarily symptomatic. It is recommended that inhalant abusers be kept for two weeks in a detoxification program before being placed in a long-term treatment program. One of the most difficult things to do is to convince the child or adolescent that there is a problem with the abuse of inhalants. Adolescents in particular are prone to perceiving themselves as invincible, or having an "it won't happen to me" attitude. Healthcare workers in the community are in an excellent position to help children learn to cope with problems of everyday life without dependence upon substances such as inhalants to provide a brief respite from reality. Nurses who volunteer in community activities such as sports (coaching soccer, baseball, basketball) or who have children on such teams have an excellent opportunity for identifying problems and helping children and families cope before it is too late. Nurses in clinics and offices may intervene early to prevent further abuse when a problem is suspected and identified. Lastly, nurses in the emergency department should be aware of the clinical signs and symptoms and be prepared to intervene to save the child's life.
American Academy of Pediatrics, Committee on Substance Abuse and Committee on Native American Child Health: Inhalant abuse, Pediatrics 97(3):420-422, 1996.
See Chapter 21 in Nursing Care of Infants and Children, 5th and 6th editions.
See Chapter 17 in Essentials of Pediatric Nursing, 5th edition
March 15, 2002