Adults Smoke. And Children Suffer.

Adults who wish to avoid exposure to secondhand smoke have options. Among my strategies: I don’t allow smoking in my home or car; I have no friends or close family members who smoke; I walk in front of smokers or cross the street to avoid them; I eat inside restaurants; and I hold my breath when passing smokers outside stores and office buildings.

But children are at the mercy of the smokers in their lives — not just parents and other relatives who smoke but also baby sitters, day care workers, school bus attendants, even teachers.

Although smokers may refrain from lighting up around children, the youngsters they contact are exposed to health-robbing toxicants in thirdhand smoke, the residue that lingers on furniture, clothing and skin. If you’re a nonsmoker, I’m sure you can smell a smoker at arm’s length. Do you really want that person holding your baby?

While only a quarter of Americans now smoke, as many as half of youngsters are chronically exposed to secondhand and thirdhand smoke. And, experts say, many of these youngsters pay a price with their health, now and in the future.

The hazards of secondhand smoke are firmly established. According to the American Academy of Pediatrics, breathing in someone else’s smoke is responsible for about 3,000 deaths from lung cancer and tens of thousands of deaths from heart disease among nonsmokers annually.

The smoke from burning tobacco contains about 4,000 chemicals, many of which are dangerous, including 50 that are known to cause cancer. Babies who live with smokers are at increased risk of sudden infant death syndrome, a fate suffered by a 7-month-old infant I knew whose mother smoked and said her smoking was at fault.

Children who breathe secondhand smoke have an elevated risk of developing ear infections, coughs and colds, bronchitis and pneumonia, and tooth decay, the pediatric association has reported. They are more likely to wheeze, have a stuffy nose and experience headaches, sore throats, eye irritation, hoarseness and difficulty recovering from respiratory infections. They also miss more days of school and athletic opportunities as well as fun times with friends.

Children prone to asthma are perhaps at the greatest risk; they have more attacks, more serious attacks, and are more likely to require emergency room treatment and hospitalization. A nephew of mine was rushed to a hospital numerous times with life-threatening asthma attacks, yet his mother continued to smoke, sometimes when he was nearby.

These are only the short-term risks. Long term, children exposed to secondhand smoke may go through life with poorly developed lungs and be more likely to become smokers themselves. Even if they themselves never smoke, they are at increased risk of developing heart disease, lung cancer, cataracts, even rheumatoid arthritis.

“Our findings indicate that children carry tobacco smoke toxicants on their hands, even when nobody around them is smoking,” Dr. E. Melinda Mahabee-Gittens and colleagues at the University of Cincinnati wrote recently in Tobacco Control, a BMJ journal. Noting that the residue from secondhand smoke “accumulates in dust, in objects, on home surfaces and on smokers’ skin and clothes,” the researchers said that these environmental tobacco toxicants are easily transferred from children’s hands to their mouths and bodies. Children, and especially infants, face a greater risk than adults of developing complications from thirdhand smoke because they spend more time indoors surrounded by objects contaminated with tobacco toxicants.

The Cincinnati researchers found evidence of high levels of nicotine on the hands of 25 young children when one or both parents smoked. The children had been taken to the emergency room with an illness potentially related to exposure to the remnants of tobacco smoke. Children exposed to both thirdhand smoke where they live and play and secondhand smoke from people who smoke around them experience a double whammy, they pointed out.

Furthermore, the team said, thirdhand smoke may be even more of a hazard than secondhand smoke because it contains “novel pollutants not found in secondhand smoke, has multiple exposure routes and has a much longer duration of exposure.” Another new study from the University of Cincinnati of 7,389 nonsmoking adolescents, published in Pediatrics, found that those who lived with a smoker and had thirdhand smoke exposure at home were more likely to be short of breath and have a harder time exercising than their peers. They were also prone to wheezing during or after exercise. These children didn’t have asthma, but were less likely to report being in very good or excellent health. They were more likely to miss school from illness and made more trips to emergency rooms and urgent care clinics.

“Children and adolescents who are exposed” to thirdhand smoke “are up to 3.5 times more likely to seek care at emergency departments,” Ashley L. Merianos, the lead author, wrote.

Of course, the most serious risks are faced by children whose parents keep smoking when they are around. Dr. Adam O. Goldstein, family medicine specialist at the University of North Carolina at Chapel Hill School of Medicine, likens this behavior to child abuse. “Society does not tolerate exposing minors to asbestos, arsenic, alcohol or lead, yet it acts as if exposing them to tobacco smoke is something different,” he said. “It is poisonous to their health. The higher the dose, the worse it is, but there is no safe level of exposure.”

In an editorial in the Annals of Family Medicine, he recounted a case in which “at least 10 times over three years, we counseled the family to quit smoking around the 5-year-old patient and her 7-year-old sister, as the kids repeatedly came to the clinic for ear infections, coughing, bronchitis and asthma.” At one point, the younger child developed pneumonia and had to be on a ventilator, yet “the parents refused to engage with us about quitting smoking, pharmacotherapy for cessation, or about not letting their children be exposed to cigarette smoke,” he wrote.

In retrospect, he said, he should have contacted Social Services to report suspected child abuse; their smoking was causing physical harm.