Exposing children to secondhand smoke despite repeated warnings should be viewed as child abuse, an expert says.

In  a debate in this week’s Annals of Family Medicine Adam O. Goldstein, director of tobacco intervention programs at the University of North Carolina School of Medicine calls on medical associations to endorse policies classifying purposeful and recurrent exposure of children to secondhand smoke — a known human carcinogen — as child abuse.

He recounts a case in which parents refused to take adequate safeguards to prevent their children’s recurrent exposure to cigarette smoke.

After frequent visits for ear infections, coughing, bronchitis, asthma and ultimately an admission to intensive care for pneumonia and severe asthma, the team placed a call to social services.

In an opposing viewpoint, Taryn Lindhorst from the University of Washington, Seattle says that expanding definitions of child abuse to include environmental tobacco smoke, while understandable based on our desire to guard children from harm, is not the answer because it reinforces a punishment orientation towards addiction that harms both child and family.

More needs to be done to ensure that all people who need treatment for smoking cessation get access to this help, she says.

“Until we know that parents have received adequate collaborative treatment, we should not resort to further sanctions by treating their behaviour as a form of child abuse,” she adds.