Today, on World No Tobacco Day (31 May), I find myself reflecting on how often I see the effects of tobacco exposure in children across Western Sydney.
In my clinical practice, the impact is something I encounter almost every week. Most of these children have never touched a cigarette.
What stands out is not only the illness itself, but the setting in which it begins: homes where smoking is not always visible, yet remains present in ways families do not expect.
Over time, patterns become clear. Children experience recurrent wheeze, frequent chest infections and asthma that is difficult to control. Tobacco exposure is often part of the picture.
Before birth, the impact begins
Tobacco exposure does not wait until childhood.
During pregnancy, chemicals such as nicotine and carbon monoxide reduce oxygen delivery to the developing baby. This can affect growth, lung development and the timing of birth.
The consequences may include premature delivery, low birth weight and increased vulnerability during the first weeks and months of life.
Importantly, exposure is not limited to the person who smokes. Second-hand smoke around a pregnant woman can also affect fetal development. A smoke-free environment during pregnancy is one of the most protective steps a family can take.
When exposure goes unrecognised
In clinics and hospitals, I often meet families who are doing everything they can for their child’s health, yet symptoms persist.
One child I recall had repeated hospital visits for breathing difficulties. The family was careful. No one smoked indoors. It was only through discussion that they realised smoke exposure was still occurring, even though smoking took place outside the home.
Another toddler was brought in with frequent respiratory infections. The family assumed that smoking in a separate room reduced the risk. Unfortunately, it does not.
The lungs of young children are still developing. Their immune systems are still maturing. Even small, repeated exposures can contribute to inflammation, infections and asthma flare-ups.
There is no safe level of second-hand smoke exposure for children.
Smoke does not stay outside
In many South Asian households, several generations share the same living space. These homes are built on connection, care and mutual support.
Yet this closeness can sometimes make it harder to maintain a completely smoke-free environment.
Tobacco smoke does not remain where it is produced. It lingers in the air and settles on clothing, furniture and household surfaces. This is known as third-hand smoke.
Infants are especially vulnerable. They spend much of their time in close contact with caregivers and household surfaces where smoke residues can remain.
Even smoking outside the home does not entirely remove the risk, as these residues can be carried back indoors on clothing and skin.
A family issue, not an individual one
It is easy to think of smoking as a personal choice. In reality, its effects extend well beyond the smoker.
The impact can be seen from pregnancy through childhood and, in some cases, may influence health well into adult life. For some families, it means repeated illness, hospital visits and ongoing stress that could often be avoided.
Importantly, this is not about blame. It is about awareness and protection.
In many families, respect for elders and strong family bonds are deeply valued. Protecting children from tobacco exposure should not be viewed as criticism of anyone. It is a shared act of care across generations.
Practical steps that make a difference
Change does not need to be complicated. Small, consistent actions can have a meaningful impact:
• Keep homes and cars completely smoke-free
• Avoid smoking near pregnant women, infants and young children
• Wash hands and change outer clothing after smoking
• Support family members who want to quit
• Have open and respectful conversations about smoking and vaping risks
The most effective step of all is quitting smoking. The health benefits begin quickly and extend to everyone in the household.
Support is available
Quitting is not easy, but no one has to do it alone.
In Australia, Quitline (13 78 48) provides free and confidential support, including counselling, interpreter services and follow-up assistance. Additional resources are available through Quit.
Many people find that professional support makes quitting more achievable and sustainable.
Protecting what comes next
World No Tobacco Day is a reminder that prevention often begins at home.
Every child deserves clean air where they live, sleep and grow. Smoke-free homes are among the simplest and most effective ways to reduce preventable illness and support long-term health.
The harm caused by tobacco exposure is real. So is the opportunity to prevent it.
Associate Professor Habib Bhurawala is a senior consultant paediatrician and Head of Paediatrics at a teaching hospital in Western Sydney. He is also a Clinical Associate Professor with interests in child health, medical education and community health promotion.
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