Waiting until your kids are teens to talk to them about drugs? You'll be late to the party. By the time most kids reach preschool, they have seen adults smoking cigarettes, drinking alcohol or doing drugs, either in person, on television or on the internet.

It's likely they already have questions. This month, Dr. Lewis First, chief of pediatrics at Vermont Children's Hospital at Fletcher Allen Health Care, offers sobering advice on how to broach the subject — before it becomes a problem.

KIDS VT: How early should parents discuss drug use with their kids?

LEWIS FIRST: When your child enters grade school is a great time to start talking with them — not at them — about drug use. And not just about street drugs. Parents should also talk about alcohol, tobacco, and even over-the-counter and prescription medications. It's important for parents to have regular times during the day, perhaps at the dinner table, to have nonjudgmental conversations. They need to make sure their kids feel safe and valued for expressing their opinions honestly, without parents saying "Don't do this, don't do that!"

KVT: What drugs are Vermont kids using the most?

LF: Most commonly, alcohol sends kids into the emergency department. In terms of overall use, alcohol, tobacco and marijuana top the list. After those come substances you wouldn't expect: over-the-counter cough and cold medicines, prescription medicines and inhalants.

KVT: What are inhalants?

LF: They are common household products — hairspray, glues, nail-polish remover, felt-tip markers — that teens inhale to get high. What kids don't realize is that these chemicals can also cause serious damage by getting into their bloodstream. Even one sniff, or "huff," can lead to sudden death. These chemicals are extremely dangerous.

KVT: How can parents tell if their kids are using inhalants?

LF: If their breath or clothing smell like chemicals, if there are spots or sores around their mouths, or if they have a dazed, glassy-eyed look, you need to at least consider inhalants as a possibility.

KVT: Generally, what red flags should parents look for that might suggest drug abuse?

LF: Signs that something is awry and that could indicate possible drug abuse include a loss of interest in school, a drop in grades, a sudden change in friends, and kids who become extremely moody, negative, want to be left alone, sleep a lot, get into fights or lose interest in activities that were once important to them.

KVT: Are there any new drugs hitting the streets that even savvy parents might not recognize?

LF: Parents may not have heard of "bath salts." Bath salts contain stimulants that kids are swallowing, snorting or injecting that can produce hallucinations, delusions, suicidal thoughts and paranoia. These are life-threatening drugs that, until recently, were sold legally over the internet or in smoke shops. Synthetic marijuana and cannabinoids are also dangerous because they multiply marijuana's negative effects and can result in an elevated heart rate, high blood pressure and anxiety. Salvia, which are plant herbs, also have hallucinogenic properties and are very dangerous.

KVT: What are the most commonly abused household medicines?

LF: Cough and cold medicines are exceedingly dangerous. Parents may not realize that the cough suppressant dextromethorphan is a narcotic found in over-the-counter cough medicines. When taken in high dosages — some kids are taking 10 times the recommended amount — it can cause the same reactions as codeine or morphine.

KVT: How can parents prevent household drugs from being abused?

LF: Parents shouldn't stockpile excess amounts of over-the-counter medicines. They should be suspicious if they find these medicines in their middle-schoolers' rooms, and they should take any medicines and lock them up. Even if your children aren't using them, they may know other kids who want to buy them.

KVT: How should parents warn younger children about the risks of drugs?

LF: First, don't talk about the long-term effects with older children and teenagers because it just won't register. For them, it's more the dangers of the now: "Do you realize that your clothes smell if you use inhalants and no one will want to spend time with you?" Or, "Do you know that one huff of an inhalant may be enough to cause you to stop breathing?" If it's cigarettes: "It's going to cause bad breath and stain your teeth." Statements like these will have a much bigger impact.

KVT: Should parents tell their kids about their own illegal drug use?

LF: Parents need to be honest and explain why they made mistakes. If there's a history of substance abuse in the family, it's very important to tell a child in middle or high school that they're at greater risk for addiction. I love it when parents give kids a plan for how to deal with difficult situations.

KVT: Such as?

LF: Parents can teach kids to change the subject if they're offered drugs. Give them lines to use for getting out of a bad situation. They can blame their parents: "I'll be grounded for life!" Or if they're athletes: "Not now, I'm in training." Parents should give their kids a guilt-free, no-questions-asked secret phrase to say over the phone, such as "I'm not feeling well," that will get them out of a sticky situation. When parents hear that phrase, they should pick their child up immediately. When kids say no to drugs, they should be praised. That's the highest form of courage and independence your child can demonstrate.