From strapping zip ties on to cabinets to popping plastic covers into outlets, new parents do what they can to control their newborn’s environment. But beyond the visible, there are more obscure health concerns from additives and contaminants found in unexpected places.
Exposure to our environment begins even before birth. Studies have shown that some chemicals, like PFAS and flame retardants, in everyday products can pass from mother to fetus through the umbilical cord, and after birth through breast milk. Socioeconomic status and race also affect lifetime exposure. Minority and low-income individuals are disproportionately affected by pollution and toxic chemicals.
A popular phrase in the public health world is that “babies are not just little adults”. Not only are they developing rapidly, but they are also physiologically different than adults: their organs are not fully developed at birth; they have more permeable skin and don’t metabolize chemicals in the same way, which can make them more vulnerable.
So, what is a parent to do? Here are some of the areas of concern experts have flagged and ways to respond to them.
In water and food
Infants take in more food relative to their body than adults, so substances found in infant formula and baby food can have an outsize effect on developing bodies and brains.
Lead, a potent neurotoxin, has long been known to reduce IQ, affect behavior and learning and slow growth, even at low levels. According to the CDC and others, no safe blood lead level has been identified for children.
Children are exposed to lead in a variety of ways, through soil and air, as well as consumer products. Lead-based paint remains the most significant and dangerous source for children, the CDC says, but drinking water can be another major source of exposure. Lead enters drinking water when pipes containing lead corrode. It is not known how many lead pipes still exist in America’s water systems. A 2016 EPA report estimated 6.5 to 10m homes had lead service lines.
Water accounts for about 20% of lead exposure, according to the EPA, but the agency estimates that, for infants fed on formula, that number jumps to 40-60%.
Even though drinking water might meet the regulatory standards of the EPA, there may still be lead present. According to the Lead and Copper Rule, set in 1991, the agency only requires public water systems to take action if lead exceeds 15 parts per billion. That so-called “action level” was not based on health effects, but on practical considerations of how utilities could control corrosion. The EPA’s maximum contaminant level goal – a non-enforceable limit based on health effects – is zero lead in water.
The agency is expected to release updates to the Lead and Copper Rule later this summer.
Food can also be a source of lead exposure for infants. A 2017 report from the Environmental Defense Fund, a not-for-profit environmental advocacy group, analyzing 11 years of FDA data found lead in 20% of baby food samples (compared to 14% of other foods). In May 2017, the FDA launched the Toxic Elements Working Group to re-evaluate when FDA should take action on lead found in certain foods, with a focus on food geared towards children.
What can parents do?
Experts say to check pipes at home for lead service lines and filter your tap water. Olga Naidenko, senior science adviser for children’s health at the Environmental Working Group, also suggests the estimated 45 million Americans who drink from private wells to test their water for lead and other contaminants, since there are no legal requirements for private well testing. Lindsay McCormick, chemicals and health project manager at the Environmental Defense Fund, advises parents to contact your local utility to ask about lead pipe installation at your house since water tests aren’t always accurate. To reduce exposure, use a water filtration system certified for lead, always use cold water, and let the water from the tap run for at least five seconds before using, a trick that McCormick says significantly reduced lead levels.
PFAS, a group of highly persistent chemicals first used to make Teflon, has been found in the drinking water samples of about 16 million Americans. Naidenko says PFAS exposure is especially problematic for infants because of multiple studies linking PFAS to immune suppression and reduced vaccine effectiveness.
What can parents do?
Taking control of other contaminants, like PFAS, is less straightforward. “PFAS removal systems are much more expensive, and that’s why we need community action so the whole water supply gets treated to remove those kinds of chemicals,” says Naidenko.
Reverse osmosis filters are most effective at removing PFAS from water, followed by activated carbon filters, according to an analysis of scientific and state agency guidance by EWG. University researchers across the country are also searching for innovative ways to break down the “forever chemicals”, while the EPA is looking into groundwater cleanup methods.
Phthalates, an endocrine-disrupting group of chemicals used in plastics, cosmetics products and food packaging, among other uses, have been found in breast milk and infant formula, as well as packaged and fresh foods. Endocrine disrupters have varying health impacts depending on the time of exposure, with fetal development, infancy and early childhood especially critical windows. In infants and children, phthalates have been linked to asthma and allergies, male genital deformities and neurodevelopment issues like lowered IQ, ADHD and behavioral problems.
BPA, another prominent endocrine-disrupting chemical found in plastic, was removed from approved use in infant bottles and sippy cups by the FDA in 2012 and formula can linings in 2013 (in both cases, manufacturers said they had already phased out use of the chemical). However, scientists have found common replacement chemicals, such as BPS, have been linked to health effects, including early puberty, disrupted metabolism and thyroid function and behavioral effects, among other impacts.
What can parents do?
To avoid exposure to BPA replacements, choose glass bottles and food containers. Avoiding phthalates, sometimes called the “everywhere chemical” can be trickier. Avoid plastic food containers when possible and, if you’re using plastic containers to heat food in the microwave, look for the words “microwave-safe”. Read labels and choose products – including lotions, soaps, shampoos and any plastic items – that are “phthalate-free”. Choose unscented cleaning and personal care items since phthalates are often found in fragrance ingredients, which companies aren’t required to disclose.
At home
From furniture to electronics, cleaning products to personal care, the average house contains a range of chemicals that eventually end up in fine particles of dust. Researchers have consistently shown that infants and young children have the highest exposure to chemicals in household dust because of their behavior – like spending more time on the floor and putting things in their mouth – and because of physiological differences like higher breathing rates.
Flame retardants have been linked to neurodevelopmental problems, endocrine disruption and cancer, among other serious health concerns. The CDC has found that flame retardants show up in Americans’ blood samples at three to 10 times the levels of Europeans. They can be found in foam used in crib mattresses, high chairs, car seats and more. The chemicals, which have a dubious record of actually slowing fire, are also found in children’s pyjamas. Even as the most demonstrably harmful types of flame retardants have been phased out, they are persistent chemicals that remain in the environment for years.
The Agency for Toxic Substances and Disease Registry says studies have shown that infants’ and young children’s bodies have higher levels of PBDEs, a type of flame retardant, than older children and adults. The youngest populations are believed to take in more of the chemical through soil and dust residue and breast milk. PBDEs may also be more concentrated in babies and young children because they have a higher chemical to body weight ratio.
What can parents do?
Experts advise parents to avoid products with polyurethane foam, which contains flame retardants, and look for natural fibers instead. The EWG recommends an organic crib mattress with a natural covering, like cotton or wool, instead of PVC or vinyl.
Clearly, the cost is an issue for many families seeking less harmful products, says Linda McCauley, dean and professor at Emory’s Nell Hodgson Woodruff School of Nursing. “If you’re living at the poverty level, you might go to places like Goodwill to buy used baby furniture, used car seats and mattresses,” she said. “This is where the ethical dilemma is: they have access to these affordable things for their families, but these old, used products are more likely to have the chemicals that are now banned.”
A 2017 analysis by researchers from the George Washington University and the NRDC found phthalates to be widespread in household dust samples. The chemicals are found in scented cleaning and personal care products, as well as vinyl flooring. While certain phthalates were banned from children’s toys in 2008, health researchers say little is known about their replacement chemicals, which include other phthalates.
What can parents do?
To reduce household dust and the chemicals found in it, clean surfaces frequently. Wet-mopping or vacuuming with a HEPA filter are thought to be most effective. To reduce chemical exposure from cleaning, choose products that are naturally derived and fragrance-free, or stick to baking soda, vinegar and castile soap. Parents can also switch to personal care products that are paraben- and phthalate-free to reduce infant exposure to these endocrine disrupters.
Higher exposure to various pesticides – especially harmful for developing children and linked to asthma, cancer, endocrine disruption and other issues – is a known problem in agricultural areas and children can be exposed through spray drifts in the air or from pesticide residues brought home by a farmworker parent. At-home pesticide use in the garden or home can also expose children, even from applications in years past.
Researchers from Emory University’s Center for Children’s Health, the Environment, the Microbiome, and Metabolomics, the first major study to examine environmental exposures of pregnant African American women and their babies in the urban south-east, found pesticide levels in the homes of pregnant African American women in Atlanta to be on par with agricultural areas. McCauley says organophosphate pesticides, thought to be especially harmful to children, were found in study participants’ homes, probably from termite insecticides. “Once you spray an apartment with these chemicals, particularly organophosphates, they don’t break down quickly. They stay cloistered in carpets and on furniture,” she says.
What can parents do?
Consider other pest control methods before resorting to pesticides at home. If you do use pesticides, choose products lowest in toxicity (organizations like the National Pesticide Information Center can help) and keep pets and children off treatment areas for the period listed on the label. Use products with the lowest toxicity if you do need chemical pesticides. Ensure all pesticide-containing products – including disinfecting cleaners, bleach and flea and tick shampoos – are stored out of children’s reach.
At daycare
Many of the same chemical concerns at home also apply to childcare facilities.
Nap mats with polyurethane foam contain flame retardants. A recent study by researchers from Indiana University and Toxic-Free Future, an environmental health advocacy group, found swapping out nap mats with safer alternatives at a small sample of daycare centers reduced flame retardant particles in dust samples by up to 90%.
What can parents do?
Toxic-Free Future, a research and advocacy group focused on phasing out highly toxic chemicals, is pushing for policymakers and manufacturers to stop the use of flame retardants in nap mats and many other products. In the meantime, the organization advises parents to advocate for stricter standards, check the labels on kid’s products labels and wash hands regularly.
Pesticides, used to repel insects and rodents and maintain outdoor spaces, are also a concern for daycare facilities. The EPA has noted infants and small children are most likely to suffer long-term harm from pesticides because they are more vulnerable and more exposed.
What can parents do?
The AAP advises parents to work with schools and government agencies to encourage the use of less toxic pesticides. The EPA recommends childcare facilities use an “integrated pest management” strategy to reduce the use of toxic pesticides. Some pesticides are restricted for use near schools and childcare facilities by state law.
Lead, too, is a sometimes overlooked concern in daycare centers. Only nine states require childcare facilities to test for lead, leaving about 500,000 childcare facilities unregulated, according to EDF’s McCormick. Last year EDF released a report sampling lead at 11 childcare facilities, mostly serving low-income children, and found three out of four water samples were below 1 ppb for lead, but seven of the centers sampled had at least one plumbing fixture that test above EDF’s proposed action level of 3.8 ppb. Lead contamination, said McCormick is “quite widespread, it just may not be at super high, concerning levels everywhere”.
What can parents do?
McCormick advises parents to simply ask their childcare facility about their lead pipes. “Just demonstrating the interest and creating the demand can prompt childcare facilities to take action.” She also says smaller childcare facilities located in retrofitted homes or churches are more likely to have lead service lines. The EPA also offers a toolkit on lead prevention for childcare providers.
The bottom line
Unavoidable exposure to potentially toxic substances that are part of modern life only adds to the many anxieties of parenting. Environmental and health advocacy groups are pushing for increased regulation or, at least, further testing of many of the chemicals Americans come into contact with daily. But consumer education might also be a key part of the solution.
McCauley, who leads Emory’s research program studying the complex interaction of the prenatal and postnatal environment, says their outreach efforts to women in the Atlanta region have been welcomed. “[These women] have been so excited about learning about how the environmental exposures might be a window into something going on in their bodies that they’ve never thought about,” she says.
The program, CCHEM2, is part of the network of Centers for Children’s Environmental Health and Disease Prevention Research, a long-running grant program on children’s health cut by the EPA this year. McCauley says future funding is uncertain.
“We’re really afraid that this is an area where communities have really benefited from this science, and we need more examples in the US of how science and communities can be linked,” she says.
Here are organizations offering additional resources on toxic chemicals and tips to reduce risks:
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Silent Spring, an independent research and advocacy group, developed a free mobile app, called Detox Me, that draws on 20 years of research for practical advise on everyday chemical reduction.
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The University of California San Francisco, a leading research institution on environmental health, also developed a Pediatric Environment Health Toolkit to help parents understand exposure risks and prevention tips. The guide is endorsed by the American Academy of Pediatrics and other medical organizations.
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Healthy Babies, Bright Futures is an alliance of non-profits, scientists and donors that develops programs to reduce babies’ chemical exposure. The group offers guides for parents to limit chemicals in the first few years of a child’s life, beginning before pregnancy.
