Bryan Judge, MD, Emergency Medicine and Medical Toxicology
Helen DeVos Children's Hospital
Grand Rapids, Michigan

I was pleased to see the new policy paper from the American Academy of Pediatrics on chemical exposure in children. The paper, published online in late April, basically says that federal authorities are not doing enough to protect kids from dangerous chemicals and recommends that chemical management policy in the United States be revised to protect children, pregnant women, and other populations.

The fact is, regulatory processes in the United States are far behind where they should be in terms of monitoring the thousands of harmful chemicals we're exposed to each year. We simply don't know enough about these chemicals and the long-term health effects. The Toxic Substances Control Act was passed more than 30 years ago to protect the public against exposure to hazardous chemicals, and yet has only been used to regulate five chemicals. 

On the flip side, we are exposed to dozens of potentially toxic chemicals every day and we're not all dying, which makes it difficult to get the importance of this issue across. Yet you know as well as I do that we've seen significant increases in rates of neurological conditions like  attention deficit hyperactivity disorder, in asthma, and in male genital deformities. 

So what does this have to do with you, the community-based pediatrician? Your role is to help patients and their families identify potential toxins present in the environment, household products, and toys that children are exposed to. You can also become involved in the policy issues around toxins at a local, state, and federal level, and/or through the AAP. For instance, there is now a bill pending in the Senate to reform the Toxic Substances Control Act. The American Medical Association, American Public Health Association, American Nurses Association, and now the APA endorse changes to the Act.

You can also work to educate yourself on toxins your patients may be exposed to, such as bisphenol A (BPA), which was recently eliminated from most baby bottles, and phthalates, used in many plastic items. Another good area to warn about are flame retardants in clothing like pajamas. There is no evidence that they are very effective and more evidence that the chemicals used can be harmful. 

A good reference is the APA's Pediatric Environmental Health, the third edition of which will be available later this year. Other good references include the Environmental Health and Toxicology pages of the National Library of Medicine web site. You can also call the Poison Control Center at 800.222.1222 for answers to many questions about chemicals and children. If they can't answer your question, they can refer you to environmental health experts or medical toxicologists.

What are your thoughts about chemical exposure in our world and the its affects on the health of children?