Pesticide Exposure in Children From the American Academy of Pediatrics
This statement presents the position of the American Academy of Pediatrics on pesticides. “Three overarching principles can be identified: (1) pesticide exposures are common and cause both acute and chronic effects; (2) pediatricians need to be knowledgeable in pesticide identification, counseling, and management; and (3) governmental actions to improve pesticide safety are needed”
Pesticides are a collective term for chemicals intended to kill unwanted insects, plants, molds, and rodents. Children encounter pesticides daily and have unique susceptibilities to their potential toxicity. Acute poisoning risks are clear, and understanding of chronic health implications from both acute and chronic exposure are emerging. Epidemiologic evidence demonstrates associations between early life exposure to pesticides and pediatric cancers, decreased cognitive function, and behavioral problems. Related animal toxicology studies provide supportive biological plausibility for these findings. Recognizing and reducing problematic exposures will require attention to current inadequacies in medical training, public health tracking, and regulatory action on pesticides. Ongoing research describing toxicologic vulnerabilities and exposure factors across the life span are needed to inform regulatory needs and appropriate interventions. Policies that promote integrated pest management, comprehensive pesticide labeling, and marketing practices that incorporate child health considerations will enhance safe use.
EXPOSURE PREVENTION APPROACHES. The concerning and expanding evidence base of chronic health consequences of pesticide exposure underscores the importance of efforts aimed at decreasing exposure. Integrated pest management (IPM) is an established but under supported approach to pest control designed to minimize and, in some cases, replace the use of pesticide chemicals while achieving acceptable control of pest populations.33 IPM programs and knowledge have been implemented in agriculture and to address weeds and pest control in residential settings and schools, commercial structures, lawn and turf, and community gardens. Reliable resources are available from the US EPA and University of California—Davis (Table 3). Other local policy approaches in use are posting warning signs of pesticide use, restricting spray zone buffers at schools, or restricting specific types of pesticide products in schools. Pediatricians can play a role in promotion of development of model programs and practices in the communities and schools of their patients.
RECOMMENDATIONS : Three overarching principles can be identified: (1) pesticide exposures are common and cause both acute and chronic effects; (2) pediatricians need to be knowledgeable in pesticide identification, counseling, and management; and (3) governmental actions to improve pesticide safety are needed. Whenever new public policy is developed or existing policy is revised, the wide range of consequences of pesticide use on children and their families should be considered. The American Academy of Pediatrics, through its chapters, committees, councils, sections, and staff, can provide information and support for public policy advocacy efforts. See http://www.aap.org/advocacy.html for additional information or contact chapter leadership.
Recommendations to Pediatricians
Acute exposures: become familiar with the clinical signs and symptoms of acute intoxication from the major types of pesticides. Be able to translate clinical knowledge about pesticide hazards into an appropriate exposure history for pesticide poisoning.
Chronic exposures: become familiar with the subclinical effects of chronic exposures and routes of exposures from the major types of pesticides.
Resource identification: know locally available resources for acute toxicity management and chronic low-dose exposure (see Table 3).
Pesticide labeling knowledge: Understand the usefulness and limitations of pesticide chemical information on pesticide product labels.
Counseling: Ask parents about pesticide use in or around the home to help determine the need for providing targeted anticipatory guidance. Recommend use of minimal-risk products, safe storage practices, and application of IPM (least toxic methods), whenever possible.
Advocacy: work with schools and governmental agencies to advocate for application of least toxic pesticides by using IPM principles. Promote community right-to-know procedures when pesticide spraying occurs in public areas.
Recommendations to Government
Marketing: ensure that pesticide products as marketed are not attractive to children. Labeling: include chemical ingredient identity on the label and/or the manufacturer’s Web site for all product constituents, including inert ingredients, carriers, and solvents. Include a label section specific to “Risks to children,” which informs users whether there is evidence that the active or inert ingredients have any known chronic or developmental health concerns for children. Enforce labeling practices that ensure users have adequate information on product contents, acute and chronic toxicity potential, and emergency information. Consider printing or making available labels in Spanish in addition to English.
Exposure reduction: set goal to reduce exposure overall. Promote application methods and practices that minimize children’s exposure, such as using bait stations and gels, advising against overuse of pediculicides. Promote education regarding proper storage of product.
Reporting: make pesticide-related suspected poisoning universally reportable and support a systematic central repository of such incidents to optimize national surveillance.
Exportation: aid in identification of least toxic alternatives to pesticide use internationally, and unless safer alternatives are not available or are impossible to implement, ban export of products that are banned or restricted for toxicity concerns in the United States.
Safety: continue to evaluate pesticide safety. Enforce community right-to-know procedures when pesticide spraying occurs in public areas. Develop, strengthen, and enforce standards of removal of concerning products for home or child product use. Require development of a human biomarker, such as a urinary or blood measure, that can be used to identify exposure and/or early health implications with new pesticide chemical registration or reregistration of existing products. Developmental toxicity, including endocrine disruption, should be a priority when evaluating new chemicals for licensing or reregistration of existing products.
Advance less toxic pesticide alternatives: increase economic incentives for growers who adopt IPM, including less toxic pesticides. Support research to expand and improve IPM in agriculture and nonagricultural pest control.
Research: support toxicologic and epidemiologic research to better identify and understand health risks associated with children’s exposure to pesticides. Consider supporting another national study of pesticide use in the home and garden setting of US households as a targeted initiative or through cooperation with existing research opportunities (eg, National Children’s Study, NHANES).
Health provider education and support: support educational efforts to increase the capacity of pediatric health care providers to diagnose and manage acute pesticide poisoning and reduce pesticide exposure and potential chronic pesticide effects in children. Provide support to systems such as Poison Control Centers to provide timely, expert advice on exposures. Require the development of diagnostic tests to assist providers with diagnosing (and ruling out) pesticide poisoning.
Pesticide Exposure in Children From the American Academy of Pediatrics
LEAD AUTHORS James R. Roberts, MD, MPH Catherine J. Karr, MD, PhD