The Quarterly Consult is a quarterly publication highlighting pediatric clinical expertise. If you would like to submit questions for a specialist at Children's to address in the Quarterly Consult, contact Kim Arthur, editor.

August 2012: Counseling Parents About Exposure to BPA and Other Endocrine-Disrupting Chemicals

Sheela SathyanarayanaDr. Sheela Sathyanarayana, an environmental health researcher at Seattle Children's and pediatrician at the Children and Teens Clinic at Harborview, addresses questions about exposure to Bisphenol A (BPA) and phthalates.

Thank you to Dr. Wendy Sue Swanson, a pediatrician at The Everett Clinic in Mill Creek, a member of Children's medical staff and author of the Seattle Mama Doc blog, for submitting these questions.

Q: What health impacts are seen with exposure to BPA?

A: Health impacts in animals include obesity; neurodevelopmental changes; and reproductive changes, such as breast tumors and early puberty. In people, we are starting to see evidence of behavioral changes, such as hyperactivity or aggression.

Q: What are the health impacts for phthalates?

A: Animal studies consistently find male reproductive tract abnormalities like undescended testes and hypospadias. Human studies are starting to see similar effects.

Q: How do we get exposed to BPA?

A: Some of the most common sources are in the lining of cans from canned food and cash register receipts. Receipts contain a very high level of BPA, so it's a good idea to wash your hands thoroughly after handling receipts. Hard polycarbonate plastics (such as a water cooler) can also contain BPA.

The single largest source of exposure to phthalates and BPA is through our diet, likely due to contamination through industrial food processing. One of the most important things is to have a diet that is low in processed foods and rich and diverse in fresh foods.

Q: How do we get exposed to phthalates?

A: Any personal care product that has fragrance is likely to contain phthalates. Since fragrances can also be irritants, I recommend avoiding products with fragrance. It's very hard to eliminate all use of these products, so it's helpful to try to reduce the number of products you use or the amount that you use.

Flexible plastics, such as IV tubing, are also an important source of exposure. Seattle Children's actually replaced tubing where alternatives without phthalates were available a few years ago.

As far as things you would find at home, it is hard to say because it varies. Plastic containers marked with the recycling code #3 may have phthalates. Another example might be soft squeezy toys that kids play with in the bathtub, although many are made with silicone now. Polyvinyl chloride tubing used on the inside of plumbing is another source of exposure at home.

Q: Besides not using plastics to heat food in a microwave, are there other ways to decrease exposure to BPA and phthalates or other endocrine-disrupting chemicals?

A: Many studies have shown that plastic components can leach into food if you heat it in a plastic container in the microwave, so it definitely is important to take food out of plastic containers before heating it. I also recommend decreasing use of plastics to store and prepare foods.

It's also helpful to keep your home environment as clean as you can, and to try to avoid tracking things in on your shoes from outdoors. New vacuums tend to have high-efficiency particulate air (HEPA) filters or an indicator that helps you see if you have cleaned up all the dust. It's also important to keep the windowsills clean in the environment where kids sleep.

Q: Which products are not legislated or controlled? It seems that nearly all bottles are now BPA-free, but what are children exposed to currently that still could cause troubles, not only during infancy but also in childhood?

A: Currently, the only chemicals that are tested for toxicity are the chemicals used to make food or in prescription drugs. So if a chemical is on the lining of a can and it wasn't meant to be ingested, then it wasn't tested - unless it was actually used to make the food in the can. There are 80,000 chemicals on the market, and less than 1% have been tested. So it's impossible to achieve zero exposure.

When addressing questions from parents, it's important to provide guidance not to worry about individual chemicals, but to think about reducing their overall exposure through reducing consumption of canned foods and reducing plastic and product use.

One of the most important things we can all do is support legislation about testing, in particular the Safe Chemicals Act of 2012. That act would require chemical companies to test chemicals before putting them on the market, and that is what we truly need to protect people from exposure.

Q: Do pregnant women need to worry since products for adults seem to be less rigorously controlled?

A: Pregnant women are more vulnerable because it is an important fetal developmental period. Making changes in your diet and in your environmental exposures to chemicals (such as taking your shoes off at home) is a great way to start on the journey of parenthood.

Q: My patients often ask if they should wait before getting into a hot car because they wonder if the plastic smell is potentially toxic to kids. Is there cause for concern?

A: It depends on the car and the plastics inside it. The smell generally comes from off-gassing, and it is way more likely that the exposure will be a respiratory irritant rather than high-level endocrine-disrupting chemicals. I generally recommend to parents that they use the heat shields on their windshield to prevent that off-gassing.

Q: What environmental health resources would you recommend for pediatricians?

A: One fantastic resource is the American Academy of Pediatrics Green Book, Pediatric Environmental Health, which is available on the AAP site. It discusses every chemical a family would ask about and exactly what to do. Our recent article on counseling preconception and prenatal patients in the American Journal of Obstetrics and Gynecology also lists a lot of resources.

I also work in the Pediatric Environmental Health Specialty Unit, which I co-direct with Dr. Catherine Karr. We provide fact sheets and environmental health consults for providers and families, focusing mainly on providers in order to provide information that they can use in the future. We are happy to help with cases. The phone number is 1-877-KID-CHEM and we also have a website.