By Jennifer Lowry, MD, FAAP
“Dr. Lowry? I read on the internet that I shouldn’t feed my child rice cereal. Is this true?”
Pediatricians love children. Pediatricians love helping children become the best people that they can be. Pediatricians love doing what is needed to make the world a better place for children to be healthy. What pediatricians don’t love is being caught unaware of the latest blog, internet chat or media storm regarding environmental health issues. Media and other news outlets often inform parents of possible environmental exposures that can cause harm to children. Unfortunately, not all of the information is true which causes undo concern for parents and confusion to pediatricians who are asked about these effects.
What is a pediatrician or family to do? It is important to realize that we are surrounded by stuff. We, or the people who have come before us, have made choices that puts stuff in our world that are supposed to make things “better” or “easier”. Unfortunately, not all of the stuff that we encounter fits both. Cell phones, plastics, better beef, lead in paint, and synthetic athletic fields are just a few examples that may make life easier, but might not (or, definitely not, in some cases) make life better. But, today, everywhere you turn, someone is saying that our children’s lives are damaged by the chemicals that we have in the environment. Is this true?
As a toxicologist, I have been taught that “everything is a poison, it is just a matter of the dose”. Paracelsus was a Swiss German Renaissance physician, botanist, alchemist, astrologer and general occultist. He founded the discipline of toxicology. He rejected the medical conditions of the times (late 1400s), and pioneered the use of chemicals and minerals in medicine. He is credited with the phrase, “the dose makes the poison”, but he is also known to have said, if given in small doses, “what makes a man ill also cures him”. Thus, he realized that medicines can be beneficial at low doses but cause harm at higher doses.
But, what about chemicals and metals (synthetic and natural)? What about plants? Is it true that there is no harm at low levels? Well, it depends. Medications that are used to treat illnesses are rigorously tested for safety and efficacy. Chemicals that are used in the environment are not. Alternative medications (dietary supplements) are not. We know that some medications have benefit at very low doses (microgram) but can cause toxicity at the milligram dosing (1000x the dose). Some medications have no efficacy at the milligram dosing and require much higher doses (grams or 1000x milligram dosing) to have effect.
Why would we expect that plants, supplements, chemicals or metals to be any different? Each chemical is different and has a different profile for efficacy and toxicity. Some chemicals (e.g., botulinum toxin) are toxic at even lower doses. Unfortunately, we are finding out that doses that were presumed safe were really not safe to begin with. Erroneously, “we” thought that because arsenic was “natural” it could be placed in soil as a pesticide. However, arsenic is relatively immobile so anything that grows where it was placed (e.g., rice fields) can incorporate it into the food. Thus, higher levels of arsenic are found in foods that are grown where arsenic was used.
The same is true regarding lead. Pediatricians know that children are not little adults. But, the level that was associated with toxicity in adults was applied to children early in the 1900s. However, it was soon realized that children were more vulnerable and action was required at lower levels. Lead has not become more toxic overtime. Our recognition of the toxicity of lead has changed for us to realize that even low levels of blood lead may result in harm.
So, what do we do? Can a 6 month old eat rice cereal? YES. Should they only eat rice cereal? NO. Does it have to be the first cereal that they eat? NO. Can my teenager have a cell phone? YES. Should they be on it all the time? NO. Should they carry it in their pants or in their bra? NO. Should an infant or toddler play with a cell phone or tablet as their entertainment? NO
How do you find this out? You have great resources available to you to help you sort this out.
- Pediatric Environmental Health Specialty Units. Staffed by health care professionals who are experts in pediatric environmental health. They can help health care providers and the public weed through the data to best inform you on how to keep your children safe from environmental toxins. The Region 7 PEHSU is located at Children’s Mercy in collaboration with the University of Kansas Hospital Poison Control Center. You can reach us at 1-800-421-9916 or our website: pehsu.net
- American Academy of Pediatrics. Through the Council on Environmental Health, health care professionals can be informed of the latest science on pediatric environmental health and how to incorporate this knowledge into your practice. The public site (heatlhychildren.org ) is a great resource for families to find out what experts in children advise.
- Poison Control Centers. Staffed by health care professionals, they are best able to help you with acute exposures. Some PEHSUs collaborate with poison control centers. 1-800-222-1222
Lastly, be smart. Do you really need that stuff? Do you really need to throw it away? Reduce. Reuse. Recycle. It is easy to blame others before us for where we are now. But, who will our children blame with what we leave them?
Dr. Jennifer Lowry is the Director to the Region 7 Pediatric Environmental Health Specialty Unit which serves Federal Region 7 (Iowa, Kansas, Missouri and Nebraska). She also serves as the Chair to the Council on Environmental Health for the American Academy of Pediatrics. Please look for a follow up survey that will help her and the PEHSU program understand what pediatricians need from the programs in regard to pediatric environmental health.