Review Article - (2023) Volume 8, Issue 4
Received: 05-Jun-2023, Manuscript No. IPPHR-23-16874; Editor assigned: 09-Jun-2023, Pre QC No. IPPHR-23-16874 (PQ); Reviewed: 23-Jun-2023, QC No. IPPHR-23-16874; Revised: 22-Dec-2023, Manuscript No. IPPHR-23-16874 (R); Published: 29-Dec-2023, DOI: 10.36648/2574-2817-8.2.1
Background: The light on some chemical substances which are widely used in many and different aspects of our children daily practices and try to get the answers for the following important questions. Do these chemicals that our children are widely exposed to since even their prenatal period and throughout their lives have real high risks and dangers on their health? Is the use of these chemicals essential for our kids or we can avoid and replace them with other non-risky substances and hazardous chemical free products! Recently, a lot of systematic review studies have been done to investigate the possible relations between the most common chemical substances that we use daily and possible risks and health problems that may affect our children. Among the chemicals that have been studied intensively in the last few years are Phthalates which are known as endocrine disruptors due to their anti-androgenic and/or estrogenic effects!
The purpose and objective of our study: Are to provide an overview of some widely and commonly used chemicals that are introduced to many of the products essentially used by our children daily, and the possible relations between their use and some of the common health problems and disorders that affect children in order to raise the awareness among parents and health care providers regarding their potential health impacts on children and to provide a proper guidance that help to minimize the avoidable exposure to these risky chemicals and replace them with hazardous chemicals free products till we get enough studies that prove or disprove their risks and effects.
Discussion: Our study tries to search through, emphasis on and spot the light on the use of common chemical substances (Phthalates) that are widely used in most of our children life aspects, searches for their possible risks and hazards on our kids' health, tries to get relations and connections between these substances and common pediatric health problems and disorders. In our study we reviewed the data collected from many evidences based systematic reviews and cohort studies have dealt with these hazardous substances and stated the high incidence of their risks and their bad impacts on our kids' health and prove the relation of these chemicals to certain respiratory problems specially wheezing in childhood, ADHD, some atopic conditions and endocrine disruptions among children.
Conclusion: Our study concluded and suggested that it is better to eliminate exposure to these chemicals as evidences are rising against their safety. It's very important to increase the awareness among parents and health care providers regarding the possible risks of these chemicals and provide them the most proven practical tips for their avoidance. Further epidemiological studies should be conducted in the future to enhance our knowledge in this area.
Pediatrics; Phthalates; Hazardous chemicals; Health
We live in a world of chemicals:
• Chemicals make our life easier, more convenient and more
comfortable, but is it healthier?
• Since 1970's, more than 85000 chemicals have been
approved for commercial use, yet only just one thousand
of them have been examined and graded for their harmful
potential.
• Most chemicals are used before being tested for safety
and would only be regulated or banned after showing
harmful effects on human, making us unwillingly
experimental mices in this industrial world.
When we talk about chemicals, we don't only mean the pollution resulted from industry. We talk about things that we buy everyday presuming that if something is sold in supermarkets or pharmacies, and if everyone consume, then they should be safe. But the truth is bitter.
What is Phthalates?
• Phthalates are a group of man-made chemicals, added to
Poly-Vinyl Chloride (PCV) to make this brittle plastic more
flexible and durable (plasticizers).
• They were invented in 1920’s and since then we witnessed
a burst in plastic use globally, making us the third or fourth
generation to be exposed to these chemicals [1].
• Many different phthalates exist with different properties,
uses and health effects.
• High-molecular weight phthalates e.g. Di-2-Ethylhexyl
Phthalate (DEHP) are primarily used as plasticizers in the
manufacture of flexible vinyl plastic which, in turn, is used
in: Waterproofs, raincoats and flip flop clothes.
• Domestic and construction: Flooring, wall coverings,
shower curtains and hosepipes.
• Food contact applications like containers, food packaging
and wraps.
• Toys, school supplies and childcare articles.
• Medical devices, like blood bags and tubing.
PVC products may contain up to 50% (by weight) phthalates
and the more flexible the product is the more phthalate it
contains [2].
• Low-molecular weight phthalates are used as solvents in
personal-care products to hold fragrance and make
products more effectively penetrate and moisturize the
skin e.g. in perfumes, lotions, cosmetics, shampoos, aftershave,
nail polishes, air fresheners and in lacquers,
varnishes and coatings, including those used to provide
timed releases in some pharmaceuticals.
How are we Exposed to Phthalates?
Since phthalates are not chemically bound to PCV polymers, they can leach, migrate or evaporate into indoor air, dust, food stuff and other materials. Human exposure to phthalates occurs through inhalation or ingestion of contaminated air and food as well as skin contact.
Phthalates in Processed and Packaged Food
• Processed and packaged food is the main source of human
exposure.
• Mostly in fatty food, dairy products, processed cheese,
processed meat, fish and oil, grain, ultra-processed food
like soft drinks and fruit drinks, ready-to-eat-food and even
in baby food and formulas [3].
• This contamination could happen either during processing
or leaching from the packaging before consumer use.
• Phthalates exposures have also been associated with food
venues, including fast food restaurants, school cafeteria
lunches and dining out.
Daycare Products and Cosmetics
• Phthalates have proven to be very effective softeners in
day care products like hair conditioners, hairsprays and
body lotions so the use of certain personal care products especially makeup, lotion, emollients and sunscreens is
associated with higher exposure to phthalates.
• Studies show that phthalates exist in the products when
manufactured and their concentrations increase with the
storage time indicating the possibility of leaching and
migration of phthalates from the container also into the
product.
• Phthalates made big news in 2008 when the American
academy of pediatrics reported that infants exposed to
infant-care products, specifically baby shampoos, baby
lotions and baby powder, showed higher than normal
levels of phthalates in their urine.
• This is also important in adolescent girls because they are
in a critical age in hormonal development and have high
use of personal care products.
Toys and Childcare Articles Made from PVC
• Plastic toys and childcare articles made from PVC are a
great source of children exposure to phthalates as they
can leach and contaminate the presumed safe surrounding
environment or due to the hand-mouth habit in younger
children [4].
• Soft toys contain higher levels of phthalates as compared
to hard toys as primary function of phthalates is softening
of hard plastic material.
• Because of their potential effects on human health, the
European Union has banned the use of six specific
phthalates in products for children.
• Toys and childcare articles made of PVC in other countries
still contain variable levels of phthalates exceeding the EU
regulations sometimes highly.
• If a toy is not designed to be sold on the European market
by the manufacturer, it seems to be more likely to contain
a phath phthalic acid ester.
Phthalates in Dust and Indoor Air
• Those dust particles accumulating on our floors might
seem like a minor annoyance, but they could be exposing
us to potentially harmful chemicals including phthalates.
• Studies confirm the occurrence of multiple phthalates
sometimes in high concentrations in indoor dust, with
DEHP being the most frequently detected phthalates in
indoor dust [5].
• Humans are exposed to phthalates in dust via ingestion,
inhalation and dermal uptake. Children are known to be
more exposed to dust than adults due to their proximity to
the floor and frequent hand-to-mouth behaviour.
• The age of the building, presence of foam mattresses and
PVC flooring, presence of old soft plastic toys and the
amount of plastic toys, the presence of electronic devices
and the low cleaning frequency were associated with
higher levels of phthalates in indoor dust [6].
Iatrogenic Phthalate Exposure
• Flexible plastic devices in hospitals like blood products
bags, intravenous tubing, endotracheal tubes, feeding tubes, catheter cannulas and others are most commonly
made of Polyvinyl Chloride (PVC).
• In November of 2014, scientists at Johns Hopkins
Bloomberg school of health reported that, “Because of
phthalates in medical devices, premature babies admitted
to the NICU can be exposed to 4,000 to 160,000 times the
amount of phthalates considered safe.
Phthalates in Medication
• A lesser-known potential source of exposure is the timedrelease
coatings on certain pharmaceuticals and dietary
supplements.
• Phthalates are used also as excipients in numerous RX and
OTC drug products and supplements from a wide range of
therapeutic categories.
• Up to 50-fold higher levels of urinary phthalate
metabolites have been observed in users of phthalatecontaining
drug products compared with non-users [7].
• Studies in children are lacking.
Phthalates Exposure
• Phthalates are rapidly metabolized and excreted in urine
as a major elimination pathway, so the measurement of
phthalate metabolites in urine is used to detect the recent
exposure.
• Yet phthalate metabolites have been measured in various
other body fluids, serum, semen, breast milk and saliva.
• Phthalates can cross the placental barrier and have been
measured in amniotic fluid in human studies [8].
• The estimated daily exposure to one major phthalate,
Di(2-Ethylhexyl) Phthalate (DEHP), ranges from 3 μg-30
μg/kg/d.
• According to the Forth national report on human exposure
to environmental chemicals, nearly all Americans in every
age group (age 6 or older) have detectable levels of
phthalate metabolites and other endocrine disrupting
chemicals in their urine [9].
• In Europe, according to the DEMOCOPHES project
phthalate metabolites were detected in almost all
participants (1844 mother-child pairs).
• In general, DEMOCOPHES results show that younger
children (6-8 years) have higher exposure levels compared
to older children (9-11 years), and higher levels in children
compared to mothers, with the exception of MEP which is
not regulated and is mainly used in cosmetics.
• A possible explanation is children’s relatively higher intake:
They are more exposed to dust, playing nearer the ground,
have more frequent hand-to-mouth contact and they eat
more than adults in relation to their weight.
• Consumption of convenience food, use of personal care
products and indoor exposure to vinyl floors and
wallpaper have all been linked to higher phthalate levels in
urine.
• In Australia, data suggest that phthalate metabolites
concentrations are at least two times higher than in the
United States and Europe.
• A study in Saudi Arabia in 2017 measured major phthalate metabolites in urine samples of children aged 3-9 years [10-12].
The results showed that urinary levels of some phthalates were detected at higher levels than those reported previously in children worldwide, that was mostly related to the frequency of eating out, consumption of hamburgers, canned food, ice cream and the use of sun creams or sun spray.
Why Phthalates Raised Concern?
• Phthalates have received considerable attention because
of their ubiquitous presence in the environment, frequent
detection in human biomonitoring studies and
demonstrated toxicity in rodents and humans.
• Phthalates are approved to have estrogenic effect making
them Endocrine-Disrupting Chemicals (EDCs).
Phthalates and Reproductive System
• Exposure to phthalates is of great concern, as they have
been suspected to have anti-androgenic and estrogenic
effects, which may alter the reproductive development of
children.
• Animal studies indicate that gestational phthalate
exposure is associated with adverse health outcomes,
including disruption of endocrine and reproductive
function and development.
• In females it induces pathological changes in ovaries,
affects organ weights, disrupts estrous cyclicity, reduces
fertility-related indices and causes some breeding
complications.
• While in males, animal studies provide consistent
evidence that certain phthalates target the developing
reproductive system causing any genital anomaly. The
connection is so clear the disorder is termed Phthalate
Syndrome (PS) and the effects mirror a set of reproductive
symptoms seen in human males, termed Testicular
Dysgenesis Syndrome (TDS).
• In human, increased evidence shows that phthalates have
adverse effects on Leydig cell development, thus causing
lower androgen and Insulin-like 3 production and
increasing the odds of any male newborn genital anomaly
(termed Testicular Dysgenesis Syndrome (TDS) including
cryptorchidism, hypospadias, shortened anogenital
distance and isolated hydrocele.
• It also leads to disrupted gonadal function and
spermatogenesis (low sperm counts and sperm motility
and maturation) [13].
• And alters reproductive function of adolescent men
including total testicular volume, reproductive hormones
and semen volume.
Phthalates and Neurodevelopment
• We are witnessing an alarming increase in learning and
behavioral problems in children.
• Although most of these problems are multifactorial, there
are increased evidences that exposure to phthalate either
prenatally or after birth can affect different aspects of
neurodevelopment in children.
• It is strongly suggested to increase the odds of ADHD,
attention deficit disorder, learning disability, social,
thought, attention, cognitive and behavioral problems and
may also affect the language development in children.
• The strongest evidence is for motor effects and BBP
exposure in girls.
Phthalates have also been associated the development of:
• Overweight and obesity in school-age children.
• Increased BMI and waist circumference in adults and
children.
• Increased insulin resistance, a precursor to diabetes, in
teenager.
• Childhood asthma.
• May worsen pulmonary function and airway inflammation
in asthmatic children [14].
How to Avoid Phthalate Exposure
• We simply cannot escape our exposure to man-made
chemicals, but there is a lot we can do to moderate and
control our exposures.
• While onetime exposure to chemicals is often considered
safe, many of these products are used every day and the
effects of long-term exposure, especially when combined
with other chemicals, is largely unstudied and unknown.
Awareness
Given the lax regulation of chemicals and the reactionary approach of governments’ regulators, it is up to the consumer to be diligent about reading labels and making healthy choices to limit exposure to chemicals and toxins.
It is ideal to adopt the precautionary principle: “Until a chemical is found to be harmless, try to not use it“, the precautionary principle means that you are maintaining awareness of what you are putting on and in your body and taking steps to avoid exposing yourself unnecessarily to toxins in your household and environment [15].
Minimize Plastic Use
• Limit exposure to plastics, especially anything with the
number 3 or 7 on them.
• Use glass, ceramic, or metal containers for food and drink.
• If you have to use plastic, don’t microwave it or wash it in
the dishwasher to limit the leaching out of chemicals.
• Minimize plastic toys especially soft ones, instead you can
use wooden toys or stuffed ones, Also, consider using
silicone bottle nipple teethers and consider glass bottles
for infants and babies that cannot feed themselves yet.
Avoid Food with High Concentration of Phthalates
• Avoid packaged foods: Studies have also shown that
phthalates are particularly high in some packaged foods.
Try to avoid these foods, especially for children.
• Foods that are higher in fat meats and cheeses, for
instance are particularly prone to chemical leaching.
• Dairy items like heavy cream, ice cream and cheese had
high to very high levels of phthalates.
• Unfortunately, you will very rarely see phthalates listed on
a product label. Luckily, there are clues. When it comes to
cosmetics, the word "fragrance" or "perfume" on a label
almost always means phthalates. What you want to see
are claims like: "No synthetic fragrance" or "scented with
only essential oils" or "phthalate-free." And always use
only natural air freshener.
• Avoid personal care items where the scent is strong and
lasts longer than 15-30 minutes as these products likely
contain synthetic chemicals instead of pure essential oils.
• Minimize the use of unnecessary personal care products
(The average man uses five to seven personal care
products a day. The average woman uses nine to twelve
products. The average teenage girl uses seventeen) and
you can follow the rule (the less ingredients is better).
• Good resources for more information on the topic and
safer alternatives include websites like
EWG (ewg.org), breast cancer prevention partners (bcpp.o
rg), IARC (iarc.fror monographs.iarc.fr), national institute
of environmental health sciences (niehs.hih.gov), national
cancer institute (cancer.gov) and the American cancer
society (cancer.org).
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Citation: Hawal AIM, Alia MA, Hussin FET, Gad SMH, Mohamed GIM, et al. (2023) Our Daily Use Chemical Products "The Enemy we Trust" Phthalates, Risks and Challenge to Avoid: An Update. Pediatr Heal Res. 8:1.
Copyright: © 2023 Hawal AIM, et al. This is an open-access article distributed under the terms of the Creative.Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, providethe original author and source are credited.
