Pediatricians play a key role in preventing medical problems in children as much as they do in treating them. It is the reason for those frequent visits with your pediatrician in the first few years when growth and development are crucial. Identifying issues early on allows intervention and improves outcomes for a child’s long term health. As a pediatrician myself, I have two main jobs: take care of children and educate parents. 

I am also a mother - and in both science and parenting there is so much to learn and discover. When my twins were infants and I made the decision to buy bright colorful plastic dishes to use when introducing solids - I believed BPA-free meant safe. My mother, an Indian immigrant, gasped when she saw this and immediately replaced those dishes with traditional Indian stainless steel (the same ones I used as a child). Her fear of chemicals leaching from the plastic into her grandchildren’s food was validated 5 years later by science.

Concerns regarding the harmful effects of plastic, climate change and air quality are growing - leading world experts on environmental health are sounding the alarms for pediatricians and parents alike. Over the past decade, scientists have published numerous reports on the interconnection between the environment and children's health. While nutrition, physical activity and other factors still heavily contribute to overall wellbeing, we must not ignore the real effect of everyday environmental exposures on health. The lasting impact between humans and the planet will be felt not by us, but by our children. 

In 2018, the American Academy of Pediatrics published a report that warned parents about the harmful chemicals in plastic that interfere with children's hormones, growth and brain development. The AAP recommended to use glass or stainless steel instead; if plastic must be used however, they suggested avoiding heat exposure in the microwave or dishwasher. So why does your pediatrician care about plastic? If you have not heard of the term Endocrine Disrupting Chemicals (EDCs) yet, you will soon as it is a growing concern to human health. In order to understand how these chemicals are affecting health, we must understand the importance of the endocrine, or hormonal, system in the body.

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What is the Endocrine System?

The endocrine system is a series of glands throughout the body that produce hormones. These hormones are natural chemicals that communicate with various organs (pituitary, thyroid, adrenal, pancreas, testes/ovaries)  in your body to regulate overall health and well-being. They are essential for normal development of the body and brain as well as critical to reproductive function. The chemicals in plastic interfere with the endocrine system because they can mimic or block natural hormones and their actions in the body. Children are particularly vulnerable to these chemical exposures because the body and brain undergo rapid growth and development during infancy and childhood. The leaching of these EDCs from plastics is of concern because they have been shown to cause abnormal reproductive, metabolic, thyroid, immune and neurological function.

Why should I be concerned about the chemicals in plastic?

My mom didn’t know it then, but her fears of plastic chemicals were rooted in the science behind how they interact with the endocrine system. The World Health Organization is also concerned about this issue. In the 2017 Atlas on Children’s Health and the Environment, they highlight the growing concern of phthalates and bisphenols used in the food industry causing harmful chemicals to leach into food from canned food, baby bottles and food containers. “Chemical additives in plastic and the threat they pose to human health and the environment is an emerging issue of global concern,” says the Endocrine Society in their recent report in December 2020 (Plastics, EDCs & Health). The group is the world’s oldest, largest and most active organization devoted to research on hormones and the clinical practice of endocrinology - it consists of over 18,000 scientists, physicians, educators, nurses and students in more than 100 countries.

Why haven’t I heard about this yet?

Many plastic additives are known to interfere with hormone functioning and are, by definition, endocrine disrupting chemicals. So why is this global threat to human health largely unknown to both pediatricians and parents? To illustrate the timeline of how science, media and consumer goods work together - let’s look at a rather recent similarity. Lead.

First comes the science. Researchers identified lead exposure to produce cognitive and developmental delays in children. Pediatricians developed new standards of care in lead screening and testing in their office. News stories highlighting this harmful link brought awareness to the general public. Policies and legislation were updated to ensure a decrease in lead exposure to children. Industries eventually removed lead from gasoline and paint. New regulations for lead testing in children’s products took effect. Now, we have a generation of children that are 4-7 IQ points higher than the generation before lead exposure was decreased. By working across industries - science, media, policy, regulatory and manufacturing - we came together to advocate for and protect our children from something we learned was dangerous to their brain development.   

Decades later, we face a similar situation with plastic. While the well-known chemical bisphenol A (BPA) was banned from many baby products, we now know that it is just the family member that received the negative press. BPA is a part of the family called bisphenols - other members like bisphenols S and F (BPS and BPF) which are used as replacements have similar or even worse health effects. We are finding bisphenols and phthalates in breast milk that has been heated in plastic bottles and even in fetuses from maternal exposure to plastic during pregnancy. In the United States, chemicals are used in consumer products and released into the marketplace and the environment before we know its toxic effects. For example, there are more than 10,000 food additives approved by the U.S. Food and Drug Administration (FDA) to modify the look, taste and texture of food or preserve and package food substances. However, a recent review of 4000 additives found that 64% had no research showing they were safe for people to eat and drink.

So now what?

If you are a parent reading this - you are probably scared. I promise, that is not my intention. I am a mother of three young kids myself so I do know how you may feel. I felt the same way when I learned about this topic. As I mentioned, my job as a pediatrician is to keep kids healthy and to educate parents. I hope that by educating parents it empowers them to make informed decisions. After reading the bad news - let me leave you with the good news. 

While we are just starting this journey for a toxic-free future for our children and pediatricians are being educated on the topic themselves, leading medical and scientific communities are recommending small changes you can take today while the policy, regulations and manufacturing catch up. While plastic is everywhere in your daily living, a few key areas of focus can help start your own journey to limit your family’s exposure to EDCs. The best part of these small changes? The research shows that by decreasing exposure to these chemicals, the levels found in the human body (which should be zero by the way) drop dramatically within just three days. This means that seemingly small change can lead to significant protection for your child. 

• Eat fresh and organic fruits and vegetables instead of processed foods or canned foods. All cans have detectable levels of bisphenols in the lining.
• Use glass or stainless steel for serving and storing food and drink instead of plastic. 
• If you do use plastic containers, don’t put them in the microwave or in the dishwasher as the heat and cleaning agents increase the leaching of chemicals out of plastic. Same goes for etched (scratched) plastic - dispose if you notice containers are etched. 
• Avoid plastic bottles with the numbers 3, 6 or 7

As parents, we want to protect our children and provide them with opportunities to thrive in a safe and healthy world. While this may feel like a mountain to climb given the overwhelming amount of plastic that persists in our lives, I have always believed in the power of parents and the cumulative effect of small changes. Taking baby steps in your own home and uniting with parents across the globe to ensure the future is bright for our kids - now, that’s a mountain worth climbing together.

For further reading, please check here for the  American Academy of Pediatrics, Endocrine Society and World Health Organization materials. 

Dr. Manasa Mantravadi MD is a pediatric hospitalist at Indiana University Health. She is a member of the Council on Environmental Health at The American Academy of Pediatrics and was named Physician Mentor of the year at Indiana University School of Medicine. She created Ahimsa, the world’s first colorful stainless steel dinnerware for children, after learning of the significant impact of plastic on pediatric health and the lack of safer options for parents to choose. Her focus is on environmental pediatrics and translating evidence-based information from scientific research into simple and practical products and education for parents.