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Article Excerpt
Every year, approximately 1.2 billion pounds of commercial agricultural and residential pesticides are used in the United States, more than double the amount used in the 1960s, accounting for almost 25% of the estimated 5 billion pounds of pesticides used globally per year (Environmental Protection Agency [EPA], 2009). According to a survey by the United States EPA in 2008, 75% of all U.S. households use at least one type of pesticide in or around the home (EPA, 2008a). Additional studies have shown that up to 80% of most pesticide exposure occurs inside the home, not only from residential pesticide use, but also from contaminated soil and dust tracked in from outside that settle on the floors and other surfaces of the home (EPA, 2008a).
While pesticides assist farmers to have better crop yields, help make many types of produce more affordable for consumers, and help control disease-carrying pests, the prevalence of pesticide use is not without consequence. Pesticides are designed to kill living organisms; thus, by their very nature, most pesticides carry risk for harm to humans, animals, and the environment (EPA, 2008c). Research on the long-term effects of chronic pesticide exposure is still underway; meanwhile, current research findings generally include studies done only on the approximately 900 registered individual pesticides and their affects on adult health (Grandjean & Landrigan, 2006). Research is lacking on the potential affect of pesticides used in combination with other pesticides and/or other chemical agents, as they are most commonly used, and on the hazards of exposure to the unborn fetus, infants, and children.
There are over 125,000 reported pesticide exposures in the United States every year, resulting in approximately 30,000 visits to a health care facility (U.S. Department of Health and Human Services, 2000). Although pesticide exposures and related health effects can occur anywhere, regardless of occupation or location, agricultural workers and their families are at particular risk (Quackenbush, Hackley, & Dixon, 2006). There are approximately 780,000 hired agricultural workers in the United States, most of whom work on farms using agricultural pesticides (U.S. Department of Agriculture, National Agriculture Statistics Service, 2008). Studies have shown that essentially 100% of households with one or more family member whose occupation is as an agricultural worker have pesticide residues present in the home (Lambert et al., 2005; Lu, Fenske, Simcox, & Kalman, 2000; Quandt et al., 2003). This results in the pesticide exposure of all adults and children living in these homes.
Health care providers in clinics providing care to migrant and seasonal farmworkers and clinics in agricultural areas are most likely to see families and children at risk for pesticide exposure or individuals who are presenting with acute or chronic conditions resulting from previous exposures to pesticides. The purpose of this article is to review current studies and strategies to reduce pesticide exposure in children of agricultural workers and to develop recommendations for pediatric health care professionals to provide education on pesticide prevention during routine well-child care visits. Recommendations for parents to help minimize their children's risk of pesticide exposure in the home will be identified.
Health Consequences of Pesticide Exposure
Health effects from exposure to pesticides and other toxic agricultural chemicals include acute symptoms, such as nausea, vomiting, salivation, dizziness, headaches, abdominal pain, skin and eye irritation, changes in heart rate, bronchospasm, convulsions, and even coma and death (Alarcon et al., 2005; Alavanja, Hoppin, & Kamel, 2004; Committee on Environmental Health [CEH] & American Academy of Pediatrics [AAP], 2003; Hollinger, 2009; Hoppin et al., 2006; McCauley, Anger et al., 2006). Acute symptoms of pesticide toxicity usually occur within minutes to hours of exposure and may present predominately as cholinergic excess (Hollinger, 2009).
Chronic health effects from long-term exposure may present as headache, dizziness, fatigue, weakness, chest tightness, difficulty breathing, insomnia, confusion, and difficulty concentrating (Alavanja et al., 2005; CEH & AAP, 2003; Dunn, Burns, & Sattler, 2003; Garry, 2004; Gilbert & Collaborative on Health and the Environment's Learning and Developmental Disabilities Initiative, 2007; Grandjean & Landrigan, 2006). Certain types of cancers, including nonHodgkin's lymphoma, leukemia, multiple myeloma, soft tissue sarcoma, prostate, pancreatic, and lung and ovarian cancers are all linked to pesticide exposure (Alavanja et al., 2004; Alavanja et al., 2005; McCauley, Anger et al., 2006; Walker, Carozza, Cooper, & Elgethun, 2007). The neurotoxic effects of chronic pesticide exposure has been extensively studied and is associated with developmental delays in children, decreased memory function, deficits in cognitive and motor function, and an increased risk for developing Parkinson's disease (Alavanja et al., 2004; Garry, 2004; Gilbert & Collaborative on Health and the Environment's Learning and Developmental Disabilities Initiative, 2007). If health care professionals are unsure about possible signs and symptoms of pesticide exposure, Pediatric Environmental Health Specialty Units (PEHSU) is a resource for advice on diagnosing and managing pesticide exposure and/or toxicity (see Figure 1). The effects of pesticide exposure on human health and clinical manifestations of exposure continue to be researched, improving the knowledge and ability of primary care providers to recognize the signs and symptoms of exposure, when to screen for pesticide exposure, and how to manage both acute and chronic conditions related to pesticide exposure (see Table 1).
Figure 1. Resources for Health Care Providers American Academy of Pediatrics: Desk resource, Pediatric Environmental Health, 3rd Edition. American Association of Poison Control Centers: For information on poison prevention and to find the Poison Control Center nearest you, visit http://www.aapcc.org Centers for Disease Control and Prevention: www.cdc.gov For information on the prevalence of pesticide use, pesticide safety laws and regulations, and guidelines for reporting pesticide poisonings, search key words: pesticide safety; pesticide safety, laws and regulations; pesticide poisoning, reporting. Environmental Protection Agency: www.epa.gov For information on health risks, food safety, worker protection, and funding opportunities for pesticide safety education programs, search key words: pesticide safety; pesticides, grants, and partnerships. For resources designed for children, teachers, and students, search key words: information for kids, pesticides, or visit www.epa.gov/pesticides/kids/ Farm Safety Just 4 Kids: Contact http://www.fs4jk.org for interactive games, coloring, and quizzes about pesticide safety. Migrant Clinicians Network: Contact http://www.migrantclinician.org for information on migrant health and http://www.migrantclinician.org/toolsource/resource/ aunque-cercasano_pesticide-comic-book-pdf.html for educational materials in comic-book style on pesticide safety and recommended practices for pesticide prevention, available in English and Spanish. The National Pesticide Information Center: For fact sheets and answers to common questions about pesticide safety, visit http://npic.orst.edu Pediatric Environmental Health Specialty Units (PEHSU): For information on children's environmental health, tutorials and training opportunities for health care professionals, visit www.aoec.org
Children and Pesticide Exposure
Children are especially vulnerable to the risks of pesticide exposure for several reasons (see Table 2). Children have higher basal metabolic rates than adults. They eat more food and drink more water per body weight than adults, increasing their risk for higher levels of ingestion of toxic chemicals found in contaminated food or water. Children have higher respiratory rates that put them at higher risk for absorption of airborne pesticide particles (Allen, 2007; CEH & AAP, 2003; Dunn et al., 2003; Garry, 2004; Schafer, Reeves, Spitzer, & Kegley, 2004; Sexton et al., 2003; Walker et al., 2007). Children also have more permeable skin, which allows for increased absorption of pesticides through dermal contact (CEH & AAP), and their behavioral and developmental patterns contribute to their increased risk of exposure. Children crawl and play on the floor and have breathing zones closer to the ground, where dust, dirt, and toxins accumulate (Dunn et al., 2003; Pope, Snyder, Mood, & Committee on Enhancing Environmental Health Content in Nursing Practice, Division of Health Promotion and Disease Prevention, Institute of Medicine, 1995). Children often put their hands and other objects in their mouths, increasing the likelihood of even further exposure to and ingestion of higher levels of pesticides (Dunn et al., 2003; Garry, 2004). Many studies suggest that the developing organ systems of children, especially the central nervous system, may be more sensitive to pesticide exposure compared with adults (CEH & AAP, 2003; Dunn et al., 2003; Lambert et al., 2005). These combined factors allow pesticides, as measured...
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