Reuters Health
4 June 2003

Pediatricians call for more action on phthalates

By Keith Mulvihill

What are phthalates, and why are there health concerns?

NEW YORK. An organization of U.S. pediatricians is calling for further research into the effects on children of chemicals used to make fragrances last longer and soften plastic in toys and medical tubes.

The chemicals, known as phthalates, have been linked in previous studies to birth defects and other harmful effects in animals, according to the report, published in the June issue of Pediatrics, the journal of the American Academy of Pediatrics (AAP).

The AAP's Committee on Environmental Health notes in the report that "no studies have been performed to evaluate human toxicity from exposure to these compounds."

The impetus to do the report was a study published by the Centers for Disease Control and Prevention (CDC) that found that some people have very high levels of phthalates in their blood, explained Dr. Michael W. Shannon, a member of the AAP committee.

Shannon also noted that media attention about phthalates is likely to have parents asking questions and expressing concern.

"We wanted to make sure that pediatricians are educated and are able to advocate for children's health," Shannon said in an interview with Reuters Health.

In the report, lead author Dr. Katherine M. Shea and other members of the committee note that two phthalates, DEHP and DINP, are of particular concern "because of their known toxicities and the potential for significant exposure in sensitive populations."

Specifically, concern is especially high for premature infants in intensive care units, where they may be exposed to DEHP in plastic medical tubing and bags, explained Shannon, who noted that these infants are immature both developmentally and physiologically.

As such, Shannon said, "we very much want to see more research conducted."

Commenting on the report, Marian Stanley, manager of the Phthalate Ester Panel at the American Chemistry Council said, "the report ... is incomplete and unjustifiably alarmist, because the report does not include significant recent research findings."

But Shea countered that she and the members of the committee took into account all published information available at the time the report was being written.

In response to the criticism of being alarmist, Shea said, "nowhere in the document do we say or imply that parents should take any specific actions. Rather we suggest that pediatricians should become educated and participate in the process of determining what is safe for children."

And she notes that a main goal in writing the report was to educate pediatricians about the complexity of determining and quantifying risks to children from chemical exposures, using phthalates as examples, and to prepare them to be active participants in the process.

"So far the exposure data on phthalates in young children is incomplete and while the toxicity data is pretty good, it's in animals not babies," said Shea.

"I don't think anyone knows all the answers, but we need to be health protective and eliminate unnecessary exposures and, when possible, minimize medical exposures, especially in premature infants in intensive care," Shea told Reuters Health.

In December last year the U.S. Food and Drug Administration (FDA) told medical professional societies that certain devices may expose people to a toxic dose of DEHP. The agency said at the time DEHP might be found in IV bags and tubing, blood bags, nasogastric tubes, dialysis bags and tubing, and other tubing used to support and feed premature infants.

The FDA advised that, if available, alternatives to phthalates should be should be used to keep plastics soft.

So far, the U.S. government has declined to ban the use of phthalates. The European Union banned their use in some products, including baby toys, in 1999. In the U.S. and Canada all phthalates have been voluntarily removed from infant bottle nipples, teethers and toys intended to go into an infant's mouth.

SOURCE: Pediatrics 2003;111:1467-1472.