The Baby in the Bathwater - OAWHealth

The Baby in the Bathwater

The Baby in the Bathwater

THE BABY IN THE BATHWATER

Shelley Page and Susan Allan
The Ottawa Citizen

Age-old wisdom dictates that mothers know best, but in a complex and chemical world it turns out mothers know less and less.

Consider the staples of a baby’s world: diapers, wipes, washes, lotions. We know very little about products and chemicals we use a lot — every day, many times a day.

Take a top-selling bottle of gentle, soothing baby wash: tear-free, dye-free, “clinically proven.” You couldn’t ask for more in a baby product but chances are you might if you knew the brand-name suds contain allergens, impurities linked to cancer and ingredients that have not undergone a public safety review.

Baby washes were among 7,500 personal-care products analyzed last year in a safety study by the Washington-based Environmental Working Group, which concluded that almost all products on the market — including those intended for babies and children — contain one or more ingredients that have not been publicly assessed for safety. The EWG petitioned the U.S. Food and Drug Administration last June and on Feb. 3, 2005, the FDA issued an unprecedented warning. Manufacturers using untested ingredients may soon be forced to tell consumers with product labels that say, “Warning: The safety of this product has not been determined.”

Dr. Samuel Epstein has long lobbied the FDA on safety issues in his role as head of the non-profit Cancer Prevention Coalition in the United States. “It’s unthinkable that women would knowingly inflict such exposures on their infants and children, let alone themselves, if products routinely used were labeled with explicit warnings,” he says.

While the U.S. government is taking a closer look at what labels reveal about ingredients, here in Canada, labels need not list ingredients at all. Some companies provide the information; others won’t until November 2006 when government legislation forces them to do so. Perhaps then parents will read the small print on shampoo bottles for questionable ingredients, just as many currently scan cracker-box labels for traces of trans fats.

“Right now, it’s hit-and-miss,” says Kathleen Cooper, senior researcher at the Canadian Environmental Law Association. “It’s hard to advise parents to read the labels (on toiletries). Maybe the ingredients are there, maybe they’re not. You want to avoid phthalates, for example — if you can find them on the label.”

Of course, even when we learn what’s in the bathwater with the baby there will be no guarantees it has been tested for safety by an independent regulatory panel.

What’s more, Dr. Phil Landrigan, an expert in child health and the environment, has suggested that of the few chemicals that have been tested, fewer still have been examined for their effects on children’s health. There are more unknowns than knowns, it seems.

Ottawa’s Donald Wigle is the author of Child Health and the Environment, considered the first textbook on the subject when it was released by Oxford in 2003. Dr. Wigle says public-health policy must work harder to protect children who, while vulnerable to environmental toxins, have no control over exposures.

“The link between environmental and health outcomes can be quite subtle but very real,” Dr. Wigle said in an interview. “Lead toxicity is a classic example where for most of the 20th century the health hazards of lead, especially the effects on the brains of children, were consistently downplayed by scientists and public-health officials. As the science got better, the effects on the brain at ever lower blood-lead levels became clear.” Today no level of exposure is considered safe.

Dr. Wigle warns at the start of his book that prenatal and early childhood exposures to environmental toxicants can disrupt development, “causing structural and functional abnormalities that range from subtle to obvious, immediate to delayed, and transient to permanent.”

If you were to judge only by their gear, you would assume babies have never been safer. New parents will purchase almost anything to protect their kids. Nursery-surveillance monitors are standard issue, along with motion detectors, tub thermometers and remote fever detectors that promise 24-hour protection. Better safe than sorry. In a market that exploits infinitesimal odds and irrational fears, someone’s come up with a disposable polypropylene shield to protect toddlers from grocery-cart bacteria.

But while children have never been better protected in some ways, mounting evidence suggests they have never been more vulnerable to things we have always considered safe: air, water, bubble bath.

– Asthma affects more kids than ever before — about 12 per cent of Canadian children under age 14.

– There is a disturbing rise in certain cancers in young adults: melanoma, testicular cancer, non-Hodgkin’s lymphoma and thyroid cancer. “Incidents have increased in recent years and they probably all have links to exposure during childhood,” Dr. Wigle said in an interview.

– Studies show that one per cent of all girls are displaying signs of puberty before the age of eight, some as early as age three.

No one knows why, though many suspect the widespread and increasing use of synthetic chemicals is to blame. “There are major gaps in understanding the relationships between prenatal and childhood environmental exposures and health outcomes,” Dr. Wigle writes.

Personal-care products are but a small part of a very large picture, but they are under increasing scrutiny because they play an intimate role in our daily routines. We lather, slather and apply liberally, even though most of us, especially babies and children, could go without the daily use of shampoos and moisturizers.

Washington’s Environmental Working Group is one of many voices asking why certain chemicals are in toiletries in the first place. And while bathwater obviously poses a lesser risk than pesticides, second-hand smoke or vehicle exhaust — exposures that we cannot always avoid — it’s a chemical world and, if nothing else, we do have say over what products we use in the tub.

Exposure to toxins begins in the womb, a vulnerable and critical time in development. Breast milk then delivers a cocktail that may include polybrominated flame retardants, dioxin, heptachlor, chlordane, mirex, benzene, perchloroethylene and even DDT — chemicals that can accumulate over a lifetime in the fatty tissues of a woman’s breasts. Although doctors insist breast is still best, some are starting to wonder.

The rough-and-tumble exposes developing kids to countless chemicals; the routines of day to day to countless more. The Center for Children’s Health and the Environment in the U.S. explained why children need protection in a series of provocative ads that ran in the New York Times in late 2002.

“Pound for pound, kids are exposed to more toxic chemicals in food, air and water than adults,” the scientists explained, “children breathe twice as much air, eat three or four times more food and drink as much as two to seven times more water.”

Nothing is known for sure about the long-term effects of these chronic and multiple low-dose exposures. One U.S. study blames environmental contaminants for 100 per cent of lead poisoning, 30 per cent of asthma, 10 per cent of neurobehaviour disorders and five per cent of cancer.

Studies are piling up, but proof is elusive.

“The thing is, there are many more unknowns than knowns,” says Dr. Vyvyan Howard, a toxicologist from the University of Liverpool who devotes much time to studying the effects of chemicals on the fetus and infants. “We can observe that there are a number of changes taking place in the frequency of certain conditions including cancer, allergies and auto-immune disease. And we can agree that those are undesirable and have our suspicions about what may be contributing.”

But there will never be absolute proof, he says.

“We are exposed to a very complicated mixture, hundreds of groups of chemicals which, if you break them down to their individual constituencies, become tens of thousands of different variants. We don’t have the toxicological tools to sort that out.”

In some countries, politicians and governments are starting to acknowledge the intricacies of these exposures. “They’re beginning to say this is an extremely complex thing, we can’t hope to unravel it, the weight of the evidence is such that we must take action.”

Robert Donkers is the co-author of REACH proposals that will overhaul chemical regulations in the European Union and force manufacturers to prove their products are safe. In part, he says the Registration, Evaluation and Authorization of Chemicals report was motivated by surprises that fuelled consumer anxiety. “We found carcinogens in diapers, PVC softeners (phthalates) were leaking from baby toys when babies sucked on them, we found chemicals in T-shirts that shouldn’t be there.”

The REACH legislation, which is not expected to receive a final vote until 2006, would apply to chemicals that go into personal-care products, but not the finished goods, which are regulated by a separate cosmetics directive that states that manufacturers have a legal obligation to provide only products that are safe.

“Sometimes, you need to set your objectives a little bit farther than your horizons,” says Mr. Donkers. “You may miss by a few years, but if you don’t set a target, industry will never work to it.”

Precaution is the only option, says Dr. Howard. “Decision-makers in Europe are beginning to act that way. There isn’t any other way forward.”

Better safe than sorry, especially when nothing about the bathwater is clear.

Environmental studies in Europe and the United States have revealed lists of potentially troublesome chemicals. Here is what is known — and not known — about five common ingredients:

Phthalates

Found in nail polish, hair spray and in the “fragrances” of some scented products. Dibutyl phthalate (DBP) is used to make nail polish last longer and reduce chipping. Diethyl phthalate (DEP) and dimethyl phthalate (DMP) make scents last longer. Chemical manufacturers insist exposure to phthalates in personal-care products is extremely low. Still, Kathleen Cooper of the Canadian Environmental Law Association cautions, “in my opinion, little girls should not be using nail polish or nail-polish remover.”

Phthalates are suspected hormone disrupters, chemicals that can mimic estrogen and interfere with systems in the body that regulate sexual development, sperm counts and fertility. The Mount Sinai School of Medicine in New York concludes that although links are tenuous, evidence is mounting that “endocrine disrupters play a significant role in reproductive problems.”

Although phthalates are classified by the Environmental Protection Agency as a “probable human carcinogen,” the industry-financed U.S. Cosmetic Ingredient Review panel maintains the chemicals used in personal-care products are safe. Health Canada agrees, but is monitoring concerns about phthalates.

The EU, meanwhile, has banned phthalates from cosmetics, citing their reproductive toxicity. In response, some U.S. cosmetics firms — including L’Oreal and Revlon — have started to formulate phthalate-free products.

Parabens

A group of compounds — methylparaben, propylparaben, ethylparaben, butylparaben, among others — used as preservatives in shampoos, bubble baths, diaper-rash ointment, baby wipes, lotions and toothpaste.

Parabens are also suspected hormone disrupters. Early studies have linked the ingredient to breast cancer and a reduction in sperm count.

“From what I’ve read in the literature, I would choose not to expose any child or baby of mine to parabens unnecessarily,” says toxicologist Dr. Vyvyan Howard. “I don’t know that we have enough information. So, therefore, on a precautionary basis, my personal choice would be to avoid them. The products are not essential.”

Sodium Lauryl Sulfate

Foaming and surface-cleansing agents, sodium lauryl sulfate (SLS) and sodium laureth sulfate (SLES) are common ingredients that create bubbles in shampoos, bath products, toothpastes and mouth rinses.

Enter sodium lauryl sulfate or SLS into an Internet search engine and you will find pages linking it to cancer. It has also been associated with eczema and with skin and eye irritation. Such is the concern that marketers are starting to tout such products as Doctor Burt’s Cinna Mint Toothpaste that are “SLS Free!”

The Cosmetic Ingredient Review committee in the U.S. says the ingredient is safe. Health Canada concurs. The American Cancer Society even issued a statement in 1998 titled “Debunking the Myth” denouncing the accusations “flying through cyberspace” that SLS causes cancer.

Still, safety remains a Frequently Asked Question, one to which Johnson & Johnson responds on its U.S. website: “Anyone anywhere can publish or send anything on the Internet regardless of validity,” the company writes. “We assure you this ingredient (SLES) is safe and approved for use by the Food and Drug Administration. No body of scientific evidence links this ingredient to cancer.”

The Environmental Working Group has another concern about SLES, which it says works as a “penetration enhancer,” allowing potentially dangerous chemicals to penetrate deeper into the skin.

Petrolatum

Petroleum jelly is listed as a probable human carcinogen on the European Union’s Dangerous Substances Directive and is banned from cosmetics in Europe unless manufacturing is proven to meet purity standards. The concern is not with the petrolatum, but rather with production procedures that may expose the jelly to polycyclic aromatic hydrocarbons, common contaminants known as PAHs, which have been linked to breast cancer.

Paula Begoun, author of Don’t Go to the Cosmetics Counter Without Me, says petrolatum does not deserve the rap. “Topical application of petrolatum can help the skin’s outer layer recover from damage, reduce inflammation, and generally heal the skin,” she notes.

The Environmental Working Group estimates there is petrolatum in one of every 14 products on the market including 40 per cent of all baby lotions and oils.

Talc

The Cancer Prevention Coalition in the United States does not waste words on the main ingredient in baby powder. “Talc is toxic,” states Dr. Samuel Epstein, citing a 1993 National Toxicology Program study that linked cosmetic grade talc to tumors in laboratory animals. “Clearly, dusting with talcum powder endangers an infant’s lungs at the prospect of inhalation. Exposing children to this carcinogen is unnecessary and dangerous.” Even without conclusive studies, many doctors discourage the use of baby powder for fear children will inhale dust-sized particles that can cause breathing problems or lung damage.

No one knows the long-term effects of using these chemicals day in and day out, one on top of the other, but it is something that will soon be considered in a massive longitudinal study in the United States.

Researchers are in the initial stages of an ambitious project designed to determine how the environment — including these low-dose and multiple exposures — affects the health of children. The National Children’s Study will follow the development of 100,000 children in 96 centers across the U.S. from before birth to age 21.

Dr. Irena Buka, who runs Canada’s only environmental health clinic at Misericordia Community Hospital in Edmonton, had hoped Canada would piggyback on the U.S. study but was unable to persuade the government to fund such a project.

There is very little in the way of environmental health research in this country, says Dr. Buka. “There isn’t even an institute that looks at environmental health. We’re in the very early stages of even considering it to be an issue in Canada.”

Dr. Donald Wigle worked at Health Canada when the National Children’s Study was discussed. “It was a missed opportunity,” he said in an interview. “My observation going back many years is that child health gets a lot of lip service by senior people in government, but when it comes time to actually allocate the money, it doesn’t happen.”

Dr. Wigle is now an affiliate scientist with the McLaughlin Centre for Population Health Risk Assessment at the University of Ottawa where he synthesizes the latest studies on children’s health. “There is an urgent need for countries and international agencies to invest in population and laboratory research on the role of environmental hazards in fetal and child health and development,” he writes in his book, Child Health and the Environment.

Scientists and doctors may agree there should be more research into the influence of environmental toxins on the fetus, yet significant funding is lacking. At the Ottawa Health Research Institute, Dr. Mark Walker heads a study that hopes to follow 8,000 pairs of mothers and babies to determine how time spent in the womb affects an individual’s health over a lifetime.

“In utero, you start as one cell and end up with umpteen billion cells, all of your organs are formed and all your physiology is programmed,” he explains. “If that’s where 99 per cent of your development is occurring, it makes perfect sense that anything affecting that would have profound downstream implications.”

So far the research team has stored the blood of 3,000 mothers for future analysis. That, of course, will depend on securing more research money.

“Right now, we only have funding to follow them until birth,” he says. “In the States, they’ll provide hundreds of millions of dollars to do a study, here we have to go one kilometer of the road at a time.”

Despite his commitment to the research, he says the lack of support is frustrating. “There’s only so many times you can get hit on the head by grant rejections until you say, ‘You know what, I’m going to change my focus. They want more heart-disease research, I’m going to do it.'”

Dr. Walker would like funding to study the concentration of phthalates in amniotic fluid and umbilical cord blood. “It may be that exposure levels are so low that it’s not a problem,” he says. “Unfortunately, when we make the discoveries, it’s going to be another 10 or 15 years of exposure before we are able to implement policy changes.”

Until we know more we should aim to use less, says Kathleen Cooper of the Canadian Environmental Law Association. She recommends reaching for the most natural ingredients while cutting back on personal-care products in the first place.

“Childproofing covers more than you think,” she observes, “and it lasts longer than you think.”

And until science confirms or invalidates suspicions about long-term exposures to synthetic chemicals, Dr. Howard says consumers have alternatives to explore and choices to make. Instead of baby wipes, for example, try using soapy water and a wash cloth or tissue for diaper changes at home. If you choose disposable over cloth diapers, consider using unbleached, chlorine-free disposables and diaper wipes. If you can’t do without talcum powder, try corn starch.

“I tend to avoid unnecessary exposure in my own life,” Dr. Howard says, “but acknowledge that I may be taking unnecessary steps.” Better safe than sorry.

All in a Day

Here are some of the ingredients found in baby products used in an average day:

Baby Wash

Typical ingredients: Water, Cocamidopropyl Betaine, Glycerin, PEG-80, Sorbitan Laurate, Sodium Laureth Sulfate, Sodium Lauroamphoacetate, PEG-150 Distearate, Glycol Distearate, Phenoxyethanol, Polyquaternium-7, Sodium Hydroxide, Fragrance, Polypropylene Terephtalate, Acrylates/C10-30 Alkyl Acrylate Crosspolymer, Tetrasoidum EDTA, Methylparaben, PEG-14M, Mineral Oil, Propylparaben, Butylparaben Suggested alternatives: Fragrance-free products generally contain fewer chemicals than scented ones. If you want fewer still, choose an organic product. The top-rated baby wash on the Environmental Working Group’s safety survey was Aveeno Soothing Baby Bath Treatment, Single Use Packets. Burt’s Bees Baby Bee, Pint-Sized Buttermilk Bath Soak was also near the top of the list. Consider bathing your baby a little less often and using soap only when truly required.

Baby Lotion

Typical ingredients: Purified Water, Propylene Glycol, Glyceryl Stearate, Myristyl Myristate, Stearyl Alcohol, Isopropyl Palmitate, Cetyl Alcohol, Dimethicone, Aloe Barbadensis (Aloe Vera Gel), Chamomilla Recutita Matricaria (Chamomile Extract), Lavandula Angustifolia (Lavender Extract), Hydrolyzed Silk Protein, Panthenol, Tocopheryl Acetate, Synthetic Beeswax, Retinyl Palmitate, Fragrance, Stearic Acid, Methylparaben, Tetrasodium EDTA, Sorbitan Stearate, Propylparaben, Butylparaben, Benzyl Alcohol, BHT, Polysorbate 60, Sodium Hydroxide, Carbomer, Oleic Acid, Cholecalciferol Suggested alternatives: Few babies actually need baby lotion. In fact, in some cases dry skin may be the result of soapy baths that rob the skin of essential oils. Organic products are one option. For suggested alternatives, see www.lesstoxicguide.ca, a consumer’s guide written by the Environmental Health Association of Noval Scotia.

Disposable Diapers

Typical ingredients: Wood cellulose fibre and polyacylate absorbents. Diaper liner includes: Petrolatum, Ethylene/VA Copolymer, C26-34 Olefin (and) Polyethylene Suggested alternatives: There’s always cloth, obviously, though even those are exposed to some chemicals since cotton diapers have usually been bleached with chlorine and will be treated with cleaning products on a regular basis. If you use disposables, author Beth Ann Petro Roybal suggests choosing unbleached diapers that do not contain water-absorbing gels. The author of 101 Simple Ways to Make Your Home & Family Safe in a Toxic World says regular disposables should be changed often; “avoid scents, colors and patterns, which are likely to contain toxic inks and other chemicals.”

Fragrance-Free Baby Wipes

Typical ingredients: Water, Potassium Laureth Phosphate, Glycerin, Polysorbate 20, Tetrasodium EDTA, DMDM Hydantoin, Methylparaben, Malic Acid, Aloe Barbadensis, Tocopheryl Acetate (Vitamin E) Suggested alternatives: The Environmental Health Association of Nova Scotia recommends using a spray bottle of soapy water and a washcloth or tissue for changes at home. There are baby-care companies that sell non-chorine bleached, unscented and alcohol-free wipes.

Diaper Rash Ointment

Typical ingredients: Zinc Oxide, BHA, Cod Liver Oil, Fragrance, Lanolin, Methylparaben, Petrolatum, Talc, Water Suggested alternatives: The Guide to Less Toxic Products recommends treating a rash with corn starch, though be sure to apply it carefully and sparingly. The guide also recommends such natural brands as Aubrey Organics, Burt’s Bees and Druide.

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