By: Lauren Zajac, MD, MPH, FAAP
Some drinking water systems in the United States are contaminated with perfluoroalkyl and polyfluoroalkyl substances (PFAS), which are sometimes called “forever chemicals.” As a parent, you may wonder if these can affect your children’s health and how to limit exposure to these chemicals. Read on to learn more about PFAS and simple steps you can take to reduce your family’s exposure.
What are PFAS and why are they called “forever chemicals?”
PFAS stands for “perfluoroalkyl and polyfluoroalkyl substances, which are a group of human-made chemicals. PFAS have been used in many consumer and commercial products since the 1950s because they are durable and resistant to heat, grease, water and stains. They are known as the “forever chemicals” because they do not break down in the environment. As a result, they remain in soil and water for very long periods of time.
There are thousands of types of PFAS compounds. Two common types are:
PFOA (perfluorooctanoic acid)
PFOS (perfluorooctane sulfonic acid)
Where are PFAS found? How can my family be exposed?
The most common way PFAS can get into the body is when we eat or drink them. PFAS may be found in the following places:
Certain foods, like fish and shellfish raised in waters contaminated with PFAS, or wild game caught in areas with PFAS contamination.
Food packaging like pizza boxes, popcorn bags and fast-food containers may be coated with PFAS to prevent sticking and leakage.
Water supplies (including public water systems and private water wells) can be contaminated with PFAS from local industries or the use of firefighting foam.
Certain consumer products like non-stick cookware, stain-resistant carpeting and fabrics/textiles.
How long can PFAS stay in the body?
PFAS chemicals can remain in the body for many years.
How can PFAS affect health?
Scientific studies have shown a possible link between PFAS exposure and health issues such as higher cholesterol levels, decreased immune system response, thyroid changes, effects on the liver and risk of certain cancers.
How can I reduce my family’s exposure to PFAS?
While it is not possible to completely eliminate exposure to PFAS, since they are so widespread in the environment, there are ways to reduce your family’s exposure:
Drinking water: If you live in a community with water contamination, use a water filter that is certified to remove PFAS. Keep in mind that these filters need to be carefully maintained to be effective (check the manufacturer instructions). You can also check with your local water system to find out if the PFAS levels in your community have been reduced through filtration or changing the water source.
Infant formula: If you live in an area with PFAS concerns, use pre-mixed baby formula or mix it using alternative water sources that do not have PFAS.
Local fish and game advisories: Check your local fish advisories before eating locally-sourced fish or seafood or wild game.
Dust control: Since PFAS (and other chemicals) can build up in household dust, dust regularly using a wet mop or wet cloth on solid surfaces, and vacuum carpets.
Cookware: Get rid of any nonstick (“teflon”) pots and pans that are cracked or chipped. Safer alternatives for cooking include stainless steel and cast iron.
Popcorn: Instead of popcorn from microwavable bags, buy corn kernels and pop them on the stovetop or in a microwavable glass popcorn popper.
Food containers: Cut back on fast food and takeout containers, since many are coated with PFAS.
Textiles: Avoid buying stain-resistant carpets and upholstery.
Can PFAS exposure be detected in a blood test?
Yes. Special blood tests can be done to measure the amount of several PFAS compounds in blood. PFAS testing in adults and children has been done for public health research in communities across the United States. Nearly all people in the United States have a detectable level of PFAS in their bodies because of their widespread use and environmental contamination. Current studies are looking at the levels of PFAS in the blood of people using a contaminated water supply.
Should I ask my pediatrician to test my child’s blood for PFAS?
In July 2022, the National Academies of Science, Engineering, and Medicine (NASEM) released a report recommending that healthcare providers offer a PFAS blood test to those “likely to have a history of elevated exposure” to PFAS. Those who may have higher exposure to PFAS include people living in communities with PFAS-contaminated drinking water.
However, PFAS blood tests are typically not available at commercial or clinical laboratories, and are often not covered by insurance. At this time, results of the PFAS blood tests cannot be used to predict your risk of health effects from PFAS exposure but can compare your PFAS level to others in the United States.
My child had a PFAS blood test. What do the results mean?
The results of a PFAS blood test can be compared to the average levels in the blood of people in the United States. However, the results cannot be used to predict the risk of future health effects.
The NASEM report gave recommendations for medical follow-up in patients who had PFAS blood testing and were found to have levels higher than typical levels in the general population.
Is there a treatment to remove PFAS from the body?
No. There are currently no recommended treatments to remove PFAS from the body. The best treatment is to prevent future exposures as much as possible.
Can I breastfeed my baby if I have been exposed to PFAS?
Yes. Breastfeeding is the best option for infants in most cases. The advantages of breastfeeding for the lactating person and baby outweigh potential risks of PFAS exposure through breastmilk. Breastfeeding parents can reduce further exposure to PFAS by following the steps in the section above, “How can I reduce my family’s exposure to PFAS?”.
Can PFAS be removed from a drinking water supply?
Yes. There are ways to reduce PFAS levels in water systems with elevated levels of these chemicals. Some public water systems have installed state-of-the-art filters that remove PFAS and other chemicals. Others have found new sources of water that do not have elevated levels of PFAS. Households can use a water filter that is certified by NSF to remove PFAS.
If you use a private well for drinking water, check with your local health or environmental agency to see what water tests are recommended for your area (general water quality tests and special tests such as PFAS) and how to find an accredited laboratory to run the tests.
What is being done to reduce PFAS in water supplies across the country?
In June 2022, the Environmental Protection Agency (EPA) updated the federal “health advisory” levels for 4 different PFAS compounds in public water systems; however, this is not a required or enforceable standard. Several states have set their own enforceable limits for PFAS in public water systems, and the EPA will release an enforceable federal drinking water limit for PFAS by the end of 2023.
Yearly Consumer Confidence Reports are available so you can learn more about your local water system and review the most recent water testing results (which may contain PFAS results, depending on the state). If you have a private water well, learn more about what tests are recommended to ensure your well water is safe to drink. You can also find out if the Centers for Disease Control and Prevention (CDC) and the Agency for Toxic Substances and Disease Registry (ATSDR) are working on PFAS studies in your area.
Talk with your pediatrician
If you have questions about PFAS exposure, talk with your pediatrician. Your regional Pediatric Environmental Health Specialty Unit (PEHSU) have staff who can also talk with pediatricians and families about concerns over environmental toxins.
- Food Additives: What Parents Should Know
- Healthy Fish Choices for Kids
- Is Your Drinking Water Safe?
- Pediatric Environmental Health Specialty Units (PEHSU)
About Dr. Zajac
Lauren Zajac, MD, MPH, FAAP, an executive committee member of the American Academy of Pediatrics Council on Environmental Health and Climate Change, is an Associate Professor in the Department of Environmental Medicine and Public Health and the Department of Pediatrics at the Icahn School of Medicine at Mount Sinai. Dr. Zajac serves as a pediatrician at the Region 2 Pediatric Environmental Health Specialty Unit, serving New Jersey, New York, Puerto Rico and the U.S. Virgin Islands.