Concerns About Probiotics Containing Plasticizers in Children

Children consuming probiotics containing plasticizers?

Hello Dr.
Hsiao,
I have two children (a daughter in fourth grade and a son in second grade) who have been taking probiotics containing phthalates at 794 ppm for a year and a half (approximately one packet every two days).
Currently, my daughter in fourth grade has a slight breast development, and my son in second grade has a normal length of his external genitalia.
What kind of examinations should I take them for?

Miss Wang, 30~39 year old female. Ask Date: 2011/06/02

Dr. Xiao Kaiwen reply Pediatrics

Attached is the latest statement from the Taiwan Pediatric Association regarding recommendations for health screening of children suspected of exposure to phthalate plasticizers, dated June 1, 2011.
1.
Research from various countries indicates that populations worldwide may be exposed to varying levels of phthalate compounds, which can originate from food, medical devices, toys, and environmental air.
Relevant authorities should continue monitoring and controlling these potential sources of exposure.
2.
Although research on the effects of phthalate compounds on human health is not yet comprehensive, studies consistently show that fetuses and children are the most vulnerable groups, particularly since these compounds exhibit anti-androgenic effects that may impact sexual function.
The government should enhance safety inspections for children's food, medications, and toys.
3.
Normal children only need to focus on balanced nutrition and appropriate diets, without the need for special health supplements, to reduce the risk of exposure to specific compounds.
4.
Recommendations from the expert meeting of the Taiwan Pediatric Association for healthcare professionals and the general public are included in Attachments 1 and 2, and a list of pediatric endocrinologists is provided in Attachment 3.
Note: Phthalate substances include DEHP, DINP, DNOP, DIDP, DBP, BBP, among others.
Attachment 1: Recommendations for Health Screening of Children Suspected of Exposure to Phthalate Plasticizers (for Pediatric Healthcare Professionals)
1.
General Examination:
- Height and Weight: Monitor if within normal ranges.
- General Physical Examination: Includes checks of the throat, neck, lungs, heart, liver, spleen, and genitals.
2.
Attention to Abnormal Signs in Boys:
- Gynecomastia: Note that overweight boys may have enlarged but drooping breasts, which could be due to lipomastia rather than glandular tissue proliferation.
During examination, boys should raise their arms fully, and palpation should be performed to check for any hard lumps beneath the areola indicating glandular development.
- Check for abnormalities such as hypospadias or cryptorchidism.
- Assess sexual development abnormalities:
a.
Newborns: A penile length of less than or equal to 2 cm may be abnormal.
b.
Ages 1 month - 13 years: Evaluate the appearance of the external genitalia for abnormalities.
c.
Age 14 and older: Secondary sexual characteristics should appear, including testicular enlargement (longest diameter should be greater than or equal to 2.5 cm), penile lengthening, and pubic hair development.
d.
Measurement of penile length: Compress the skin around the penis down to the pubic area, straighten it, and measure with a ruler.
3.
Attention to Abnormal Signs in Girls:
- If secondary sexual characteristics appear before age 8, this may be abnormal, including breast development or pubic hair, or if menstruation occurs before age 10.
4.
Consider blood tests to assess liver and kidney function as needed.
5.
If significant abnormalities are noted, refer to a pediatric endocrinologist for further evaluation.
6.
Phthalate compounds are rapidly metabolized and their concentrations in the body do not reflect potential impacts on health; therefore, testing for blood or other bodily fluid concentrations is not recommended.
Attachment 2: Public Recommendations Regarding Phthalate Plasticizer Contamination Events
1.
Currently, there is no definitive research data showing the effects of phthalate exposure on children; more studies are needed to clarify this.
2.
For children's food and medications, please use products certified by health authorities as free from contamination risks.
3.
Substances like plasticizers are continuously metabolized and expelled from the body and do not accumulate long-term.
4.
If children exhibit the following conditions, it is recommended to consult a pediatric specialist:
- Boys over 14 years without secondary sexual characteristics, including testicular enlargement (longest diameter should be greater than or equal to 2.5 cm), penile lengthening, or pubic hair development.
- Girls under 8 years showing secondary sexual characteristics, including breast development or pubic hair, or menstruation before age 10.
- Confirmed long-term high-level exposure to phthalates or similar compounds.
Attachment 3: List of Pediatric Endocrinologists
Name | Region | Current Position
--- | --- | ---
Zhu De-Ming | Taipei City | Tri-Service General Hospital
Li Zheng-Ting | Taipei City | National Taiwan University Hospital
Li Jun-Xian | Taipei City | National Taiwan University Hospital
Tong Yi-Jing | Taipei City | National Taiwan University Hospital
Cai Wen-You | Taipei City | National Taiwan University Hospital
Xiao Pei-Hong | Taipei City | National Taiwan University Hospital
Yan Rui-Long | Taipei City | Taipei City Hospital
Niu Dao-Ming | Taipei City | Taipei Veterans General Hospital
Yang Chen | Taipei City | Taipei Medical University
Xu Xun-Hui | Taipei City | Taipei Medical University Hospital
Li Yan-Jin | Taipei City | Mackay Memorial Hospital
Huang Qi-Yu | Taipei City, Taitung City | Mackay Memorial Hospital, Taitung Mackay Memorial Hospital
Ding Wei-Xin | Taipei City, New Taipei City | Mackay Memorial Hospital, Tamsui Mackay Memorial Hospital
Hou Jia-Wei | Taipei City | Cathay General Hospital
Fan Yang-Hao | Taoyuan County | Linkou Chang Gung Memorial Hospital
Lin Guo-Feng | Taoyuan County | Linkou Chang Gung Memorial Hospital
Xu Bing-Yi | Hsinchu City | Hsinchu Hospital, Ministry of Health and Welfare

Reply Date: 2011/06/02

More Info

The concerns regarding the consumption of probiotics containing plasticizers, particularly phthalates, in children are indeed significant. Phthalates are a group of chemicals used to make plastics more flexible and harder to break. They are commonly found in various products, including food packaging, toys, and personal care items. Research has indicated that exposure to phthalates can have adverse effects on health, especially in vulnerable populations such as children.

Given your situation, where your children have been consuming probiotics with a plasticizer concentration of 794 ppm for an extended period, it is crucial to take appropriate steps to assess their health. The symptoms you mentioned, such as breast development in your daughter and concerns about your son's genital development, warrant immediate medical attention.

Recommended Actions:
1. Consult a Pediatrician: The first step is to schedule an appointment with a pediatrician who can evaluate your children's overall health and development. It is essential to discuss the specific concerns regarding their exposure to probiotics containing plasticizers.

2. Endocrine Evaluation: Given the potential effects of phthalates on hormonal development, it may be advisable to refer your children to a pediatric endocrinologist. They can perform a thorough assessment of their growth and sexual development. This may include:
- Physical Examination: A comprehensive physical examination to assess secondary sexual characteristics and overall growth patterns.

- Growth Measurements: Monitoring height and weight to ensure they are within normal ranges for their age.

- Genital Examination: For your son, a detailed examination of the genitalia to check for any abnormalities in size or development.

3. Blood Tests: While measuring the levels of phthalates in the body is not typically recommended due to their rapid metabolism and excretion, blood tests may be useful to evaluate liver and kidney function, as well as hormone levels. This can help identify any potential endocrine disruptions.

4. Monitoring Symptoms: Keep a detailed record of any changes in your children's health, including physical development, behavioral changes, or any other symptoms that may arise. This information will be valuable for the healthcare provider.

5. Discontinue Use of the Probiotics: It is advisable to stop giving your children the probiotics containing plasticizers immediately. Discuss alternative options with your pediatrician that do not contain harmful substances.

Understanding the Risks:
Research indicates that phthalates can disrupt endocrine function, potentially leading to developmental issues in children. They are known to have anti-androgenic effects, which can interfere with normal sexual development. In boys, exposure to phthalates has been associated with conditions such as hypospadias and cryptorchidism, while in girls, early breast development (thelarche) can occur.

Conclusion:
In summary, it is crucial to take your concerns seriously and seek medical advice promptly. The potential impact of plasticizers on children's health, particularly regarding hormonal development, cannot be overlooked. By consulting with healthcare professionals and taking appropriate measures, you can ensure that your children receive the necessary evaluations and care. Always prioritize their health and well-being by being vigilant about the products they consume and their potential risks.

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