“My child’s commute to school is a half-hour ride, but it takes an hour for her to reach home everyday. The commute itself makes her so tired and the dust is so high during the after-school hour that her cough almost always worsens when she comes back home,” says Tanu, worried mother of a second-grade child in Bengaluru. Tanu is just one parent among the vast numbers across our cities, as air pollution puts their children’s health and well-being at grave risk.
In 2021, 15% of all global deaths in children under five were linked to air pollution. As per the World Health Organisation (WHO), 99% of the world’s population live in places where air pollution levels exceed WHO guideline limits. The ones paying the heaviest price are children and adolescents today, who are particularly affected as their organs and immunity are still developing.
A publication from the European Environment Agency points out that children breathe in more air and their breathing rate is higher than adults, as their metabolism is higher as well. Owing to their smaller body proportion, they are also closer to the ground, where they inhale large proportions of pollutants faster.
Citizen Matters analysed 35 such research studies and publications to assess the impact of poor air quality on children, and spoke to parents, paediatricians and air quality experts. Sadly, the future does not look promising.
The unborn ain’t spared either
The impact starts from even before birth today. For the longest time, the placenta protected the unborn child from various environmental threats. But the intensity and prolonged exposure of the mother to air pollution is changing this.
Prof Dr Arvind Kumar, founder trustee of Lung Care Foundation, New Delhi, affirms that there is no particular section of society that is not impacted by air pollution and that the impact starts in the womb for all and will haunt them throughout life.
“Research finds fine metal particles and toxins in the cord blood during the gestational period. This shows that the impact of air pollution is the same as engaging in active smoking during pregnancy,” said Dr Aparna Birajdar, consultant pulmonologist, Pune, adding that these particles are now crossing the placental barriers and affecting the unborn baby and its lung development.
The United Nations Children’s Fund (UNICEF) states that air pollution accounts for 26% of newborn deaths worldwide, most related to complications of low birth weight and preterm birth. “Birth complications are directly related to birth weight. Lower birth weight would mean difficulty in maintaining temperatures, longer stays in ICUs, breathing difficulties, higher probability of getting jaundice and many other complications,” says Dr Samantha Castellino, pediatric consultant, Giggles Child Health Clinic, Mumbai.
“Along with physical health complications, premature birth impacts cognitive and neurodevelopment in the newborn,” added Dr Prahlad Kadambi, junior consultant neonatology & pediatrics, Apollo Cradle & Children’s Hospital, Bengaluru. In 2021 lower respiratory infections were the second leading cause of death (14.37%) in infants aged below 5 years in India.
Downhill road: Impact after birth
WHO and UNICEF recommend exclusive breastfeeding for the first six months for optimal growth and health of the baby. However, recent studies from South California show a change in composition in breast milk, correlated with exposure to increased ambient air pollution and even traces of black carbon (study from Belgium). Several doctors I spoke to mentioned that while this has not been immediately observed in India, the threat isn’t too far away either.
Drawing upon their experiences, experts from Bengaluru, Delhi, Mumbai and Pune that we spoke to for this report talked about a significant 15-20% rise in children with respiratory issues coming in for treatment in the last five years. “When the AQI (Air Quality Index) gets worse in Mumbai, we needn’t even wait for the media to report it. We will anyway start seeing an influx of patients with respiratory issues,” says Dr Samantha.
Children born today are developing asthma, allergic rhinitis, allergic conjunctivitis, bronchitis, acute respiratory infections, immune deficiency and related conditions too easily. “I see a lot of eczema and pollutant allergy cases from the city on a daily basis. Today’s children’s lungs are not developing effectively and air pollution is a major causal factor here,” says Dr Vijay Warad, director of Indian Allergy Asthma Network, Pune.
Read more: Bengaluru school kids breathe polluted air, shows study
“In my 30 years of experience, I have seen the colour of lungs change from bright pink to having black spots in them. The youngest patient I operated on for lung cancer was only 24 years old,” said Dr Arvind.
Cases of childhood cancer are also on the rise with air pollution being a major contributory factor. “A lot of air pollutants are heavy with carcinogens (cancer causing agents). Exposure has begun now, we will start seeing more numbers in 10 years,” said Dr Samantha.
Significant carcinogenic air pollutants
- PM 2.5 and PM 10
- Tobacco smoke
- Asbestos (used mainly in construction)
- Radon (naturally occurring radioactive gas)
- Formaldehyde (chemical used in building materials and products)
- Some pesticides
- Some chemicals like benzene, arsenic found in industrial emissions, cigarette smoke etc
Conditions afflicting children
Chronic Obstructive Pulmonary Disease (COPD) is a long-term lung condition which makes breathing harder, and typically affects people aged 40 and older. However, conditions as intense as COPD are being diagnosed in children today. “Non-smoking causal factors have crossed smoking causal factors for COPD in India, reflecting the role of air pollution here,” said Dr Aparna.
“I have treated four patients in their early 20s with conditions similar to COPD,” added Dr Vijay. Air pollution also has adverse impact on cardiovascular health; exposure is linked to the exacerbation of all major Cardiovascular Diseases (CVDs), including Ischemic heart disease (IHD) and stroke. Studies show that pollution is responsible for nearly 1 in 3 CVD-related deaths in South Asia. Experts strongly agree that children today are at a definite risk of developing COPD and CVD-like conditions as adults or even sooner.
Air pollutants also compromise the child’s immune system against pathogens in the respiratory tract. It is expected to affect child growth and development through its impact on the loss of nutrients when fighting infectious agents.
Rising pneumonia cases is a steady pattern observed across cities in India. Globally, pneumonia is the leading infectious cause of paediatric mortality, especially among children under the age of 5 years. In 2019, pneumonia accounted for 14% of the deaths among children under the age of 5 years and 22% of the deaths among children aged 1–5 years. “Pollutants cause changes in bacteria, viruses and fungi, making them more potent and resistant. Morbidity of pneumonia is rising and air pollution is a factor that cannot be overlooked,” said Dr Vijay.
Cognitive and neurodevelopmental risks
Children in polluted cities are also showing detrimental effects on the brain. Children living in cities may show differences in how their brains develop, both in the physical structure and the overall volume. Their bodies might also depict signs of increased inflammation, which is like an overactive immune response.
These changes can affect their senses, making it harder for them to smell things, hear properly, and keep their balance. The main mechanisms involved in brain damage associated with Particulate Matter (PM) include the breakdown of nasal and olfactory pathways (that activates your sense of smell) and the alveolo-capillary pathway (part of lungs where oxygen enters the bloodstream).
“Physical, mental and social wellbeing of children are affected owing to air pollution. Absence of disease does not indicate well being,” says Dr Preeti Galagali, Vice President, south zone, Indian Academy of Paediatrics. Air pollution does not affect the child’s health alone, it extends to affect every aspect of their life, obstructing their overall growth and development.
Immature births and low birth weight have an impact on neurodevelopment, increasing the probability of cognitive issues in children. These include autism, Attention Deficit Hyperactivity Disorder (ADHD), hypertension etc. Additionally, when children fall sick too often — coughing all night or have difficulty breathing — their sleep and rest are impacted, leading to low concentration, and mood disorders like anxiety and depression.
“I’m worried about sending my children anywhere else after school, even to play. Both my children already have asthma, and when they stay out more it worsens at night; keeping them awake,” shares Raju, father of two children, one in the fifth grade and one in the ninth, in Bengaluru.
“Due to bad air, children are playing less outside and are more glued to their digital devices these days. This is leading to delayed speech and development which is raising symptoms of ADHD and autism spectrum disorders, which were primarily genetic disorders,” said Dr Preeti.
“Hardly any organ in children is unaffected by air pollution. It is responsible for eye problems, skin allergies, diabetes, obesity, heart attacks, brain attacks, faster aging, congenital defects and the list goes on and on. It starts weakening our lungs and immunity making our body more vulnerable to every possible health issue,” said Dr Arvind.
What does the future hold?
There are countless papers and research highlighting the fact that air pollution is a massive health emergency which needs immediate action, yet we see minimal work or funding in that direction.
“The minute particles we are breathing are affecting every organ in our and our children’s bodies. You want to reduce air pollution impact, stop creating air pollution. We have less than 10 years to ensure that our children are not born with a doomed future,” said Dr Harsha G, PG in paediatrics, MVJ Hospital, Bengaluru.