A network of experts in reproductive and children’s environmental health

Children’s Health in the Aftermath of Floods

Children are different from adults. They may be more vulnerable to chemicals and organisms they are exposed to in the environment because:
 
  • Children’s nervous, immune, digestive and other bodily systems are still developing and are more easily harmed;
  • Children eat more food, drink more fluids, and breathe more air than adults in proportion to their body size – so it is important to take extra care to ensure the safety of their food, drink and air;
  • The way children behave – such as crawling and placing objects in their mouths – can increase their risk of exposure to chemicals and organisms in the environment.
Even adolescents are still in the formative part of their lives when they are more vulnerable to environmental hazards than are adults.i Their brains, lungs, endocrine system and other parts of the body are still developing; and therefore, more vulnerable to chemical, physical and biological toxicants that they can encounter in their environment.
 
Choose from the topics below to learn more about potential hazards to children's health after floods:
 
Also, find a Pediatric Environmental Health Specialty Unit (PEHSU) in your area.
 

Children, Adolescents, & Pregnant Women Should Not Participate in Flood Cleanup Activities

Places that have been flooded – open lots or building of any type – should be considered as hazardous sites. These places may contain chemicals, mold, damaged building materials that are structurally unsafe, vermin, including poisonous snakes, and other hazards. Depending on the post-flood weather, specifically temperature and humidity, there are risks of hypo- or hyper-thermia (body temperatures that are too low or too high). Adults working at such sites must be properly trained to deal with the potential hazards and must wear appropriate personal protective equipment
 
Many chemicals cross the placenta from a pregnant women into the fetus. Moreover, should a pregnant woman become ill or injured as a result of working in a hazardous cleanup environment, the health of the fetus may be compromised. In addition, it may be difficult to provide pregnant women with well-fitting personal protective equipment. For all of these reasons, we strongly recommend that pregnant women not participate in cleanup activities.
 
While civic organizations, religious organizations or schools want to provide their children and adolescents with opportunities for community service, disaster cleanup should not be an option. The adults who supervise children and adolescents almost never receive training about cleanup of hazardous sites, which means the children and adolescents also don’t get that training. Usually, appropriately sized personal protective equipment cannot be provided for the children and adolescents who would be involved. Children, and many adolescents, will not have the judgment capacity to determine what is safe for them to do as they move through a post-disaster cleanup site. 

Toxic materials can hitch a ride to a volunteers’ (or workers’) home and family, on their hair, skin, clothing and shoes.ii,iii To protect their families, adult workers should have PPE which they put on before entering the site and remove before returning home. Workers need to be able to leave their shoes at the worksite. (Workers also need the opportunity to wash before eating during lunch and breaks so that they do not ingest toxic materials with their food.)
 

Mold

After homes have been flooded, moisture can remain in drywall, wood furniture, cloth, carpet, and other household items and surfaces and can lead to mold growth. Exposure to mold can cause hay-fever-like reactions (such as stuffy nose, red, watery or itchy eyes, sneezing) to asthma attacks. It is important to dry water-damaged areas and items promptly to prevent mold growth. Buildings wet for more than 48 hours will generally contain visible and extensive mold growth.

Some children are more susceptible than others to mold, especially those with allergies, asthma and other respiratory conditions. To protect your child from mold exposure, you can clean smooth, hard surfaces such as metal and plastics with soap and water and dry thoroughly. Flood water damaged items made of more absorbent materials cannot be cleaned and should be discarded. These items include paper, cloth, wood, upholstery, carpets, padding, curtains, clothes, stuffed animals, etc.

If there is a large amount of mold, you may want to hire professional help to clean up the mold. If you decide to do the cleanup yourself, please remember:

  • Clean and dry hard surfaces such as showers, tubs, and kitchen countertops.
  • If something is moldy, and can't be cleaned and dried, throw it away.
  • Use a detergent or use a cleaner that kills germs.
  • Do not mix cleaning products together or add bleach to other chemicals.
  • Wear an N-95 respirator, goggles, gloves so that you don't touch mold with your bare hands, also wear long pants, a long-sleeved shirt, and boots or work shoes.
Homes, apartments, childcare centers, schools and other buildings that have sustained heavy water damage will be extremely difficult to clean and will require extensive repair or complete remodeling. It is strongly advised that children not stay in these buildings. Find EPA mold resources, read the Environmental Protection Agency’s (EPA) brochure, "Flood Cleanup and the Air in Your Home," or refer to this PEHSU fact sheet to learn more about mold in homes and schools.
 

Carbon Monoxide Poisoning and Portable Generators

Due to loss of electricity, gasoline- or diesel-powered generators may be used in the aftermath of floods. NEVER use portable generators indoors! Place generators outside and as far away from buildings as possible. Do not put portable generators on balconies or near doors, vents, or windows and do not use them near where you or your children are sleeping. Likewise, charcoal grills and kerosene cooking devices should not be used indoors for heating or cooking; and gas ovens should not be used for heating purposes. These devices release carbon monoxide, a colorless, odorless and deadly gas. Simply opening doors and windows or using fans will not prevent carbon monoxide buildup in the home or in partially enclosed areas such as a garage. From 1999 to 2012, each year an average of nearly 2,300 people were hospitalized due to unintentional, non-fire-related carbon monoxide poisoning.iv Of all deaths from unintentional, non-fire-related carbon monoxide poisonings in the United States during this period, 61% of these fatal exposures occurred in the home.v Children and young adults  (< 17 years of age) are especially vulnerable with an incidence of 25.7 per 1 million people.vi

If your children or anyone else in your family starts to feel sick, dizzy or weak or experiences a headache, chest pain or confusion, get to fresh air immediately and seek medical care as soon as possible. Fetuses and infants are especially vulnerable to the life-threatening effects of carbon monoxide.

Install a carbon monoxide detector that is Nationally Recognized Testing Laboratory (NRTL) approved (such as UL). These are generally available at local hardware stores. Carbon monoxide is lighter than air, so detectors should be placed closer to the ceiling. Detectors should be placed close enough to sleeping areas to be heard by sleeping household members.

Learn more about carbon monoxide from the PEHSUs, American Academy of Pediatrics (AAP), the Centers for Disease Control and Prevention (CDC), and the EPA.

Contaminated Drinking Water

While all people need safe drinking water, it is especially important for children because they are more vulnerable to harm from contaminated drinking water. If a tap water source is potentially contaminated with flood waters, children, pregnant women and nursing mothers should drink only bottled water, which should also be used to mix baby formula and for cooking. We also recommend you sponge bathe your children with warm bottled water until you are certain your tap water is safe to drink.

Your child may or may not show symptoms or become ill from swallowing small amounts of contaminated drinking water. Symptoms can vary by contaminant. If your child drinks water contaminated with disease-causing organisms, he/she may come down with symptoms similar to the “stomach flu.” These include stomach ache, nausea, vomiting, and diarrhea, and possibly dehydration.

Some contaminants, such as pesticides and gasoline, may cause the water to smell and taste strange, and others such as lead and disease-causing organisms may not be detectable. Drinking water contaminated with chemicals such as lead or gasoline may not cause immediate symptoms or cause your child to become ill but could still potentially harm your child’s developing brain or immune system.
 
Because you cannot be sure if your tap water is safe until private wells are professionally tested or city water is certified as safe by local officials, we urge parents to take every precaution to make sure their child’s drinking water is safe.

Private Wells: If you have a flooded well, do NOT turn on the pump, and do NOT flush the well with water. Contact your local or state health department or agriculture extension agent for specific advice on disinfecting your well. View more information on how to manage a flooded well.

Public/City Water Supply: Your public water system or local health agency will inform you if you need to boil water prior to using it for drinking and cooking. View additional information about emergency disinfection of drinking water.

Tap water that has been brought to a rolling boil for at least 1 minute will kill disease-causing organisms. Boiling will not remove many potentially harmful chemicals, and may actually increase concentrations of heavy metals (including lead), which can be harmful to a child’s developing brain. Chemically treating tap water with either chlorine or iodine will kill many disease-causing organisms, but will not remove harmful chemicals or heavy metals.
 
For more detail on disinfecting contaminated drinking water by boiling or by using liquid chlorine bleach consult this guidance from the Washington State Department of Health

Health professionals can learn more about lead in drinking water in this fact sheet from the PEHSUs.

Household Items Contaminated by Floodwaters

Drinking Water Containers: Clean thoroughly with soap and water, then rinse. For gallon-sized containers, add approximately 1 teaspoon of bleach to a gallon of water to make a bleach solution. Cover the container and agitate the bleach solution thoroughly, allowing it to contact all inside surfaces. Cover and let stand for 30 minutes, then rinse with purified and/or uncontaminated water.

Kitchenware and Utensils: In general, metal and glazed ceramic that are thoroughly washed and dried can be sanitized and kept. Follow local public health guidance on effective and safe sanitation procedures. Wood items must be thrown away, as these items can absorb contaminants or grow mold from the exposure to flood water and they cannot be properly sanitized.

Children's Toys and Baby items: Throw away ALL soft or absorbent toys because it is impossible to clean them and they could harm your child. Throw away ALL baby bottles (unless glass bottles are sterilized), nipples, and pacifiers that have come in contact with flood waters or debris.
 

Other Flood Topics

Older Adults and People Living with Chronic Diseases: Flooding often leads to the development of micro-organisms and the release of dangerous chemicals in the air and water. Older adults and people living with chronic diseases are especially vulnerable to these contaminants.

Bleach: Household bleach contains chlorine, a very corrosive chemical which can be harmful if swallowed or inhaled. It is one of the most common cleaners accidentally swallowed by children. Children – especially those with asthma – should not be in the room while using these products. Call Poison Control at (800) 222-1222 immediately in case of poisoning.

Formerly Flooded or Debris-filled Areas: Children in these areas may be at risk of exposure to dirt and debris that may have been contaminated with hazardous chemicals like lead, asbestos, oil and gasoline. Children can be exposed by direct contact through their skin, by breathing in dust particles or fumes, or by putting their hands in their mouths.

Mosquitoes and Disease-Causing Pests: Receding flood water may increase the number of mosquitoes and other disease-causing pests. To protect your child, ensure that they use insect repellents containing up to 30% DEET (N,N-Diethyl-meta-toluamide), Picardin, or Oil of Lemon Eucalyptus. The AAP recommends that DEET not be used on infants less than 2 months of age and that Oil of Lemon Eucalyptus not be used on children under 3 years of age. Other ways to protect children include staying indoors while the sun is down, wearing light colored, long sleeved shirts and pants, covering baby carriages and playpens with mosquito netting, clear areas of standing water, and empty water from flower pots and other containers.

The AAP has more information on selecting an insect repellent for children.
 

PEHSU National Fact Sheets 

The PEHSU network has created the following fact sheets to assist parents and families in the aftermath of flooding: 
 

Other Helpful Resources 

For Health Professionals
For the General Public
For State/Local Government
 
The content on this page is based on information provided by the US Environmental Protection Agency, http://www.epa.gov/children.

i Hubal, E. A. C., de Wet, T., Du Toit, L., Firestone, M. P., Ruchirawat, M., van Engelen, J., & Vickers, C. (2014). Identifying important life stages for monitoring and assessing risks from exposures to environmental contaminants: results of a World Health Organization review. Regulatory Toxicology and Pharmacology, 69(1), 113-124.
ii Zirschky, J. (1996). Take-home toxin pathway. Journal of Environmental Engineering, 122(5), 430-436.
iii Sattler, B., & Davis, A. D. B. (2008). Nurses' role in children's environmental health protection. Pediatric nursing, 34(4), 329.
iv Sircar, K., Clower, J., Shin, M., Bailey, C., King, M., & Yip, F. (2015). Carbon monoxide poisoning deaths in the United States, 1999 to 2012,. The American Journal of Emergency Medicine33(9), 1140–1145. 
v Sircar, K., Clower, J., Shin, M., Bailey, C., King, M., & Yip, F. (2015). Carbon monoxide poisoning deaths in the United States, 1999 to 2012,. The American Journal of Emergency Medicine33(9), 1140–1145.
vi Centers for Disease Control and Prevention. (2011). Carbon monoxide exposures---United States, 2000--2009. MMWR: Morbidity and mortality weekly report, 60(30), 1014-1017.