Arsenic
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Arsenic occurs naturally in our environment. It can get into soil and groundwater from agricultural and industrial activities. Inorganic arsenic is toxic and can cause cancer. The biggest health risks from exposure to inorganic arsenic occur during pregnancy, infancy and early childhood.
Children can be exposed to arsenic by:
- Drinking arsenic-contaminated well water.
- Eating rice-based cereals, snacks, baby formula made with rice, foods made with brown rice syrup, juices, apple juice and other foods contaminated with arsenic.
- Ingesting contaminated soil or dust.
Young children have very small bodies and eat more food per pound of body weight than adults as they grow. As a result, they get more arsenic from food or drinks compared to adults. Babies and young children can be more sensitive to the harmful effects of arsenic because their bodies are rapidly growing. They may not have fully developed systems to get rid of harmful chemicals compared to adults.
Arsenic over time can lead to:
- Lower IQ
- Impaired brain development
- Growth problems
- Breathing problems
- An unhealthy immune system
- Cancer as an adult
Arsenic can cross the placenta, which means that a pregnant woman’s arsenic exposure through food and water may affect her baby’s growth and development or lead to health problems later in his or her life.
Family and Communities
Prevention is Key for Ensuring Child Safety Amid Arsenic Hazards
If you're concerned about arsenic in your child's food, talk with your pediatrician.
Vary the grains in your child's diet. Rice cereal fortified with iron is a good source of nutrients. However, rice can absorb more arsenic from groundwater than other crops. Rice cereal does not need to be the only or even your baby’s first cereal. Other options you can introduce as first foods can include oat, barley and multigrain cereals.
Serve a wide range of foods to your family. A variety of nutrients support healthy growth and development. While rice can be a part of a child’s balanced diet, make sure to include other grains such as oats, barley, wheat and corn.
Do not use rice milk as a dairy substitute for cow's milk. In many cases, dairy-sensitive children can be given other dietary sources of calcium instead of rice milk, a highly processed dairy substitute. Also, avoid brown rice syrup as a sweetener in processed foods for kids. Arsenic in rice is concentrated in rice syrup, which is sometimes used as a sweetener in toddler snacks or puffs.
Limit fruit juices. Concerns have also been raised about arsenic in apple juice and other juice products. Infants can be encouraged to eat whole fruits that are mashed or pureed. Toddlers and young children can be encouraged to eat whole fruits instead of juice.
If your family's drinking water comes from a private well, test your water in the spring or early summer. The EPA recommends water tests for families. In areas with elevated levels of arsenic in drinking water, consider drinking bottled water. Boiling does not remove arsenic and most filtration systems do not remove arsenic.
Make sure young children wash their hands after playing outside. Soil and old playground equipment, decks, and picnic tables can sometimes have arsenic from an older method to pressure-treat wood. Ask whether wood in your home or playground has been treated with Chromated Copper Arsenate (CCA). Try to prevent children from eating dirt or putting their hands in their mouth when playing outside. Wash fruits and vegetables before eating or cooking.
Avoid smoking, as arsenic (and other toxins) can be found in cigarette smoke.
Avoid playing in areas of potentially contaminated soil (like former industrial sites or hazardous waste sites). If exposed to potentially contaminated soil, wash hands thoroughly with soap and water.
Tips to Reduce Arsenic in Your Baby’s Diet – HealthyChildren.org
Your regional Pediatric Environmental Health Specialty Unit (PEHSU) has staff who can also talk with clinicians and/or parents/caregivers about concerns over environmental toxins. Find an expert link
Health Professionals
Health professionals are encouraged to follow the guidance below to help navigate discussions with patients and families who are concerned about arsenic exposure in children.
In addition to being naturally present in the environment, arsenic has also been used for many years for industrial purposes, including:
- pest control,
- animal antimicrobial treatment,
- wood preservation,
- petroleum refining, and
- in the mining/smelting industries.
Release of arsenic through these processes can lead to increased inorganic arsenic in the atmosphere, in water, and in soil. Workers in industrial processes and communities near these industries may have a higher rate of exposure. Arsenic has been reported in imported folk or homeopathic remedies.
Clinical effects are different for acute versus chronic exposures.
Arsenic can impact every organ system. The primary targets are the gastrointestinal tract and skin due to the high metabolic rates in those organs.
Early childhood exposure is linked to increased risk of infection, bronchiectasis, altered hepatic function, neurodevelopment and cognitive effects, skin changes (eczema eruptions, hyperkeratosis and hyperpigmentation) and increased risk of skin cancer. Arsenic toxicity may be worse in children who are chronically malnourished, especially those with deficiencies in methionine, zinc, folate, vitamin A and/or selenium.
Prenatal exposure can lead to spontaneous abortion, stillbirth, preterm birth, and later a risk of neurodevelopmental disorders and cancer.
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Acute, high-dose exposure |
Chronic exposure |
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Nausea, vomiting, hematemesis, diarrhea, anorexia, weight loss, bone marrow suppression, cardiac dysfunction and sensorimotor peripheral neuropathy (stocking-glove distribution that may mimic Guillain-Barre). |
Increase risk of bladder, lung, and skin cancers |
Diagnose and treat arsenic exposure.
- Timed urine collection for 8 to 24 hours is the best diagnostic test. “Speciation” of the arsenic is mandatory to determine if the patient has been exposed to the toxic “inorganic” form of arsenic or the relatively non-toxic “organic” form of arsenic.
- The patient should avoid consuming seafood for at least 5 days prior to collecting the urine sample to rule out the contribution of the organic arsenic commonly found in many types of seafood.
- Hair and fingernail analysis have not been validated and are not recommended.
- Children suspected of having had significant arsenic exposure should be referred immediately to a medical toxicologist, Poison Control Center, or Pediatric Environmental Health Specialty Unit for possible chelation therapy.
Prevention and Risk-Reduction Communication
Health professionals can:
- Share recommendations in the family and community section (anchor) to communicate to patients.
- Consult with local or state environmental health agencies to determine the potential
for arsenic in drinking water, especially important for private well users, as these
systems are not regulated by EPA. - Consult with your regional PEHSU unit for additional guidance relevant to your state or community.
The PEHSU Environmental Health Toolkit offers anticipatory guidance at specific ages.
Additional Resources
- Arsenic Toxicity: Where is Arsenic Found? | Environmental Medicine | ATSDR (cdc.gov) – Information on where arsenic is found both naturally and manmade
- Pediatric Environmental Health, 4th Edition – AAP Policy Manual
- PEHSU Fact Sheet: Arsenic in Food – PEHSU Resource
- What You Can Do to Limit Exposure to Arsenic: Tips to Limit Exposure to Arsenic – FDA Resource
Regional PEHSU Resources
- Region 2 Pediatric Environmental Health Specialty Unit – PDF on heavy metals in baby food and juices.
- Region 4 Pediatric Environmental Health Specialty Unit – Information on arsenic exposure and how to reduce it.
- Region 5 Pediatric Environmental Health Unit – Guides on environmental exposure to arsenic and other contaminants.
- Region 8 Pediatric Environmental Health Specialty Unit – Information sheets on arsenic.
Updated July 9, 2024
Funder Disclaimer
The Pediatric Environmental Health Specialty Units (PEHSU) are supported by cooperative agreement FAIN: NU61TS000356 with the Centers for Disease Control and Prevention/Agency for Toxic Substances and Disease Registry (CDC/ATSDR). The U.S. Environmental Protection Agency (EPA) also provides support through Inter-Agency Agreement 24TSS2400078 with CDC/ATSDR. The Public Health Institute supports the PEHSU as the National Program Office. The content on this website has not been formally disseminated by CDC/ATSDR or the EPA and should not be construed to represent any agency determination or policy. Use of trade names that may be mentioned is for identification only and does not imply endorsement by the CDC/ATSDR or EPA.
The information contained on this website should not be used as a substitute for the medical care and advice of your/your child’s primary care provider. There may be variations in treatment that your provider may recommend based on individual facts and circumstances.