Exposure to Perfluorinated Alkyl Substances and Health Outcomes in Children: A Systematic Review of the Epidemiologic Literature
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Perfluoroalkyl substances (PFAS), chemicals used to make products stain and stick resistant, have been linked to health effects in adults and adverse birth outcomes. A growing body of literature also addresses health effects in children exposed to PFAS. This review summarizes the epidemiologic evidence for relationships between prenatal and/or childhood exposure to PFAS and health outcomes in children as well as to provide a risk of bias analysis of the literature. A systematic review was performed by searching PubMed for studies on PFAS and child health outcomes. We identified 64 studies for inclusion and performed risk of bias analysis on those studies. We determined that risk of bias across studies was low to moderate. Six categories of health outcomes emerged. These were: immunity/infection/asthma, cardio-metabolic, neurodevelopmental/attention, thyroid, renal, and puberty onset. While there are a limited number of studies for any one particular health outcome, there is evidence for positive associations between PFAS and dyslipidemia, immunity (including vaccine response and asthma), renal function, and age at menarche. One finding of note is that while PFASs are mixtures of multiple compounds few studies examine them as such, therefore the role of these compounds as complex mixtures remains largely unknown.
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Several epidemiological studies have reported positive associations between PFAS exposure and the prevalence of ADHD or impulsivity in children, but the current evidence base is inconsistent and insufficient for inferring causality between developmental exposure to long-chain PFAS and adverse neurobehavioral outcomes in humans.
“Several epidemiological studies have also reported positive associations between PFAS exposure and the prevalence of ADHD or impulsivity in children, however the current evidence base is inconsistent, and is insufficient for inferring causality between developmental exposure to long-chain PFAS and adverse neurobehavioral outcomes humans (Rappazzo et al., 2017; Cao and Ng, 2021).”
From A Critical Review and Meta-Analysis of Impacts of Per- and Polyfluorinated Substances on the Brain and Behavior (2022) · cites this paper as Rappazzo et al., 2017
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- Authors
- Rappazzo, K., Coffman, E., & Hines, E.
- Affiliations
- Environmental Protection Agency (US)
- Corresponding author
- Hines, Erin
- Venue
- International Journal of Environmental Research and Public Health
- Publisher
- MDPI AG
- Published
- 2017-06-27
- Volume
- 14
- Issue
- 7
- Pages
- 691
- ISSN
- 1660-4601 (ISSN-L)
- PMC
- PMC5551129
- OpenAlex
- W2666354105
- Cited by
- 405
- References
- 118
- Citations by year
- 2026: 44 · 2025: 57 · 2024: 50 · 2023: 52 · 2022: 46 · 2021: 69 · 2020: 45 · 2019: 22 · 2018: 19 · 2017: 1
- FWCI
- 2.64
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- International Journal of Environmental Research and Public Health (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- RePEc: Research Papers in Economics (submittedVersion)
- Topics
- Physical Sciences › Environmental Science › Environmental Chemistry › Per- and polyfluoroalkyl substances research
- Physical Sciences › Environmental Science › Health, Toxicology and Mutagenesis › Effects and risks of endocrine disrupting chemicals
- Physical Sciences › Materials Science › Polymers and Plastics › Synthesis and properties of polymers
- Keywords
- perfluorinated compounds, PFAS exposure, children, prenatal exposure, children's exposure, child health outcomes, immune function, asthma, dyslipidemia, brain development, vaccine response, thyroid function, renal function, age at menarche, chemical mixtures, risk of bias
- MeSH terms
- Adolescent, Caprylates, Child, Child, Preschool, Environmental Exposure, Environmental Pollutants, Female, Fluorocarbons, Humans, Immunity, Innate, Infant, Infant, Newborn, Kidney, Male, Menarche, Alkanesulfonic Acids, Dyslipidemias
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