Air Pollution And Kids: Reviewing The Best Evidence

I’ve discussed many wellness topics on my expat health blog, but the major interest — by far — is air pollution. Beijingers are thirsty for quality information about air quality, especially regarding how could it affect their children. Let’s review the data now and also talk about healthy steps.

In terms of health risks, there is accumulating research that air pollution does cause both long-term and short-term risks, and children are considered more at long-term risk mostly because their lungs are still developing. For girls, lungs finish developing at 18 years, while a boy’s lungs mature by their early 20’s. The Academy of Pediatrics has an official position paper in 2004 ( which details the health risks and recommends an aggressive community approach, led by pediatricians, to ensure children’s health. One of most concerning research findings is from the USC Children’s Health Study (, following thousands of kids in smoggy Los Angeles over 9 years, from 4th to 12th grade. The results showed a worsening of lung function over those years of exposure in those children who had the most exposure to air pollution. In Los Angeles, the average annual Air Quality Index is around 50, which is almost 3 times lower than here in Beijing.

So what can we do about this? I think community action plans, especially in schools, are important. As for guidelines, I think it’s useful to model the air pollution action plans from places such as Los Angeles, which is the most polluted city in the U.S. For example, California law calls an AQI over 200 (a PM10 level >350 ug/m3) as a Stage 1 Episode and asks that “outdoor physical education (PE) classes, sports  practices, and athletic competitions should be re-scheduled or canceled if practicable”. AQI levels above 300 and 400 are considered Stage 2 and 3, and they recommend “all children discontinue all outdoor activities”.

Many schools in Beijing are now following their own action plans using similar criteria, and most are following the air pollution numbers from the US Embassy’s particle monitor in Chaoyang, near east third ring. The best way to access this feed is from the website at The Chinese government now has a new website which also lists hourly pollution numbers from all over China, including many spots in Beijing. You can access this information at their official website at It’s a bit complicated to use, but schools and parents all over China now can get the AQI for their area and make informed health decisions for their family.

It’s important to remember that we all spend about 80-90% of our lifetime indoors, so it’s also good to protect your indoor air, which often has similar pollution levels as outside. I do feel that indoor air purifier systems are very effective, whether it’s a stand-alone machine or built-in HVAC filters in your home vents and air conditioning units. Such machines, especially in bedrooms, are very effective in lowering indoor air pollution levels. Indoor plants also help a bit.

And when people must be outside on bad days (which I would say includes any AQI over 200 AQI), I recommend using a good protective mask. The key is to find a good mask, and industrial-grade commercial masks that say “N95” are the best. “N95” means that mask eliminates 95% of larger air particles; this theoretically would bring down an AQI day of 500 to a healthy 25 AQI. You can usually find good masks, especially made by the 3M company, at the local expat stores like April Gourmet or Jenny Lou’s. These masks became more available all over China after the recent H1N1 scare. Many masks are uncomfortable, especially for kids. The Totobobo company has comfortable and less awkward-looking masks made of comfortable transparent plastic. These can also be cut down to fit the smaller faces of your children. They currently are available only from their website but soon should have local distribution.


This article was originally printed in my monthly column in Beijing Kids magazine. You can click here to read the rest of my “The Doc Is In” columns.

Follow me on:
Twitter @RichardStCyrMD
Facebook @BainbridgeBabaDoc

5 thoughts on “Air Pollution And Kids: Reviewing The Best Evidence”

  1. Dr. Saint Cyr,

    Good advice and the same messages that I give clients frequently. I find it surprising that residents here (Shanghai) consistently are more concerned about the quality of tap water than they are the air. Some clients with water that has been treated four times (municipal water facility, compound filtration of the water main, whole house system, then point of use sink filter) are still hesitant to use the water to wash vegetables, but meanwhile are unaware of the impact of leaving their doors and windows open all the time.

    Up in Beijing, have you come across any research on airborne lead levels or had seen significantly high blood lead levels in patients? In Shanghai, the air regularly tests about 3-5x higher than the EPA standard (0.15 microgram/m3) and indoors, this is usually replicated. In my mind, lead poisoning is given short shrift and usually ignored compared to particulates, VOCs, allergens, mold, etc.

    As an aside, I have procured samples of 3 different types of the 3M N95 masks, commercial masks by Totobobo, I Can Breathe, and Respro, and even the local masks favored by ayis, and will be doing a review on fit, filtration, and bang-for-buck. We’ll have a group of panelists representing perspectives from bikers, moms, walkers, asthmatics, etc providing input. Once that’s complete, will forward it on to you.

    Keep up the good work — I consistently am telling clients about this blog as a resource!

    PureLiving China – Indoor Environmental Solutions

    1. Thanks for doing that real-world testing of masks — people will really be interested in the results! As for lead in the air, I haven’t heard of any data on that. I would have to assume that it’s not a major problem because I haven’t heard any reports of high lead levels in Beijing children. Do any readers have info on this?

  2. I have a few about lead levels of Chinese children
    first, this, from recent news

    September 16, 2011
    Associated Press

    Shanghai families claim children poisoned by lead


    November 2009 – Volume 20 – Issue 6 – p S95
    doi: 10.1097/01.ede.0000362997.67179.79



    4) and the one that started the flurry of above papers (some by the same authors)

    Shunqin Wang, Jinliang Zhang, Blood lead levels in children, China, Environ. Res. (U.S.A), 101/3 (2006) 412-418. I have the fulltext pdf of this, but cannot find a link online to it. I can send it to Dr Saint Cyr.

    5) good article about living in China, and when to test for lead, who should test for lead, and special circumstances which would warrant closer lead monitoring

    6) Association of Traffic-Related Air Pollution with Children’s Neurobehavioral Functions in Quanzhou, China also online here

    7) and good newish and general lead research article by none other than Herb Needleman. I had plenty of opportunity, and now badly wish I had taken a photo with the man or at least given him props and shook his hand and acknowledged what I know now. I didn’t know it at the time, but now know that he is the single major driving force in lead research for the past 40+ years. He was the subject of a book, Toxic Truth, because he was the very first researcher to warn of lead’s multiple hazardous effects, , and stood up to big industry as far back as the 60’s and 70’s regarding leaded gasoline. In 1997-2003, I worked in the same building, so saw him frequently and his research and ours (ADHD) overlapped some so he collaborated with our PI’s and we sat in on his presentations, etc. Nice man, too!

    Liora (Lourie) Pearlman (Collins)

  3. hi, sorry, the link to the Chinese hourly AQI is no longer working.

    (located in the fourth paragraph – the one beginning with Many schools in Beijing…)

Leave a Reply