As winter sets in across North India, rising air pollution is becoming a serious health concern, particularly for children whose lungs, airways, and brains are still developing. The effects extend beyond coughing, wheezing, and breathlessness. Doctors are reporting an increase in asthma exacerbations, allergic rhinitis, enlarged adenoids and allergic conjunctivitis among children. Repeated respiratory illnesses, disrupted sleep and prolonged exposure to pollutants may also have wider implications for children's physical growth, cognitive development and overall well-being.

Even before birth, exposure to polluted air is a concern because the baby's organs begin developing during pregnancy. In an interaction with Raising India, Dr Sivaranjani Santosh, an eminent paediatrician and activist, fondly known as the ORS lady of India, discusses the growing burden of respiratory and allergic conditions among children, why they are particularly vulnerable to polluted air, and the possible long-term consequences for their health and development.

Q: What changes have you observed in children's health, particularly about respiratory and allergic conditions?

Dr Sivaranjani Santosh: We have seen a huge increase in exacerbations of asthma. Cases of children with adenoid hypertrophy and allergic rhinitis have also gone up significantly in recent years. Even symptoms such as cough are becoming increasingly common. The burden of respiratory and allergic conditions among children is clearly rising.

Asthma is a chronic inflammatory condition of the airways that can cause wheezing, coughing, chest tightness, and breathing difficulties. Air pollutants can irritate the airways and trigger or worsen asthma symptoms. Allergic rhinitis causes inflammation of the nasal passages, leading to sneezing, a runny or blocked nose, and itching. Adenoids are lymphoid tissues located behind the nose. When enlarged, they can obstruct airflow through the nose and contribute to breathing difficulties and sleep disturbances.

Q: Why are children more vulnerable to air pollution than adults? What makes their developing lungs and airways particularly susceptible?

Dr Santosh: Children are not miniature adults, and we should not treat them as such. Their bodies are still developing, including their lungs and airways. From the very beginning of life, we are exposing their developing lungs and airways to these pollutants.

Repeated exposure to polluted air can have consequences not just in the immediate term but also in the long run. Their lungs are still developing, and continuously loading them with pollutants makes it much more difficult for them to cope with the exposure.

Children's respiratory systems are still maturing, making them particularly susceptible to environmental pollutants. They also breathe faster and inhale more than adults. Because of its extremely small size, fine particulate matter (PM2.5) can travel deep into the lungs and reach the alveoli, the tiny air sacs where oxygen enters the bloodstream. Exposure can trigger inflammation and aggravate existing respiratory conditions. The concern is that repeated exposure during critical stages of lung development may have consequences that extend into adulthood.

Q: Can the effects of air pollution go beyond immediate respiratory symptoms? How can repeated exposure affect a child's health and development?

Dr Santosh: Repeated asthma and other allergic flare-ups can affect a child's growth and development. The impact isn't limited to the respiratory system. There are also concerns about brain development and cognitive performance.

Children's health and development are interconnected. Repeated respiratory problems can affect their overall well-being and quality of life. Recurrent respiratory illnesses can lead to frequent school absences, reduced physical activity, and disrupted sleep. These factors can affect a child's ability to participate in everyday activities and potentially influence their development.

Q: You have raised concerns about the impact of air pollution on brain development and cognitive performance. How can polluted air affect a child's ability to learn and concentrate?

Dr Santosh: Air pollution can affect brain development and cognitive performance. We need to understand that children's brains are still developing. Exposure to pollutants during this period is a concern because the effects may extend beyond respiratory symptoms.

The brain continues to develop throughout childhood and adolescence. After inhalation, fine particles enter the bloodstream, while some ultrafine particles may reach the brain through pathways involving the olfactory nerve. Researchers have investigated how these exposures may contribute to inflammation and oxidative stress in the nervous system.

Q: You mentioned an increase in children with enlarged adenoids. How can this affect their sleep, growth, and development?

Dr Santosh: Enlarged adenoids can interfere with a child's sleep. Sleep is extremely important during childhood, not just for physical growth but also for brain development and cognitive functioning. When a child does not get adequate, good-quality sleep, it can affect overall development.

Q: Can repeated respiratory illnesses, disturbed sleep and prolonged exposure to pollution affect a child's physical growth?

Dr Santosh: There is concern about growth faltering and stunting. Repeated respiratory illnesses and disrupted sleep can affect growth and development. We should not look at these conditions in isolation; they can have wider consequences for a child's health.

Q: You also mentioned an increase in allergic conjunctivitis. How does polluted air affect children's eyes, and what symptoms should parents look out for?

Dr Santosh: We are seeing more cases of allergic conjunctivitis among children. They may complain of irritation or a gritty sensation in their eyes. These symptoms tend to become more noticeable during winter, when the weather is dry, and pollution levels are high.

Q: Is the rise in pollution-related health problems confined to North India, or are you seeing similar concerns in other parts of the country?

Dr Santosh: Pollution is increasing in other parts of the country as well, including southern India. However, the situation is particularly difficult in North India because of winter weather conditions. These conditions worsen the pollution problem.

Q: What are your concerns about a pregnant woman's exposure to air pollution? How might it affect the developing baby?

Dr Santosh: During pregnancy, the mother supplies oxygen and nutrients to the developing baby. The baby's lungs, brain, and other organs develop from the very beginning. Exposure to air pollution during this period is therefore a concern because it may affect the development of these organs. Studies have shown that pollutants can cross over the placenta and harm the growth and development of the feotus.