Pesticide Exposure Pathways and Pediatric Health in Agricultural Communities

Pesticide Exposure Beyond the Worksite

Each year, it is estimated that over a billion pounds of pesticides are used in the United States.¹ Pesticides are extensively used in agriculture to manage weeds, insects, and other pests that threaten crops. While discussions about pesticide safety often focus on workers during pesticide application or fieldwork, pesticide exposure has long been recognized as extending beyond the workplace into homes and agricultural communities.²

Children living in agricultural areas can come into direct contact with pesticides in several ways. They might inhale airborne chemicals drifting from nearby fields, touch residues that linger on clothing or skin, or be exposed at home if proper safety measures are not in place. Exposure can start even before birth (in utero), and children may also consume small amounts of pesticides present in their food.^2,3

Among these pathways, take-home exposure has been documented as an important source of household contamination. Residues can travel home on workers’ clothing, shoes, skin, and vehicles, contaminating household environments and exposing family members, particularly children, to repeated low-dose exposure. This para-occupational pathway, commonly known as take-home pesticide exposure, can contribute to meaningful environmental health risks in agricultural communities. Children are especially vulnerable to pesticide exposure because of their smaller body size, developing organ systems, and behaviors such as frequent hand-to-mouth activity and time spent on floors where pesticide residues may accumulate.^3,4 These findings reinforce the importance of environmental and occupational screening in pediatric care in agricultural areas, as well as education delivered by community health workers and outreach teams serving agricultural communities.

Case Study

A case presented during a Migrant Clinicians Network webinar on pediatric pesticide-related illness highlighted the clinical complexity and diagnostic challenges associated with take-home organophosphate exposure in infants.⁵

A 4-month-old infant living in a farmworker household presented to the emergency department with fussiness, decreased appetite, vomiting, diarrhea, lethargy, and poor respiratory effort. On the way to the hospital, caregivers reported episodes in which the infant’s “eyes rolled back.” Clinical examination showed limpness, miosis (pinpoint pupils), increased secretions, and respiratory compromise, with vital signs documenting a heart rate of 178 beats per minute, respiratory rate of 34 breaths per minute, and temperature of 98.6°F.

The infant had experienced five previous hospital admissions, including one in which organophosphate exposure had already been suspected. The sepsis workup was negative, and the infant received fentanyl, pralidoxime, and atropine during treatment, and laboratory evaluation demonstrated decreased red blood cell and plasma cholinesterase levels consistent with organophosphate exposure. Initial urine, blood, and breast milk samples were negative for pesticide metabolites, complicating early diagnosis. An environmental investigation later revealed that the infant’s father and uncle were both farmworkers living with their families in a shared farm trailer. Both workers had been trained as pesticide handlers and assisted with moving pesticide containers in the fields, although they did not directly spray pesticides. Family members reported routinely wearing the same work clothing home from the fields before changing, but washed work clothes separately from household laundry. Additional environmental testing later detected organophosphate residues within the trailer environment. Investigators also noted that although the family later attempted to establish a decontamination area away from the main living space, workers sometimes returned home during lunch breaks and held the infant still in their work clothes.⁵

How Pesticides Enter the Home

Children in farmworker households may be exposed to pesticides even when they never enter an agricultural field. Pesticide residues can enter and persist in the home through multiple pathways, including take-home (para-occupational) exposure, pesticide drift from nearby fields, and in-home pesticide use.^2,6

Take-home contamination occurs when pesticide residues are transported from the workplace into the household environment. Residues may remain on:

●   Work clothing
●   Boots and shoes
●   Hats, sunglasses, bandanas
●   Skin and hair
●   Tools and equipment
●   Vehicle seats and floors
●   Washing machines
●   Other personal items in the fields or adjacent to the fields, like cell phones, lunch containers, backpacks, and water bottles

In agricultural communities, additional contamination may occur when pesticide drift settles on or near homes, or when pesticides are applied indoors to manage pests, particularly in housing with structural or maintenance challenges. Once present in or around the home, residues can transfer to surfaces such as:

●   Floors and carpets
●   Bedding and furniture
●   Car seats
●   Kitchen and bathroom surfaces

Young children are particularly vulnerable to this type of exposure. Infants and toddlers spend significant time on floors and frequently place their hands or objects in their mouths. Close contact with caregivers, such as being held after a work shift, may increase exposure through contaminated clothing or skin.^2,3,6 Household contamination may also occur when work clothing is washed with family laundry or when work equipment is stored inside living areas.

Educational programs developed for farmworker communities emphasize practical prevention strategies such as removing work shoes before entering the home, changing clothing after work, and washing work clothes separately from family laundry.^2,7 Understanding these pathways helps clinicians provide practical prevention counseling and highlights the importance of workplace protections designed to reduce contamination before workers leave the job site.

Common Pesticide Classes and Pediatric Health Effects

Pesticides used in agriculture include several chemical classes with different mechanisms of action. The term “pesticide” includes insecticides, herbicides, and fungicides. Understanding potential health effects can help clinicians recognize possible pesticide-related illnesses in children. Clinical descriptions summarized below are of the most common insecticides and herbicides in use in the US, based on the American Academy of Pediatrics’ Pediatric Environmental Health text.³

Insecticides

Insecticides, a type of pesticide, are used to control crop-damaging or disease-spreading insects. They are applied to fruits, vegetables, and field crops, leaving residues on plants, soil, and equipment.^1,2 Common types include organophosphates, pyrethroids, neonicotinoids, and carbamates, which primarily affect the nervous system and vary in toxicity and mode of action.^1,2

Class	Common Uses	Mechanism and Potential Health Effects on Children
Organophosphates	Used in US agriculture on fruits, vegetables, and herbs. Common examples include chlorpyrifos, malathion, and diazinon. Many have been restricted or phased out for residential use but remain in agricultural settings.	Inhibit acetylcholinesterase, an enzyme necessary for normal nerve function. Potential acute health effects include headache, dizziness, nausea, excess salivation, wheezing, and muscle weakness. Chronic exposure has been associated with possible neurodevelopmental effects in children, including impacts on attention, behavior, IQ and learning.^3,8,9
Pyrethroids	Synthetic insecticides are widely used in both agricultural and residential pest control. They are frequently used as replacements for organophosphates in some settings and are widely applied to crops, homes, and public spaces.	Affect the nervous system. Potential health effects include skin irritation or tingling sensations, eye irritation, headache, and mild respiratory symptoms. Although generally less acutely toxic than organophosphates, repeated exposure may still affect the nervous system.³
Carbamates	Used in agriculture and some pest control products.	Also inhibit acetylcholinesterase, causing acetylcholine to accumulate in the nervous system. Like organophosphates, they can overstimulate muscarinic and nicotinic receptors. Because inhibition is reversible, poisoning is usually shorter in duration, and recovery is often faster. Possible symptoms include nausea, vomiting, sweating, and weakness.^2,3,10
Neonicotinoids	Commonly used as seed treatments on crops such as corn and soybeans and may also be found in residential pest control products.	Act on nicotinic acetylcholine receptors in the nervous system. Potential health effects may include fatigue, nausea, headache, dizziness, and possible neurologic symptoms with higher exposures. Human evidence on chronic, low-level exposure is still limited; however, some studies suggest possible associations with neurologic or developmental outcomes, particularly in children.¹¹

Herbicides

Herbicides are used to control weeds and vegetation, and their toxicity varies by compound. Common herbicides widely used in crop production include glyphosate-based herbicides, triazines, bipyridyls such as paraquat, and chlorophenoxy herbicides such as 2,4-D.^2,3

Class	Common Uses	Mechanism and Potential Health Effects on Children
Glyphosate	Among the most used herbicides in agricultural settings. Widely applied in crop production and vegetation control.	Toxicity varies by formulation and route of exposure. Potential health effects may include skin or eye irritation, upper airway or respiratory irritation, and gastrointestinal symptoms after ingestion. Although glyphosate is generally considered less acutely toxic than many insecticides, exposure may still pose health concerns depending on formulation, route, and duration of exposure.^3,12
Triazine	Widely used in agriculture to control broadleaf weeds and grasses. Atrazine is a common example.	Toxicity varies by compound. Potential health effects may include skin or eye irritation, respiratory irritation, and gastrointestinal symptoms. Some triazine herbicides, including atrazine, have also been studied for possible endocrine or developmental concerns with longer-term exposure.²
Bipyridyl	Includes paraquat and diquat; used in agricultural weed control.	Associated with greater acute toxicity than many other herbicides. Potential health effects may include gastrointestinal injury after ingestion, kidney injury, and lung toxicity, particularly with paraquat.^2,3
Chlorophenoxy	Includes 2,4-D and related compounds; commonly used in crop production and vegetation control.	Potential health effects may include skin or eye irritation, gastrointestinal symptoms, and neurologic symptoms with significant exposure. Because chlorophenoxy herbicides differ in toxicity and clinical effects, identifying the specific product involved is important when evaluating possible exposure.^2,3

Evidence of Exposure and Biological Impact

Numerous studies have highlighted the presence of pesticide exposure among children living in agricultural communities. Arcury and colleagues examined pesticide metabolites among children in farmworker households in North Carolina and found repeated exposure to multiple pesticide classes, including organophosphates and pyrethroids.¹³ These findings were consistent across different sampling times, indicating ongoing environmental exposure rather than one-time events. Longitudinal research has highlighted concerns regarding the developmental impact of pesticide exposure. The Center for the Health Assessment of Mothers and Children of Salinas (CHAMACOS) study, a comprehensive birth cohort conducted in an agricultural area of California, has demonstrated associations between prenatal and early-life exposure to pesticides and negative neurodevelopmental outcomes, including effects on attention, behavior, and cognitive abilities in children.¹⁴ A follow-up CHAMACOS analysis by Bouchard and colleagues found that higher prenatal organophosphate exposure was associated with lower IQ scores in children at 7 years of age, further strengthening concerns about the cognitive effects of early-life pesticide exposure.⁸ More recent research has shed light on the possible biological effects linked to pesticide exposure. Lepetit and colleagues studied hair follicle cells in children from both rural and urban areas and observed increased DNA damage associated with higher levels of pesticide exposure.¹⁵ Hair follicle cells, which divide rapidly, can act as indicators of genotoxic stress. These results suggest that environmental pesticide exposure may be associated with measurable biological changes, even in the absence of acute poisoning. Overall, these studies indicate that pesticide exposure in agricultural communities is quite common and may lead to cumulative environmental exposure and biological stress in children living in farmworker households.

Clinical Recognition

Children residing in agricultural regions are routinely subjected to chronic, low-level pesticide exposure through environmental drift, take-home contamination, residential application, dietary intake, and prenatal contact; chronic exposure is more likely than acute poisoning.^2,6 Consequently, it can be challenging to clinically identify pesticide-related illnesses. Pediatric patients often encounter low-dose pesticide exposure from diverse sources, and the resulting symptoms may be subtle, nonspecific, and easily confused with more common pediatric conditions.³

Possible clinical presentations may include:

•   Headaches
•   Dizziness or fatigue
•   Nausea, vomiting, or diarrhea
•   Abdominal pain
•   Persistent cough, wheezing, or worsening asthma symptoms
•   Skin or eye irritation
•   Irritability or behavioral changes
•   Attention difficulties or difficulties concentrating
•   Learning challenges or school difficulties
•   Developmental concerns or delays

In some cases, children may also present with neurologic or functional changes, such as clumsiness, tremors, excessive sleepiness, or changes from their usual behavior or activity level.^2,3 These symptoms are nonspecific and may overlap with common pediatric illnesses. They may be intermittent or persistent and are often identified only when an environmental or occupational exposure history is obtained. Different pesticide classes may contribute to different clinical effects. For example, organophosphates and carbamates are associated with cholinesterase inhibition and may present with gastrointestinal symptoms, respiratory effects, and neurologic findings such as weakness or increased secretions (including excessive salivation , tearing, or nasal secretions), while pyrethroids are more commonly associated with skin irritation, paresthesia, and mild neurologic symptoms such as dizziness or tremor.^3,18 Although acute pesticide poisoning may present with more severe symptoms, such as excessive salivation, respiratory distress, muscle weakness, or seizures, these findings are less common in chronic or low-dose exposure scenarios.² Children in agricultural communities are more likely to present with subtle or nonspecific symptoms related to cumulative exposures over time rather than acute toxicity.

Children with underlying respiratory conditions may be particularly vulnerable to the respiratory effects of pesticide exposure. Pesticides can irritate the airways and may trigger asthma symptoms or make asthma more difficult to control. Helping families reduce pesticide exposure at home and in other environments may help decrease respiratory triggers.^2,3

Because pesticide-related illness is frequently underrecognized and symptoms may overlap with other diagnoses, obtaining an environmental and occupational exposure history is essential.¹⁶ Clinicians should maintain a high index of suspicion when evaluating children living in agricultural communities, particularly when symptoms are persistent, unexplained, or involve respiratory, neurodevelopmental, or behavioral concerns.^2,3

Taking an Occupational and Environmental History

Environmental and occupational screenings are essential when evaluating children living in agricultural communities.

Clinicians may consider asking caregivers simple questions such as:

●   Does anyone in the household work in agriculture?
●   What tasks do those household members perform at work?
●   Are work clothes changed before entering the home?
●   Are work clothes washed separately from household laundry?
●   Do children ride in cars, trucks, or vans used to travel to farms or fields or used for farm work?

These simple questions can foster an open dialogue and collect important information in a non-judgmental way. Even brief screening questions can help identify potential environmental exposure pathways. Occupational health guidance emphasizes that understanding a patient’s work environment is often essential for identifying risks of pesticide safety exposure.²

Two Lines of Defense

Reducing take-home pesticide exposure requires both workplace protection and household prevention strategies.

Prevention at the Worksite: Worker Protection Standard

The Worker Protection Standard (WPS) is a federal regulation designed to reduce pesticide exposure among agricultural workers._2,17

The regulation requires employers to:
●   Provide pesticide safety training
●   Enforce restricted entry intervals
●   Post pesticide application information
●   Provide decontamination supplies
●   Supply appropriate personal protective equipment
●   Provide emergency assistance when exposure occurs

Clinicians can support prevention by helping patients understand these protections and encouraging them to participate in safety training programs. Educational materials and programs relevant to the community, including those delivered by community health workers/promotores, can reinforce WPS training and help workers translate workplace safety practices into household prevention strategies.⁷
Household Prevention Strategies

Clinicians can also provide practical guidance to reduce take-home contamination.^2,3,7

Recommended strategies include:
●   Removing work shoes before entering the home
●   Changing out of work clothing immediately after work
●   Washing work clothes separately from family laundry
●   Showering as soon as possible after returning home

Prevention counseling also needs to recognize the structural barriers many families face, such as shared housing, limited access to laundry facilities, or a lack of running water, which can slow adherence to certain recommendations. In these cases, community health workers and promotores are often essential in reinforcing prevention messages within farmworker communities and helping families adopt practical strategies suited to their daily realities and routines.

Conclusion

Pesticide exposure remains an important but often overlooked issue in pediatric environmental health within agricultural communities. While children might not work directly in the fields, they may be exposed through multiple pathways, including pesticide drift from nearby fields, take-home contamination, in-home pesticide use, dietary exposure, and prenatal exposure. Because symptoms related to this exposure can be subtle and nonspecific, health care providers should include occupational and environmental screening as part of routine checkups for children from farmworker families. Prevention strategies should focus on workplace safety, household risk reduction, and education that is relevant for the community being served. Recognizing multiple exposure pathways allows clinicians to enhance prevention counseling, promote safer home practices, and help lower pesticide exposure risks for children in agricultural communities.

Resources

Migrant Clinicians Network Webinar: Field to Clinic: Recognizing Pesticide-Related Illness in Children
Provides clinicians with practical guidance on recognizing, diagnosing, and managing pediatric pesticide-related illness, including exposure pathways, clinical signs, case-based learning, and exposure identification in agricultural communities.
https://www.migrantclinician.org/webinar/field-clinic-recognizing-pesticide-related-illness-children-2026-04-29.html

Migrant Clinicians Network Pesticide Webinar Series: How to Prevent Pesticide Poisonings in Farmworkers
This three-part webinar series covers diagnosis and management of pesticide illness, public health and legal issues, and culturally informed prevention for farmworker communities. It highlights the need to address both workplace and household risks. https://www.migrantclinician.org/webinar/diagnosis-and-management-pesticide-related-illness-how-prevent-pesticide-poisoning

Worker Protection Standard (WPS) Pesticide Safety Training Curriculum and Resources
These resources offer materials and tools to help meet Worker Protection Standard requirements and minimize pesticide exposure among farmworkers.
https://www.migrantclinician.org/resource/worker-protection-standard-pesticide-safety-training-curriculum-and-resources.html

Juan, Abre los Ojos: Cómo Protegerse de los Pesticidas
This Spanish-language comic book provides practical, culturally appropriate education for farmworker communities on pesticide exposure prevention and take-home contamination.
https://www.migrantclinician.org/resource/juan-abre-los-ojos-como-protegerse-de-los-pesticidas-comic.html

Migrant Clinicians Network Pesticides Resource Page
Central hub for clinical tools, training materials, patient education resources, and pesticide prevention materials for clinicians serving agricultural communities.
https://www.migrantclinician.org/explore-environmental-and-worker-health/pesticides.html

EPA Recognition and Management of Pesticide Poisonings (6th Edition)
Comprehensive clinical guidance for diagnosing, managing, and preventing pesticide-related illnesses, including occupational exposure pathways and treatment considerations.
https://www.migrantclinician.org/announcement/now-available-epas-recognition-and-management-pesticide-poisonings-6th-edition.html?language=en

Pediatric Environmental Health Specialty Units (PEHSU)
PEHSU offers clinical consultation, education, and resources on children's environmental exposures, including pesticides.
https://pehsu.net/

Asthma Community Network
Provides evidence-based educational materials, tools, and community resources to help families manage asthma, reduce environmental triggers, and improve asthma outcomes for children and families.
https://www.asthmacommunitynetwork.org/

EPA Worker Protection Standard (WPS)
Overview of federal regulations designed to reduce pesticide exposure among agricultural workers, including training, protective equipment, and safety requirements.
https://www.epa.gov/pesticide-worker-safety/agricultural-worker-protection-standard-wps

References

U.S. Environmental Protection Agency. Pesticides Industry Sales and Usage: 2008–2012 Market Estimates. Washington, DC: U.S. Environmental Protection Agency; 2017.
U.S. Environmental Protection Agency (EPA). Recognition and Management of Pesticide Poisonings. 6th ed. Washington, DC: U.S. Environmental Protection Agency, Office of Pesticide Programs, 2013
American Academy of Pediatrics Council on Environmental Health. Pesticides. In: Etzel RA, Balk SJ, eds. Pediatric Environmental Health. 4th ed. Itasca, IL: American Academy of Pediatrics; 2019.
US Environmental Protection Agency. Pesticides and Their Impact on Children: Key Facts for Health Care Providers and the Public. 2015.
Roberts J. Field to Clinic: Recognizing Pesticide-Related Illness in Children. Migrant Clinicians Network webinar. 2026.
López-Gálvez N, Wagoner R, Quirós-Alcalá L, Ornelas Van Horne Y, Furlong M, Avila E, Beamer P. Systematic literature review of the take-home route of pesticide exposure via biomonitoring and environmental monitoring. Int J Environ Res Public Health. 2019;16(12):2177. doi:10.3390/ijerph16122177
Liebman A, Galván A, Costa M. Culture Is Key! Prevention of Farmworker Pesticide-Related Illness Using Cultural Contextual Education. Video Session 3. Migrant Clinicians Network webinar series. 2024.
Bouchard, Maryse F et al. “Prenatal exposure to organophosphate pesticides and IQ in 7-year-old children.” Environmental Health Perspectives. vol. 119,8 (2011): 1189-95. doi:10.1289/ehp.1003185
Stein, L. J., et al. “Early Childhood Adversity Potentiates the Adverse Association between Prenatal Organophosphate Pesticide Exposure and Child IQ: The CHAMACOS Cohort.” Neurotoxicology, vol. 56, 2016, pp. 180–187. doi:10.1016/j.neuro.2016.07.010.
Barr DB, Buckley B. In vivo biomarkers and biomonitoring in reproductive and developmental toxicity. In: Gupta RC, ed. Reproductive and Developmental Toxicology. Academic Press; 2011:253-265. doi:10.1016/B978-0-12-382032-7.10020-7.
Cimino AM, Boyles AL, Thayer KA, Perry MJ. Effects of neonicotinoid pesticide exposure on human health: a systematic review. Environ Health Perspect. 2017;125(2):155-162. doi:10.1289/EHP515.
Eskenazi, Brenda et al. “Association of Lifetime Exposure to Glyphosate and Aminomethylphosphonic Acid (AMPA) with Liver Inflammation and Metabolic Syndrome at Young Adulthood: Findings from the CHAMACOS Study.” Environmental health perspectives vol. 131,3 (2023): 37001. doi:10.1289/EHP11721
Arcury TA, Chen H, Arnold TJ, et al. Pesticide exposure among Latinx child farmworkers in North Carolina. Am J Ind Med. 2021;64(7):602-619.
Marks AR, Harley K, Bradman A, et al. Organophosphate pesticide exposure and attention in young Mexican American children: the CHAMACOS study. Environ Health Perspect. 2010;118(12):1768-1774
Lepetit C, Gaber M, Zhou K, et al. Follicular DNA damage and pesticide exposure among Latinx children in rural and urban communities. Exposure and Health. 2024; 16:1039-1052.
Shannon B. Diagnosis and Management of Pesticide-Related Illness: How to Prevent Pesticide Poisoning. Video Session 1. Migrant Clinicians Network webinar series. 2024.
Forst L. Public Health & Legal Considerations in Pesticide-Related Illness in Farmworkers. Video Session 2. Migrant Clinicians Network webinar series. 2024.
Peter JV, Sudarsan TI, Moran JL. Clinical features of organophosphate poisoning: A review of different classification systems and approaches. Indian J Crit Care Med. 2014;18(11):735-745. doi:10.4103/0972-5229.144017.

This publication was developed by Migrant Clinicians Network (MCN) through a cooperative agreement (agreement #FW-84115801) between the U.S. EPA’s Office of Pesticide Programs and MCN.

Disclaimer: While multiple experts reviewed this guide, the views expressed in the guide are those of the authors and do not represent the views and policies of state agencies or the EPA. The EPA does not endorse any products or commercial services mentioned in this document. The reviewers provided content expertise and feedback.

Authors

Francelly Jiménez-Palacios

MPH

Migrant Clinicians Network

Doctoral Fellow, Environmental & Occupational Health Communications