30 November,2025 12:22 PM IST | Mumbai | Arpika Bhosale
Concerns about the effect of rising AQI and unbreathable air on the city’s children have been rising in the city. Representational pic/Nimesh Dave
The city's air quality index (AQI) has been hovering around 300 (as per BMC) for a while now, and everyone's falling ill more often than not, including children. A few schools have shifted to online classes until the situation gets better. As it gets harder and harder to breathe, the familiar excuses are being offered - "it's the lack of wind during winter months; it's just a matter of a couple of months".
Set aside the question of why we should choke without complaining even for a few weeks - the bigger question is how do we know that the thick blanket of smog smothering our city won't have a more long-lasting impact, especially on our children's growing bodies and brains?
In 2024, the State of Global Air report that's released annually by UNICEF in collaboration with US-based non-profits Institute For Health Metrics and Evaluation, and Health Effects Institute, stated that as many as 2000 children under the age of five are estimated to die across the world every day from air pollution-related health impacts - this accounts for 15 per cent of all global child deaths. The same report also stated that the impact extends to unborn children as well, with air pollution linked to 34 per cent of preterm births globally in 2021. It added that among affected babies, those who survive may face developmental delays, disabilities and health consequences throughout their life.
It's a worry that has plagued Pemiya Gandhi ever since she gave birth to her son, Theo, six months ago. The toddler is relegated to the bedroom in his parents' south Delhi apartment to keep him safe amid Delhi's dismal air quality. Gandhi, already overwhelmed as a new mother, checks the AQI every few hours. For the past month, the capital's AQI has mostly stayed upwards of 300, climbing as far as 727 on November 7.
"We escaped to Dehradhun during Diwali, but as soon as we came back, he fell sick. He had a runny nose, cold and cough. Even now, a month later, his cough hasn't gone," she tells us.
There are no medicines that can be given to a six-month-old, apart from saline drops and steam inhalation. "It's heartbreaking to hold my baby down to put the saline drops in his nose. He begins to wail. Then I have to hold under a bedsheet with steam for some time just so he can take a breath," she adds.
Theo has also just begun to crawl and explore. "He loves greenery, but I can't even take him to parks. There's nothing I can do," she says as frustration takes over.
Gandhi, who is originally from Mumbai, even discussed moving back here with her husband. But seeing the AQI plummet to hazardous levels in Mumbai too, the couple was disheartened. "My husband and I thought, maybe Mumbai is not as bad as Delhi now, but in a few years it will get there too. Then would we have to move again?"
Now, they are thinking of moving to tier-2 or tier-3 cities, even if it means Gandhi takes a massive pay cut as a corporate communications employee. "And if I do take a pay cut, I still need to move to a city that has good medical facilities for Theo. So again, less money and sub-par medical facilities are added concerns," she says.
It's a lose-lose equation, Gandhi fears. "I have so much self-doubt right now; I keep thinking âWas I right to have a baby in this environment in the first place?'"
There is little research about the correlation between polluted air and its impact on a growing child. The most exhaustive one we came across was a study done by American and Mexican researchers as far back as 2008, which continues to be cited often in subsequent studies. The research (Lilian Calderón-Garcidueñas et al) was conducted through a series of autopsies on road accident victims between the ages of two to 47 and residing in Mexico City, which had seen fast-paced urbanisation, with rampant construction and a city-wide vehicle count that had reached 40 lakh.
Mumbai has seen similar conditions, with many asking for an immediate ban on construction work ongoing across the city. The city's vehicle count is even higher, with four-wheelers touching the 48-lakh mark in March.
The Mexico City study found that even clinically healthy, cognitively and neurologically intact children, teenagers, and young adults who grow up breathing polluted air can not only show compromised immune systems, but also early brain and nerve inflammation, as well as blood-brain barrier damage. These are changes associated with increased risk for neurodevelopmental problems, cognitive decline, and neurodegenerative conditions like Alzheimer's disease and dementia later in life. The study also highlighted inhibitors that might affect memory, attention, decision-making, academic performance, and emotional regulation in children and teens.
In the same study, during the autopsy of an 11-year-old, the researchers found the protein, synuclein, in the brain stem nuclei. This finding is associated with neurodegenerative diseases like Parkinson's disease, dementia, as well as hampered breathing, heart rate, and movement coordination.
This is the same protein that was at the centre of a 2025 study by US researchers - titled Lewy body dementia promotion by air pollutants and published in the Science journal. The scientists combined data from over 56 million US patients with laboratory and animal studies, revealing a molecular connection between air pollution and dementia development. The study stated that exposure to pollutants, particularly PM 2.5, triggers the formation of toxic protein clumps in the brain and increases the risk of lewy body dementia by up to 17 per cent.
Developmental paediatricians say there is enough empirical data and undeniable lived experience to draw a direct relation between high AQI and its impact on children's cognitive abilities.
Dr Preeti Mhatre, a developmental paediatrician, cites WHO's global air quality guidelines published in 2021, as well as her own experience as a professional in the field for over 15 years, and says, "Air pollution is often seen as a problem for the lungs, but research now shows it can also interfere with how a child's brain develops, starting as early as pregnancy. Scientific studies consistently show that children exposed to high levels of air pollution are more likely to have slower learning, reduced attention span, weaker memory, and lower developmental or IQ scores. Several studies have also reported a higher risk of neurodevelopmental conditions such as ADHD and autism. The changes in each child may appear subtle, but with millions of children exposed daily, the impact on society is enormous," she says.
Mhatre then adds, "We now have enough evidence - from both global and Indian research - demonstrating this link. Recent Indian studies are reporting findings identical to international data, showing the same adverse effects on cognition, attention and behaviour in children exposed to toxic air. WHO has repeatedly raised concerns about air pollution being one of the biggest threats to children's health and development. Children are more vulnerable than adults because they breathe faster, spend more time outdoors, and their natural protective systems, including the blood-brain barrier, are still developing. Clean air is therefore not just a respiratory need, but a developmental necessity," she adds.
Dr Mhatre also points out to us that many of the children in her care are coming in more often with health issues as AQI has reached hazardous levels in the city in the past few years. "Children are coming back sooner with the same sicknesses that we treat them for in a shorter span of time. Which indicates that there is a loss of natural immunity among children; they are hardly in recovery mode and are back at the hospital for the same issue," she says.
"At this point, the science is clear. It is high time that Indian policy makers treat clean air as a core requirement for child development. Reducing exposure - at home, school, and community-level - is one of the strongest investments we can make in safeguarding our children's learning, behaviour and long-term potential," she adds.
In a glaring example of how the authorities do not follow a people-first policy when it comes to development-versus-health debate, even when the National Capital Region (NCR)was experiencing AQI upwards of 700, the Union government's Commission for Air Quality Management did not impose their most stringent restrictions (stage IV) under its Graded Response Action Plan (GRAP). Even the stage III curbs that had been imposed were revoked on November 27 after the air quality improved slightly. These measures included a ban on non-essential construction and demolition work, as well as stone crushing and mining activities.
Neha Gupta Jain, who lives in the Haus Khaz enclave in South Delhi, is mother to a two-year-old and nine-year-old, and has been struggling with the decision to send her youngest to playschool. "My child has grown up with nebulisers, something I never experienced as a child. The fact that they have revoked the [strictest curbs under] GRAP is just making me so angry. What are they thinking?" she asks.
Jain is also very clear that this is not an indictment of any one government, rather a series of bad decisions over two decades. "It's a failure on part of the policy makers involved in the decision-making process who have not turned up for us and our children," adds the entrepreneur.
We see the same negligence in Mumbai when it comes to keeping people first in policies, as well as failure to enforce existing regulations to minimise particulate matter dispersion.
On Thursday BMC gave 53 construction sites a work stop notice in a bid to regulate the increasing AQI.
The need of the hour is still more focused studies linking cognitive dysfunction to air pollution, as that is more likely to push the authorities into action. But Dr Manisha Mukhija, developmental and behavioural paediatrician, feels that while even the medical fraternity might demand more data to conclusively prove the connection, studies have long since established the impact that second-hand smoking can have on a pregnant woman or a child aged 0-5.
"There is a genetic component to children who have Neurodevelopmental conditions, and there are epigenetic or environmental factors that act on the genes. These factors are yet to be completely identified," she says. "This includes social environments, for example, a child who is not exposed to friends, to outdoors, to language, will have delays and difficulties in language later on in life. Now, how does a polluted environment contribute to this? We still don't have enough data to say that it is directly related. But we know that smoking around a pregnant mother affects the newborn in terms of growth and their development. Can we extrapolate this to general environmental pollutants? We also know that in cities we are exposed to endocrine disrupting chemicals in the air, water, and food. These can disrupt the way our hormones are released in the body and can cause a whole host of health issues," she adds.
Back in Mumbai, Arun Jain has been trying to inculcate clean habits in his 15-year-old for a while, but has refrained from scaring the teenager over the AQI. "I have try to lead by example, he starts his day with soaked dry fruits and a glass of turmeric and ginger milk," says Jain. "Homemade amla concoction and salads are a part of their daily lunch routine and we prefer sprouts, fresh fruits and healthy home made Indian breakfast and meals. While juices and shakes are always freshly prepared, the packaged foods and drinks are extremely rare," he adds.
Growing up in the '80s and '90s in Kota, Jain says there was no awareness about AQI at the time, and he and his friends were accustomed to dusty roads and smoke from factories. He hopes all this talk of AQI doesn't stop children from going outdoors altogether. "I am a strong advocate of being health centric while being watchful of our ever changing surroundings. I firmly believe that children should play outside as much as possible. Wait for the air to improve, but make sure they step out, play and interact. It not only strengthens their immunity but also helps them develop essential social skills," he says.
53
no. of construction sites in Mumbai that have received work stop notice from the BMC to control reduce the rising AQI
2000
no. of children under 5 estimated to die every day from air pollution-related health impacts - accounting for 15 per cent of all global child deaths
34%
of preterm births globally in 2021 were linked to air pollution
'Source: UNICEF's State of Global Air report, 2024
17%
Rise in risk of developing Lewy body dementia on chronic exposure to PM2.5
'Source: Johns Hopkins research study, 2025
Nine-year-old Ella Adoo-Kissi-Debrah suffered from severe asthma from a young age and was hospitalised 27 times in the three years before her death following an asthma attack in 2013. Ella lived on London's South Circular Road, known for high air pollution levels.
Legal case: A landmark inquest in 2020 ruled that air pollution was a "material contribution" to her death. Her family later settled a legal case against the government, which expressed sincere condolences for her loss. Ella's lawyers proved that she was exposed to illegal levels of nitrogen dioxide.
Advocacy: Ella's mother, Rosamund Adoo-Kissi-Debrah runs the Ella Roberta Foundation and continues her campaign for legally binding air quality targets to be lowered to meet World Health Organisation (WHO) guidelines.
Juice
Pomegranate, cranberry, blueberry, and grape juices Citrus juices like oranges, which are rich in vitamin C Beet juice for nitrates, tomato juice for lycopene, and
green juices made from ingredients like spinach, kale, or cucumber
Other sources
. Nuts and seeds (almonds, walnuts, flaxseeds)
. Legumes and lentils Dark chocolate
Habits
. Exercising indoors
. Indoor swimming
Anuja Bali is a well-known advocate for clean air for children. "In 2008 when in Gurgaon my eight month son experienced breathing issues. That changed our lives and we got into figuring out, learning, safeguarding and overprotecting mode. But I remember that doctors had normalised it; one told me, âCalm down, every kid in Delhi is on a nebuliser'. I was stunned at the apathy. After no improvement in his health, we moved to Chennai in 2010, where within a few months he was better and did not have any breathing problems even in Alaska and the coldest winters in the USA," she says. "After returning back to India in 2019 Bali became a core team member of Warrior Moms and started talking about air pollution and its long term health implications. "We came back to India six years ago and now live in Pune. As soon as we returned, so did my son's breathing issues," she adds.
When the summer vacations begin and he no longer has to commute in the smoke-heavy traffic of Pune city, the teenager's health markedly improves. But then school reopens and his health comes crashing down with a vengeance. "He has had to miss the first month of school every year because of the wheezing. He keeps asking me why we came back from the US. I didn't want to stay in a foreign land away from home. But now I find myself thinking - will I have to move again? How many times will I move? And how many other parents can move? Why is basic need such as clean air such a rare commodity?"
The special needs educator feels there are direct links between neurodivergence and air pollution. "People are scared to come out and talk abt the link between neurodivergence and cognitive issues especially when at risk children, unborn babies are exposed to polluted air. There is even a Harvard study about it. As a special educator I feel that despite a rise in such cases in India there is an acute absence of studies being done in India," she says.
