Children's environmental and occupational exposures to pesticides in low- and middle-income countries rural areas - an elephant in the room.

In rural areas of Low- and Middle-Income Countries, children are regularly exposed to pesticides through various environmental, para-occupational, and occupational pathways, often connected to family-based agricultural activities. Work and living spaces are commonly intertwined, increasing the likelihood of unintentional pesticide exposure among children, including before birth. This commentary explores how such wide-spread exposures to these pervasive chemicals occur - even before birth, and affect critical aspects of child health and development through life. Using the history of Zeca, a child living in rural Brazil whose asthma worsens due to pesticide applications near his home, this discussion paper illustrates how this critical issue is deeply embedded in daily life in many agricultural communities. However, these risks are frequently overlooked in clinical assessments, health surveillance, and policy responses. We discuss how broader structural conditions contribute to children's exposure to pesticides, including poverty, lack of healthcare access, weak surveillance or enforcement of occupational and environmental protections, and the chemical colonialism. These patterns reflect entrenched social and environmental injustices that disproportionately affect rural children. Thus, we call for a coordinated and systemic response involving stronger regulation, enhanced health surveillance and management, support for safer and more sustainable agricultural practices, and the inclusion of rural communities in decision-making processes. The protection of children from harmful pesticide exposure must be recognized as a public health priority and a matter of social and environmental justice.