Addressing Environmental Contaminants in Pediatric Practice

Abstract

1. Catherine Karr, MD, MS, PhD* 1. *Assistant Professor of Pediatrics; Director, Pediatric Environmental Health Specialty Unit, University of Washington, Seattle, WA. After completing this article, readers should be able to: 1. Recognize the basis for children's susceptibility to environmental contaminants. 2. Identify common pediatric environmental health problems. 3. Take an environmental history to discern risks. 4. Access reliable and useful resources on pediatric environmental health topics. 5. Discuss environmental exposure reduction and prevention with patients and families. The past decade has been marked by a rapid expansion of scientific inquiry, media reports, and public interest in the topic of environmental contaminants and child health. There are few pediatric environmental health specialists, and most health conditions associated with contaminants in food, water, the home environment, and the community present initially to the primary care clinician. Consequently, pediatricians are increasingly called on to answer questions about environmental health. Although standard medical education on these topics is limited and self-reported confidence among pediatric clinicians is low, extensive knowledge of toxicology is not required to suspect environmental health problems. This article reviews core concepts of pediatric environmental health, commonly encountered pediatric environmental hazards, and the environmental history. Understanding these areas of knowledge should allow the clinician to develop a degree of suspicion that is the foundation for discerning and preventing the potential adverse effects of environmental contaminants in child health. Children's susceptibility to environmental contaminants differs from that of adults. Pediatricians are familiar with the differences inherent in children across the life stages. Therapeutic interventions such as dosing based on weight or surface area is part of everyday practice. Injury prevention advice for a newborn is unique from that given during an adolescent visit. Similar concepts apply to the potential vulnerability of children to adverse consequences of exposure to environmental contaminants, reinforcing …