Introduction

Abstract

In October 1999, the American Academy of Pediatrics (AAP) entered into a 5-year cooperative agreement with the Agency for Toxic Substances and Disease Registry (ATSDR) to form a partnership to establish an “environmental safety net” for children. This partnership aims to increase pediatricians’ and public health officials’ awareness of pediatric environmental health issues, to encourage increased environmental health activity within communities, and to enhance the dialogue between pediatricians and public health officials. The communication fostered by this partnership may help partners to better diagnose and treat patients with environmentally related illness, thus forming an “environmental safety net” for pediatric patients.There are several reasons to develop this “safety net.” Clinicians, scientists, and governmental agencies increasingly recognize that infants and children have unique vulnerabilities and increased exposures to chemicals and other environmental health hazards. Although environmental hazards are among the top health concerns many parents have for their children,1,2 physicians still receive little training during medical school and residency on environmental hazards and their relationship to chronic conditions and illness.3 Textbooks of pediatric medicine devote relatively little attention to illnesses resulting from environmental factors. Information about pediatric environmental health is generally found in epidemiologic and specialty journals not regularly read by clinicians.4 In a major step taken to address these issues, the AAP in 1999 released the Handbook of Pediatric Environmental Health.5 The Handbook is an evidence-based manual, the first publication devoted exclusively to pediatric environmental health written for pediatric clinicians. The partnership of the AAP with the ATSDR, a federal agency whose mission includes educating primary care physicians about environmental health issues*, *The mission of the ATSDR is to serve the public by using the best science, taking responsive public health actions, and providing trusted health information to prevent harmful exposures and disease related to toxic substances. The Web site is available at: http://www.atsdr.cdc.gov/about.htm. was conceived to build on the effort begun by the Academy, further enhancing both organizations’ efforts to provide environmental health education to practicing pediatricians and to broaden interest in pediatric environmental health.As an initial activity of the partnership, the AAP Committee on Environmental Health and the ATSDR developed and implemented a 2 1/2-day workshop in March 2001 titled “Establishing an Environmental Safety Net for Children, a Joint Project of the Agency for Toxic Substances and Disease Registry and the American Academy of Pediatrics” (“Safety Net Workshop”). The workshop was unique because it was developed specifically for and directed toward practicing pediatricians, bringing together pediatricians interested in environmental health and professionals working in public health. We invited 1 pediatrician from each AAP chapter in the United States, Canada, and Puerto Rico, representatives from the ATSDR’s Pediatric Environmental Health Specialty Units (PEHSUs), regional representatives from the ATSDR, and representatives from the Office of Children’s Health Protection of the US Environmental Protection Agency. Approximately 100 participants and faculty attended the workshop. The 2 main components of the Safety Net Workshop were: 1) 13 lecture sessions; and 2) a series of interactive breakout sessions designed to allow participants to learn about 1 environmental health topic in depth. The workshop culminated in a series of presentations made by participants based on the topics of each breakout session. Detailed information about the planning and implementation of the project is available from the authors on request.This supplement to Pediatrics contains articles based on several of the lectures delivered at the plenary sessions of the Safety Net Workshop. These talks were designed as practical, state-of-the-art reviews of environmental health topics important to pediatric practice. Plenary speakers also included perspectives on each topic that would be useful to public health officials involved in communities where children may be at risk for environmental health hazards. Although all lectures included updates on recent developments in environmental health areas familiar to practicing pediatricians, presenting original research was not the purpose of the workshop.Initial feedback from the practitioners and public health officials who participated in this innovative and interactive workshop was that the process prepared participants to return to their communities and begin new environmental initiatives in their practices and communities. It is our hope that the contents of this supplement to Pediatrics will be equally useful to a larger number of pediatricians as they become more aware, knowledgeable, and proactive in their practice of pediatric environmental health.This supplement was supported in part by funds from the Comprehensive Environmental Response, Compensation, and Liability Act (CERCLA) trust fund through a cooperative agreement with the Agency for Toxic Substances and Disease Registry, Public Health Service, US Department of Health and Human Services.