The following stories are selected case studies presented in the interactive Pediatric Environmental Health Toolkit (PEHT) Training Module. This module and the PEHT reviews children’s unique vulnerabilities to environmental hazards, sources of exposure, and offers suggestions for incorporating anticipatory guidance in well-child visits. The animated stories below are part of the free online 1 1/2 hour continuing education (CE) course for physicians, nurses, health educators, and other health professionals interested in pediatric environmental health. The entire PEHT Training Module and access to the free CE given by the CDC are found at http://www.atsdr.cdc.gov/emes/health_professionals/pediatrics.html. Dr. Mark Miller from the UCSF PEHSU was the lead author working in collaboration with the Agency for Toxic Substances and Disease Registry (ATSDR) and Physicians for Social Responsibility (PSR) to develop this course, which supports use of the PEHT. The PEHT materials are available at http://www.psr.org/resources/pediatric-toolkit.html.
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Nitrates
It is important to understand the unique vulnerabilities of children. Children are often at higher risk from toxic exposures because of diet, certain behaviors, key windows of vulnerability, and physiologic factors.
From birth, children breathe more air, drink more water, and eat more food per kilogram of body weight than adults. An infant’s respiratory rate is more than twice that of an adult’s.
Children may be more prone to carcinogenic effects of some chemicals due to rapidly proliferating tissues, their susceptibility and their young age, which allows many years in which latent effects may manifest.
This video discusses how children's unique susceptibilities puts them at higher risk than adults from toxic exposures.
(From ATSDR eLearning course: Pediatric Environmental Health Toolkit Training Module http://www.atsdr.cdc.gov/emes/training/index.html)
Nail Solvents
A good intake form that deals with patient and family environmental history will alert you to at work exposures that could harm children.
There are many potential health dangers in a nail salon, such as chemical fumes, equipment, and fluids. Growing children may be particularly vulnerable to pollutants.
(From ATSDR eLearning course: Pediatric Environmental Health Toolkit Training Module http://www.atsdr.cdc.gov/emes/training/index.html)
Lead with Walking Toddler
This scenario is based on an actual case reported in the newsletter of the California Department of Health Services Childhood Lead Poisoning Prevention Branch.
The case illustrates how an environmental illness can be indicative of a larger public health problem. Where one person is exposed, there may be many others. Identifying the source of an exposure can result in mitigating illness in many succeeding workers, tenants, neighbors, etc. Note how children were affected in this case.
(From ATSDR eLearning course: Pediatric Environmental Health Toolkit Training Module http://www.atsdr.cdc.gov/emes/training/index.html)
Mercury in Fish
Some fish have higher levels of mercury and suggested it’s best to serve children a variety of fish and seafood that have low levels of mercury, which include haddock, pollock, wild salmon, shrimp, canned chunk light tuna, and catfish. Fish sticks are also usually made from fish that are low in mercury.
By following the recommendation for selecting and eating fish or shellfish, women and young children will still receive the benefits of eating fish and shellfish, and can be confident that they have reduced their exposure to mercury.
(From ATSDR eLearning course: Pediatric Environmental Health Toolkit Training Module http://www.atsdr.cdc.gov/emes/training/index.html)
Healthy Food and Exercise
Outdoor play time, especially unstructured, imaginative and exploratory play is increasingly recognized as an essential component of wholesome child development. Play in natural settings seems to offer special benefits.
Children are more physically active when they are outside, a plus at a time of sedentary lifestyles and an epidemic of children being overweight. Studies at the University of Illinois show that children with Attention-Deficit Disorder have fewer symptoms, and enhanced ability to focus, after outdoor activities. Children focus better when camping, exploring and fishing as compared to indoor activities such as watching t.v. and playing video games.
(From ATSDR eLearning course: Pediatric Environmental Health Toolkit Training Module http://www.atsdr.cdc.gov/emes/training/index.html)
In collaboration with California EPA’s Office of Environmental Health Hazard Assessment and the Center for Integrative Research on Childhood Leukemia and the Environment at the University of California Berkeley, the UCSF PEHSU sponsored a symposium to present the latest research on children’s environmental health topics. Speaker’s topics included children's exposure to chemicals, how the environment changes the development of the brain and nervous system in children, and childhood leukemia.
SYMPOSIUM ON CHILDREN'S ENVIRONMENTAL HEALTH RESEARCH and IMPLICATIONS FOR RISK ASSESSMENT and PUBLIC POLICY, January 11-12, 2012, Oakland, CA.
Organized by the California Office of Environmental Health Hazard Assessment http://oehha.ca.gov, Pediatric Environmental Health Specialty Unit at UCSF http://coeh.berkeley.edu/ucpehsu, and the Center for Integrative Research on Childhood Leukemia and the Environment at the University of California, Berkeley http://circle.berkeley.edu.
Speakers are from Children's Environmental Health Research Centers and Pediatric Environmental Health Specialty Units on the West Coast. Topics include: (1) Children's exposure to chemicals; (2) How the environment changes the development of the brain and nervous system in children; (3) Childhood leukemia.
Research funding is from the National Institute of Environmental Health Sciences and the US Environmental Protection Agency. Presentations do not represent the views of these agencies. For some slides, unpublished data is blurred. This is done to protect the ability of the investigators to publish the data.
The playlist of nine presentations is viewable at this link: http://www.youtube.com/playlist?list=PLBFF2D8E138A22D23.
1. Children’s Exposures to Chemicals in Farming and Child Care
Dr. ASA BRADMAN of the Center for Environmental Research on Children’s Health at the University of California Berkeley http://cerch.org describes pesticide exposures to children from the Salinas Valley, California and discusses the challenges in conducting environmental health research. He also explains why manganese is a concern for children and discusses chemical exposures in child care centers, including measurements of volatile organic compounds (VOCs), flame retardants, and other chemicals.
2. Using House Dust to Measure Chemicals Affecting Children
Dr. TODD WHITEHEAD of the Center for Integrative Research on Childhood Leukemia and the Environment at the University of California Berkeley http://circle.berkeley.edu shows that dust from houses can be used to measure chemicals that children are exposed to at home, particularly PAHs, PCBs, PBDEs, and tobacco smoke constituents. He shows that measurements taken several years after a child is born are useful to estimate earlier exposure.
3. Effects of Air Pollution on Immune Function and Asthma.
Dr. JOHN BALMES of the Berkeley/Stanford Center for Children's Environmental Health shows that polycyclic aromatic hydrocarbons (PAHs) in air contribute to allergy and asthma in children. PAHs reduce the production of proteins that are important to regulating immune response. PAHs set markers through epigenetic methylation that reduce the expression of a gene known as Foxp3. This leads to more asthma, reduced lung function, and greater wheezing.
4. Evidence to Practice: Perspective of the Clinical Community
Dr. CATHERINE KARR of the Northwest Pediatric Environmental Health Specialty Unit of the University of Washington http://depts.washington.edu/pehsu discusses the medical community as a resource for children’s environmental health using asthma as a case study. She recommends additional training for health care professionals, developing materials including targeted journal articles and fact sheets, and involving clinical trainees in public health research and practice.
5. Toward autism: Exposures Affecting Neuroexcitability and Oxidative Stress
Dr. ISAAC PESSAH of the Center for Children’s Environmental Health http://www.vetmed.ucdavis.edu/cceh/index.cfm and the MIND Institute http://www.ucdmc.ucdavis.edu/mindinstitute at the University of California, Davis explains that genetic and environmental factors interact to cause autism, which takes many forms. Research on the less stable parts of the genome identified genetic copy number variants as important. Environmental factors may contribute to making autism more severe.
6. Epigenetic Mechanisms in Childhood Disease: Environmental Exposures, Childhood Leukemia & the Role of DNA Methylation.
Dr. JOSEPH WIEMELS of the Center for Integrative Research on Childhood Leukemia and the Environment http://circle.berkeley.edu and UCSF explains the importance of epigenetics. Epigenetic changes do not damage DNA (like mutations), but alter when DNA is expressed. This can affect development in early life. Epigenetic changes may be a cause some types of leukemia. Leukemia includes a number of different diseases with different patterns of epigenetic markers including methylation. Environmental agents may change methylation patterns,and the changes may be heritable from parent to child.
7. Use of Chemicals at Home and Risk of Childhood Leukemia
Dr. CATHERINE METAYER of the Center for Integrative Research on Childhood Leukemia and the Environment at the University of California, Berkeley http://circle.berkeley.edu shows that use of pesticides around homes, particularly during the prenatal period, may increase risk of childhood leukemias, particularly acute lymphoblastic leukemia or ALL. Pesticides may not be persistent enough to be detected in house dust collected years after exposure. Use of paint in the home after pregnancy may increase risk of ALL.
8. Parents’ Smoking Linked to Higher Risks of Leukemia in Their Children
Professor PATRICIA A. BUFFLER, director of the Center for Integrative Research on Childhood Leukemia and the Environment and Professor at the University of California, Berkeley http://circle.berkeley.edu, presents data from the California Childhood Leukemia Study showing that children whose parents smoked are more likely to develop leukemia in early childhood. Risks vary by the time period of smoking (preconception, prenatal, and early childhood), type and subtype of leukemia, and which parents smoked.
9. Could Infection Contribute to a Possible Leukemia Cluster in Fallon Nevada?
Dr. STEPHEN S. FRANCIS, of the Center for Integrative Research on Childhood Leukemia and the Environment at the University of California Berkeley http://circle.berkeley.edu, discusses whether infectious agents may have contributed to a possible cluster of childhood leukemia cases in Fallon, Nevada. A role for an infectious agent, in this case a virus, is suggested because there was a spike in cases of childhood leukemia in US military dependent populations at around the same time; Fallon had a naval air station that brought military personnel into the town; and the locations where children with the disease lived tended to be in areas where transmission by mosquitoes might occur.
Coming soon, a video recording of the presentation by Professor Elaine Faustman of the Center for Child Environmental Health Risk Research of the University of Washington http://depts.washington.edu/chc/about_chc.html.
