This is the current release of the guideline.

All clinical reports and policy statements from the American Academy of Pediatrics automatically expire 5 years after publication unless reaffirmed, revised, or retired at or before that time.

Noninfectious health effects from exposure to molds, including:

• Immune mediated (allergic rhinitis/conjunctivitis, asthma, hypersensitivity pneumonitis, allergic bronchopulmonary aspergillosis [ABPA], allergic fungal sinusitis [AFS])
• Nonimmune mediated (irritant symptoms, inhalation fever, acute idiopathic pulmonary hemorrhage [AIPH] in infants, toxin-mediated diseases)

Evaluation
Management
Prevention

Allergy and Immunology
Family Practice
Pediatrics

Physicians

To describe the pediatrician's role in the education of families about mold, its adverse health effects, exposure prevention, and remediation procedures

Children with environmental exposure or potential exposure to molds

1. Inquiring about presence of mold or water damage in patient's home
2. Providing guidance for families on:
   • Health issues associated with mold exposure
   • Prevention/reduction of mold exposure
3. Education of families on mold remediation

Adverse health effects associated with exposure to mold

Searches of Electronic Databases

Not stated

Not stated

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Not applicable

Review

Not stated

Not stated

Not applicable

A formal cost analysis was not performed and published cost analyses were not reviewed.

Not stated

Not applicable

1. Because there are established health hazards, inquire about the presence of mold as part of a "healthy home" inventory. Questions about a child's environment are basic to a comprehensive pediatric health history (American Academy of Pediatrics, 2003). Questions can be incorporated during visits for health supervision or sick visits. Asking about a child's environment should be routine for children with common illnesses, such as allergic rhinitis/conjunctivitis and asthma, as well as for those with less common illnesses, such as hypersensitivity pneumonitis.
2. Provide guidance to parents of all children about:
   • The adverse health effects of mold exposure, especially the causal relationship between mold and allergic illness and respiratory symptoms; and
   • Preventing and reducing mold exposure in the immediate indoor and outdoor environments.
3. Educate families on mold remediation. Visible signs of mold growth (e.g., discolored patches or cottony or speckled growth on walls or furniture, evidence of dampness or water damage or an earthy musty odor in a particular area) suggest a damp environment and mold growth. In areas where flooding has occurred, prompt cleaning (within 24 hours) of walls and other flood-damaged items is necessary to prevent mold growth. Testing the environment for specific molds is usually not necessary. In general, individuals can perform mold cleanup for areas less than 10 ft (Centers for Disease Control and Prevention, 1997).
4. When treating an infant with acute idiopathic pulmonary hemorrhage (AIPH), inquire about mold and water damage in the home. Report cases of AIPH to state health departments. Although a causal relationship between AIPH and damp, moldy indoor environments has not been firmly established, the knowledge is incomplete at this time. Therefore, it is prudent to recommend that parents of infants with AIPH try to find and eliminate sources of chronic moisture and mold growth before the child returns to the home. Avoidance of exposure to secondhand cigarette smoke is always recommended, but especially in cases of AIPH.
5. Be aware that there are no uniformly accepted, valid, quantitative environmental sampling methods or serologic tests to assess exposures to mold and other agents associated with damp indoor environments. There are also no accepted valid airborne levels of mold that predict adverse health effects.
6. Be aware that there is currently no method to test humans for toxigenic mold exposure (California Department of Health Services, 2005).
7. Be aware that mold-contaminated foods (especially grains) can contain harmful amounts of mycotoxins. The US Department of Agriculture has set allowable limits in certain food items and has some routine monitoring in place to prevent harmful ingestion of mycotoxin-contaminated foods. Inquire about dietary history if a mycotoxin-induced illness is suspected.

See the original guideline document for recommendations to government.

None provided

The type of evidence supporting the recommendations is not specifically stated.

Prevention of mold-related clinical illness in children and improvements in environmental quality

Not stated

The guidance in this report does not indicate an exclusive course of treatment or serve as a standard of medical care. Variations, taking into account individual circumstances, may be appropriate.

An implementation strategy was not provided.

Getting Better
Staying Healthy

Effectiveness
Patient-centeredness

Not applicable: The guideline was not adapted from another source.

2006 Dec

American Academy of Pediatrics - Medical Specialty Society

American Academy of Pediatrics

Committee on Environmental Health

Committee on Environmental Health, 2005-2006: Michael W. Shannon, MD, MPH, Chairperson; Dana Best, MD, MPH; Helen J. Binns, MD, MPH; Joel A. Forman, MD; Christine L. Johnson, MD; Catherine J. Karr, MD, PhD; *Janice J. Kim, MD, PhD, MPH; *Lynnette J. Mazur, MD, MPH; James R. Roberts, MD, MPH

Liaisons: Elizabeth Blackburn, RN, US Environmental Protection Agency; Mark Anderson, MD, Centers for Disease Control and Prevention/National Center for Environmental Health; Martha Linet, MD, National Cancer Institute; Walter Rogan, MD, National Institute of Environmental Health Sciences

Staff: Paul Spire

*Lead authors

Not stated

This is the current release of the guideline.

All clinical reports and policy statements from the American Academy of Pediatrics automatically expire 5 years after publication unless reaffirmed, revised, or retired at or before that time.

None available

This NGC summary was completed by ECRI on April 2, 2007. The information was verified by the guideline developer on April 9, 2007.

This NGC summary is based on the original guideline, which is subject to the guideline developer's copyright restrictions. Please contact the Permissions Editor, American Academy of Pediatrics (AAP), 141 Northwest Point Blvd, Elk Grove Village, IL 60007.