Children's Exposures

Children are at higher risk than adults of being exposed to hazardous substances and of suffering adverse health effects as a result of their exposure. Children’s activities put them at higher risk of exposure to hazardous substances that might be in water or soil. Their height puts them at a level where they are more likely to breathe dust and vapors close to the ground. Small children often put their hands in their mouths, which can allow contaminants into their bodies.

Children’s smaller body size and developing systems also place them at greater health risk than adults. Because they are smaller, children receive higher doses of toxicants per pound of body weight. Pound for pound, children drink more water, eat more food, and breathe more air than adults do. Many organ systems in young children, such as the nervous system and the lungs, undergo rapid growth and development in the first years of life. During these periods of development, children’s organ systems are especially vulnerable to injury. Of special concern is exposure of the fetus, whose organ and body systems are still developing.

Environmental toxicants are a growing cause of preventable illness in children. Exposure to the following toxicants can cause a variety of health and learning disorders.

• Benzene causes leukemia and possibly other cancers.

• Environmental tobacco smoke can raise children’s risk of ear infections and breathing problems and trigger asthma attacks.

• Lead causes learning and behavioral problems.

• Mercury can lead to cerebral palsy, severe mental retardation, neurodevelopmental delays, and seizures.

• Nitrates and nitrites cause methemoglobinemia (the decreasing capacity of the blood to transport oxygen).

• Pesticides can cause cancer, birth defects, and nerve damage.

• Polychlorinated biphenyls (PCBs) might lead to lower intelligence quotients (IQs) in children.

• Trichloroethylene (TCE) is associated with hearing loss and delays in speech development.

In addition, environmental triggers of asthma are also a concern. Environmental pollutants are major contributors to asthma, the most common admission diagnosis in many children’s hospitals.

Some of these environmental toxicants are addressed in this issue; others will be discussed in the Children’s Environmental Health section in future issues.

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ATSDR's Special Emphasis

ATSDR has placed special emphasis on children in conducting its health studies and other activities. The agency has conducted or funded large studies to assess whether the infants of mothers who live near hazardous waste sites are at higher risk for various birth defects or other adverse health outcomes (e.g., small for gestational age). Some of these studies found an increased risk for neural tube defects. Several studies also showed an increased risk for musculoskeletal and heart defects.

Since 1998, ATSDR has been producing Toxicological Profiles that highlight the scientific issues relating to children and hazardous wastes. The profiles now have four sections and two subsections specifically addressing child health issues. Other sections also include an additional focus on issues relevant to children. Health care providers treating patients potentially exposed to hazardous substances will find useful information in the Toxicological Profiles; these comprehensive, peer-reviewed reference documents are also used by other health professionals, private-sector groups, and members of the public.

The Pediatric Environmental Health Specialty Unit (PEHSU) Program

The ATSDR PEHSU Program promotes children’s health by linking medical specialists who have environmental expertise with pediatricians, parents, and communities. PEHSU physicians at 11 units in academic medical centers throughout the United States offer community education, training, consultations, and clinical referrals (see PEHSU map and listing).

In the aftermath of the World Trade Center attacks, the PEHSU in New York City responded in several ways. PEHSU responses included press interviews; public presentations; and consultation with government agencies, parents, and physicians to answer questions over the telephone and in person. The PEHSU also provided practical advice, such as

• practicing prudent avoidance of visible hazards,

• limiting time outdoors near the World Trade Center site,

• limiting outdoor exercise and vigorous play,

• using high-efficiency particulate air (HEPA) vacuums or damp mops and rags,

• cleaning air-handling systems properly,

• keeping windows closed, and

• taking shoes off at the door.

The PEHSUs increase access to (a) information, (b) clinical referrals, and (c) training in pediatric environmental health and medicine for physicians and other health care providers. The PEHSUs link environmental medicine and pediatric specialists to improve environmental health services for children exposed to hazardous substances.

PEHSU Program partners are ATSDR, the U.S. Environmental Protection Agency (EPA) and its regional offices, and the Association of Occupational and Environmental Clinics (AOEC).

Child Health Workgroup

The ATSDR Child Health Workgroup is a multidisciplinary panel of experts appointed by ATSDR’s Board of Scientific Counselors. The workgroup makes recommendations to the agency regarding research and policy directions for pediatric environmental health practice.

The most recent Child Health Workgroup meeting in April 2002 addressed

• children’s environmental health response to bioterrorism and diseases,

• urban sprawl and brownfields, and

• characteristics of schools located near hazardous waste sites.

The Children’s Trust: The Community’s Legacy of a Healthy Environment

ATSDR is developing a community action plan to help communities deal proactively with children’s exposure to toxic substances. The action plan will create safe environments for children in communities at risk. The program will

• provide a comprehensive framework for communities to understand children’s risk for exposure to toxic substances,

• educate residents of all ages about risks and prevention, and

• enlist and educate agencies and organizations in these communities to do their part to create safe environments for children.

A key component of the project will be the development of a database of information about educational, policy, and programmatic resources available for community use. This database will include products from government, medical, and educational organizations. The plan will include the roles of and suggested activities for segments of the community that have an impact on environmental health and children, including health care and public health, government, education, media, and business and industry. This plan will be developed with experts in the field and state and community representatives.

Conclusion

ATSDR recognizes that children today face an array of exposures to potentially toxic environmental hazards. These exposures can have a significant impact on their health and well-being. Children are at risk for learning disabilities, chronic and acute respiratory diseases, cancers, and illnesses caused by damage to the nervous system from hazardous substances. The incidences of chronic childhood diseases are increasing. It is essential that every effort be made to better understand children’s unique susceptibilities to environmental hazards.

Dr. Amler also practices emergency medicine at Children’s Health Care of Atlanta because “I enjoy helping people during emergencies,” he says, “and because it keeps me current in the latest techniques and methods in handling medical and surgical emergencies.”

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Moderate Lead Poisoning: Spotlight on Region 1 PEHSU

Three children were referred by their pediatrician to the Region 1 Pediatric Environmental Health Specialty Unit (PEHSU) for evaluation and management of moderate lead poisoning. All three children (2, 3, and 4 years old) had lead levels of 21–26 micrograms per deciliter (µg/dL) with corresponding elevations in blood concentration of zinc protoporphyrin. (Elevated blood lead levels are defined as greater than or equal to 10 µg/dL.)

The children’s mother reported that her home had been completely renovated, and she believed it was lead free. (The state childhood lead poisoning prevention program inspected the home and found no accessible lead hazards.) When asked about other potential environmental sources of lead, the mother said that the children often played outside in the home’s unfinished driveway. An environmental inspection of the driveway found that the soil lead concentration was greater than 25,000 parts per million (ppm), far above the 400 ppm considered acceptable by the U.S. Environmental Protection Agency. The mother was later told that the driveway had been used by previous residents for car repair that included sanding, painting, and soldering.

Despite the availability of state funds for residential lead abatement, funds were not available to clean up soil. However, with the PEHSU serving in an advocacy role, funds were secured and the driveway soil was completely cleaned up. In less than 6 months, the children's blood lead levels dropped to less than 20 µg/dL as a result of the combination of abatement, close monitoring, and a brief course of chelation therapy.

"This unusual case showed us that outdoor lead sources are occasionally significant. We also learned that resources for the abatement of out-of-home lead hazards are insufficient. Additional infrastructure and support are needed to help families such as this one," said Dr. Michael W. Shannon, MD, MPH, Co-Director of the Pediatric Environmental Health Center.

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Stars indicate PEHSU locations on map.

 

Region 1, Massachusetts (featured in Spotlight on Region 1 PEHSU): Pediatric Environmental Health Center, Children’s Hospital Boston

Toll-free telephone: 1-888-Child14 (1-888-244-5314) Web site: www.childrenshospital.org (In the “find” box, enter the key word “environmental”)

Region 2, New York: Mt. Sinai Pediatric Environmental Health Unit/Mt. Sinai-Irving J. Selikoff Center for Occupational and Environmental Medicine, New York

Toll-free telephone: 1-866-265-6201 Web site: www.mssm.edu/cpm/peds_environ.shtml

Region 3, Washington, DC: Mid-Atlantic Center for Children’s Health and the Environment (MACCHE), George Washington University Medical Center, Washington, DC

Toll-free telephone: 1-866-MACCHE1 (1-866-622-2431) Web site: www.health-e-kids.org

Region 4, Georgia: The Southeast Pediatric Environmental Health Specialty Unit at Emory University, Atlanta

Toll-free telephone: 1-877-33PEHSU (1-877-337-3478) Web site: www.sph.emory.edu/PEHSU

Region 5, Illinois: Great Lakes Center for Children’s Environmental Health, Cook County Hospital, Chicago

Toll-free telephone: 1-800-672-3113 Web site: www.uic.edu/sph/glakes/kids

Region 6, Texas: Southwest Center for Pediatric Environmental Health, University of Texas Health Center at Tyler, Tyler, Texas

Toll-free telephone: 1-888-901-5665 Web site: research.uthct.edu/swcpeh

Region 7, Iowa: Midwest Regional Pediatric Environmental Health Center, University of Iowa, Iowa City, Iowa

Toll-free telephone: 1-866-697-7342 Web site: www.uihealthcare.com/depts/pediatricenvironmentalhealth/index.html

Region 8, Colorado: Rocky Mountain Regional Pediatric Environmental Health Specialty Unit, National Jewish Medical and Research Center, Denver

Toll-free telephone: 1-877-800-5554 Web site: rmrpehsu.org

Region 9, California: University of California-San Francisco (UCSF)/University of California-Irvine (UCI) Pediatric Environmental Health Specialty Unit

Toll-free telephone: 1-866-UC-PEHSU (1-866-827-3478) (for both sites) Web site: www.ucsf.edu/ucpehsu

Region 10, Washington State: Pediatric Environmental Health Specialty Unit, Harborview Medical Center, Seattle

Toll-free telephone: 1-887-KID-CHEM (1-887-543-2436) Web site: www.depts.washington.edu/oemp/grants/PEHSU.html

For more information on the PEHSU Program, call Katherine Kirkland, MPH, Executive Director, AOEC (202-347-4976) or Christine Rosheim, DDS, MPH, Project Officer, ATSDR (404-498-0323).

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NIEHS/EPA/CDC Children's Research Centers

In 1998, the National Institute of Environmental Health Sciences (NIEHS), the U.S. Environmental Protection Agency (EPA), and the Centers for Disease Control and Prevention (CDC) developed the Centers for Children's Environmental Health and Disease Prevention Research program. The program promotes both basic research and the translation of research findings into applied intervention and prevention methods. The following 12 centers in the program address a range of environmental health-related issues, diverse populations, and a variety of settings:

• University of California at Davis: The Center for the Study of Environmental Factors in the Etiology of Autism investigates how environmental risk factors might contribute to childhood autism.

• Robert Wood Johnson Medical School/University of Medicine and Dentistry of New Jersey: The Center for Childhood Neurotoxicology and Exposure Assessment assesses the possible influence of mercury, lead, and valproic acid on autism, learning disabilities, and regression.

• Children's Hospital Medical Center of Cincinnati: The Children's Environmental Health Center heads a research program in which community participants attempt to lower lead levels in their homes so that their children accumulate only traces of lead.

• University of Illinois at Urbana-Champaign: The Friend's Children's Environmental Health Center works with nearby Hmong and Laotian communities to study the impact of polychlorinated biphenyls (PCBs) and mercury on the motor, sensory, and mental development of their children.

• Columbia University School of Public Health: The Columbia Center for Children's Environmental Health is undertaking a comprehensive community-based assessment of environmental risks to African American and Latino children living in New York.

• University of Southern California: The Respiratory Disease and Prevention Center is assessing the impact of environmental tobacco smoke and determining whether sensitization to cockroach and dust mite allergens can be reduced to improve the health of a multiethnic cohort of children in Los Angeles who have asthma.

• The Johns Hopkins University: The Center for Childhood Asthma in the Urban Environment examines how exposures to environmental pollutants and allergens exacerbate asthma in children living in Baltimore's inner city and searches for new ways to reduce the incidence of asthma by reducing exposure to these agents.

• Mt. Sinai School of Medicine: The Center for Children's Health and the Environment identifies, characterizes, and prevents neurodevelopmental deficits that result from exposures to pesticides in the home and polychlorinated biphenyls in the diet.

• University of Michigan School of Public Health: The Michigan Center for the Environment and Children's Health investigates mechanisms of asthma in children and translates those findings into risk assessment and comprehensive neighborhood and household interventions.

• University of Iowa School of Medicine: The Children's Environmental Airway Disease Center studies environmental models of asthma to investigate the biological origin and persistence of airway disease in children.

• University of Washington School of Public Health and Community Medicine: The Center for Child Environmental Health Risks Research conducts research to understand the mechanisms that define children's susceptibility to pesticides and the implications for assessing pesticide risks to normal development and learning.

• University of California at Berkeley, School of Public Health: The Center for the Health Assessment of Mothers and Children of Salinas (CHAMACOS) focuses on the environmental health risks of Latino farmers in California. Children in this region are exposed to organophosphate pesticides. The effects of chronic low-level exposures on the growth and development of these children are unknown.

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This page last updated on October 24, 2003
Contact Name: Wilma López/ WLópez@cdc.gov