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Agency for Toxic Substances and Disease Registry Case Studies in Environmental Medicine (CSEM)
Pediatric Environmental Health
Special Susceptibilities and Anticipatory Guidance about Opportunities for Hazardous Exposure by Developmental Stage
Developmental Stage |
Developmental Characteristics |
Vulnerabilities |
Anticipatory Guidance |
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- Male and female parental reproductive systems
- Occupational, environmental, and vocational exposures
- Pharmaceuticals
- Substance abuse
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- Dietary advisories (mercury and PCBs)
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- Rapid cell division
- Organogenesis
- Mother's internal environment
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- Dividing cells sensitive to transplacental carcinogens
- Developing reproductive system can lead to transgenerational effects
- Critical periods of organ development
- Immature blood-brain barrier
- Placenta as semipermeable membrane
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- Dietary advisories (mercury and PCBs)
- Occupational, environmental, and avocational exposures
- Take-home occupational exposures
- Pharmaceuticals and herbal and alternative remedies
- Substance abuse
- Topical insect repellents
- Baseline household environmental survey
- Maternal exposures during preparation of nursery and other remodeling (lead and volatile organic compounds)
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The information in this table is adapted from Bearer (1995).
Anticipatory guidance is the education provided to parents or caretakers during a routine prenatal or pediatric visit to prevent or reduce the risk that their fetuses or children will develop a particular health problem (CDC 1997). |
Developmental Stage |
Developmental Characteristics |
Vulnerabilities |
Anticipatory Guidance |
- Newborn (birth to 2 months)
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- Nonambulatory
- Restricted environment
- High calorie and water intake
- High air intake
- Highly permeable skin
- Alkaline gastric secretions (low gastric acidity)
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- Brain development
- Immature blood-brain barrier
- Synapse formation
- Lungs
- alveolar development
- lung fluid cleared by pulmonary lymphatic system
- High respiratory rate
- Skin very permeable with large surface-to-volume ratio
- Gastrointestinal tract: highly permeable, increased pH
- Immature detoxification capacity of liver, kidney, and digestive system
- Skin
- Contaminants used or deposited on floor, especially household products, pesticides, and take-home occupational agents
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- Consider day care and home, indoor, and outdoor environments
- Ingestion
- Breast milk
- Infant formula (tap or well-water contaminants)
- Respiratory
- Indoor air contaminants, especially those layering near the floor (e.g., mercury, pesticides, allergens,
radon,
asbestos, and take-home occupational agents).
- Outdoor air pollutants, especially ozone and particulates
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The information in this table is adapted from Bearer (1995).
Anticipatory guidance is the education provided to parents or caretakers during a routine prenatal or pediatric visit to prevent or reduce the risk that their fetuses or children will develop a particular health problem (CDC 1997). |
Developmental Stage |
Developmental Characteristics |
Vulnerabilities |
Anticipatory Guidance |
- Infant/Toddler (2 months to 2 years)
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- Crawling and early walking
- Oral exploration
- Limited diet
- High intake of fruits and vegetables
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- Brain development
- Immature blood-brain barrier
- Synapse formation
- Lungs: alveolar development
- High respiratory rate
- Skin very permeable with large surface-to-volume ratio
- Small intestine avidly absorbs lead if diet deficient in iron and calcium
- Immature detoxification
- capacity of liver, kidney, and digestive system
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- Consider day care and home, indoor, and outdoor environments
- Ingestion
- Pesticides on fruit and vegetables
- Tap water contaminants
- Contaminants on floor and within easy reach, especially medicines, household products, pesticides, lead, and take-home occupational agents
- Pica
- Respiratory
- Indoor air contaminants, especially those layering near the floor (e.g., mercury, pesticides, allergens, radon,
asbestos, and take-home occupational agents)
- Outdoor air pollutants, especially ozone and particulates
- Skin
- Contaminants on floor and within reach, especially household products, pesticides, and take-home occupational agents
- Topical insect repellents
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The information in this table is adapted from Bearer (1995).
Anticipatory guidance is the education provided to parents or caretakers during a routine prenatal or pediatric visit to prevent or reduce the risk that their fetuses or children will develop a particular health problem (CDC 1997). |
Developmental Stage |
Developmental Characteristics |
Vulnerabilities |
Anticipatory Guidance |
- Young child (2 to 6 years of age)
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- Expanded environment, still includes significant time on floor
- Increased independence
- High intake of fruits and vegetables
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- Brain developing
- Lungs: alveolar development and increasing volume
- Small intestine avidly absorbs lead if diet deficient in iron or calcium
- Immature detoxification capacity of liver, kidney, and gastrointestinal system
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- Consider home, day care, preschool, and playmates' indoor and outdoor environments
- Ingestion
- Pesticides on fruit and vegetables
- Tap water contaminants
- Contaminants on floor and within easy reach, specially medicines, household products, pesticides, lead, and take-home occupational agents
- Pica
- Respiratory
- Indoor air contaminants, especially those layering near the floor (e.g., mercury, pesticides, allergens, radon, asbestos, and take-home occupational agents)
- Outdoor air pollutants, especially ozone and particulates
- Skin
- Contaminants on floor and within reach, especially household products, pesticides, and take-home occupational agents
- Topical insect repellents
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The information in this table is adapted from Bearer (1995).
Anticipatory guidance is the education provided to parents or caretakers during a routine prenatal or pediatric visit to prevent or reduce the risk that their fetuses or children will develop a particular health problem (CDC 1997). |
Developmental Stage |
Developmental Characteristics |
Vulnerabilities |
Anticipatory Guidance |
- School-aged child (6 to 12 years)
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- Increased number of environments and less supervised play: school, playground, friends' houses
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- Brain developing
- Lungs: increasing volume
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- Consider home, school, friends, and afterschool programs' indoor and outdoor environments
- Ingestion
- Respiratory
- Indoor and outdoor air quality
- Hazards associated with hobbies and school crafts
- Take-home occupational hazards
- Skin
- Hazards associated with hobbies and school crafts
- Take-home occupational hazards
- Topical insect repellents
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The information in this table is adapted from Bearer (1995).
Anticipatory guidance is the education provided to parents or caretakers during a routine prenatal or pediatric visit to prevent or reduce the risk that their fetuses or children will develop a particular health problem (CDC 1997). |
Developmental Stage |
Developmental Characteristics |
Vulnerabilities |
Anticipatory Guidance |
- Adolescent (12 to 18 years)
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- Puberty
- Accelerated growth
- Experimentation with controlled substances
- Independence and exposure to multiple environments
- Possible employment, work in family business, or training in hazardous trades
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- Brain and lungs continue to develop
- Muscles and bones grow rapidly
- Gonad maturation
- Breast development
- Ova and sperm maturation
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- Consider home, school, friends, occupational, and trade school environments
- Ingestion
- Tap water
- Food
- Occupational hazards ingested because of poor poor hygiene
- Substance abuse
- Respiratory
- Indoor and outdoor air quality
- Occupational and trade school hazards
- Take-home occupational exposures
- Hazards associated with hobbies and school crafts
- Substance abuse
- Skin
- Occupational and trade school hazards
- Take-home occupational exposures
- Hazards associated with hobbies and school crafts
- Topical insect repellents
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The information in this table is adapted from Bearer (1995).
Anticipatory guidance is the education provided to parents or caretakers during a routine prenatal or pediatric visit to prevent or reduce the risk that their fetuses or children will develop a particular health problem (CDC 1997). |
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