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Agency for Toxic Substances and Disease Registry Case Studies in Environmental Medicine (CSEM)
Pediatric Environmental Health
Appendix C: Summary of Questions for an Environmental History
- Do you live in an apartment, house, or mobile home?
- On what level of your dwelling is the child's room located?
- What are the age and condition of your home?
- How is your home heated?
- Do you have a fireplace or a wood stove?
- Do you use pesticides inside or outside your home (including use on children and pets)?
- What are the hobbies of your child and other family members?
- Is your home (day-care center, etc.) near a polluted body of water, industrial plant, commercial business, or dump site?
- What is your occupation?
- What is your spouse's occupation?
- Do other members of the family have jobs?
- If so, what are they?
- For teenagers:
- Do you work?
- What kind of job do you have and what hours do you work?
- Do you smoke tobacco products?
- If yes, do you smoke in your home?
- Does your spouse, other family member, or babysitter smoke?
- If you take your child to a babysitter, does he or she smoke at home?
- Do visitors smoke in your home?
- Does anyone smoke in your car?
- For breastfeeding mothers:
- Have you tested your water supply for lead?
- If not and you make the baby's formula with tap water, what procedure do you follow?
- Do you ever use hot tap water or water from instant hot taps or refrigerator taps to make the formula?
- Do you wash fruits and vegetables before giving them to your child?
- What do you wash them with?
- What kind of produce do you usually buy? Organic? Local? In season?
- Does the child live with an adult whose job or hobby involves exposure to lead?
- Is there a brother, sister, housemate, or playmate being followed or treated for lead poisoning (i.e., blood lead 15 µg/dL)?
- Does the child live with an adult whose job or hobby involves exposure to lead?
- Does the child live near an active lead smelter, battery recycling plant, or other industry likely to release lead?
- Do you use home remedies or pottery from another country?
Adapted from Balk (1996).
Topics |
The Right Time |
Home renovation, smoking, breast and bottle issues |
Prenatal period |
Environmental tobacco smoke |
When child is 2 months old |
Poison exposures, including household pesticides and lead poisoning
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When child is 6 months old |
Arts-and-crafts exposures
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Preschool period |
Occupational exposures, exposures from hobbies
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When patient is a teenager |
Lawn and garden products, lawn services, scheduled chemical applications
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Spring and summer |
Wood stoves and fireplaces, gas stoves |
Fall and winter |
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