Pediatric Environmental Health Tools from the Physicians for Social Responsibility

The Physicians for Social Responsibility have a nice page of environmental health information on their web site. First among these is a Pediatric Environmental Health Tool Kit that combines a reference guide and "anticipatory guide" for health providers with educational materials for parents on preventing chemical exposures that can affect infant and child health. According to PSR’s web site, the tool kit is endorsed by the American Academy of Pediatrics.

The Reference Guide, a four page table of information on several chemical substances of concern for pediatric health, provides reasonable introductions to each substance. However, as with any document that provides an extremely tight summary of hazard information, some useful information is left out, such as what levels of exposure in the body or environment are of concern. It’s an inevitable result of the process of producing a readable summary, and it may be useful to also point health providers to the next layer of detail about specific chemicals, such as the resources provided by ATSDR, including ToxFAQs and the toxicological profiles.

The Anticipatory Guidance Pocket Card is a handy item that:

. . . fits in a large pocket for handy use during a well child visit. The topics on the pocket card are both developmentally appropriate and take advantage of “teachable moments.” For example, at a newborn visit, the provider will naturally discuss infant feeding. Exchanging mercury thermometers for safer digital ones is another easy step that a provider can mention at an early visit. These flexible guidance points provide clinicians with an age appropriate menu of choices to discuss during routine visits.

The advice on it is linked to various development stages. For example, advice during prenatal development includes “avoid eating fish high in mercury or PCBs/dioxins”. Advice for parents with newborns includes “encourage breastfeeding” and “avoid polycarbonate bottles which may leach plasticizers”. There are also safety tips covering carbon monoxide detectors and smoke detectors, encouragement to avoid pesticide use, as well as mention of indoor air pollutants including radon and molds, lead exposure, childhood poisoning prevention, prevention of overexposure to sunlight, healthy eating, TV watching, physical activity, noise exposure, and tobacco use and substance abuse. It’s more of a checklist, without any details on what to do regarding each of these hazards, and presumably the pediatrician provides the specifics during wellness visits. About the only omissions I observed were that it doesn’t mention brominated fire retardants and allergens that could provoke childhood asthma; I call these out because previous studies suggest that carpet dust can be a reservoir for both BFRs and allergens, which should trigger a reminder regarding vacuuming carpets.

However, the 4 page paper “Key Concepts in Pediatric Environmental Health” does include mention of BFRs and asthma. This paper also highlights childrens’ vulnerabilities to toxic substances based on their higher rates of exposure and lesser-developed metabolic defense mechanisms. It mentions the influences of food choices and the built environment on health, setting the stage for preventing childhood obesity. It also focuses on preventing exposure pathways in the built environment, mentioning dust as an exposure medium for pollutants (PCBs, BFRs and lead) and allergens. Other topics addressed in this paper include body burden and breast feeding, “acceptable risk” (or as the paper states it, the declining threshold of harm) and higher risk communities, with low-income or minority populations who experience higher levels of exposure to air pollutants or other hazardous substances.

The most important feature for me is the statement in the paper that “[p]hysicians can protect their pediatric patients by taking environmental/occupational histories of parents and caregivers, and offering appropriate recommendations”. Again, I feel that physicians can be provided with more information regarding the appropriate recommendations, but overall this paper as advertised discusses the “key concepts”.

For the parents, there is a fact sheet “Rx for Prevention”, which goes through the hazards and prevention steps at different developmental stages, and refrigerator magnets and posters with prevention messages. PSR also sponsors training events around the country for health providers.

On a little more political note, PSR also provides a “Prescription for a Secure and Healthy World”, focusing on issues of ending dependence on foreign oil, global climate change and proliferation of nuclear weapons. It contains an online petition that PSR will send to members of Congress, and a resource guide. Another feature of the “prescription” is the “Comprehensive Briefing Book on Key Environmental Health Issues”, addressed to the members of Congress, but a good source of talking points for anyone on fifteen key environmental health issues.