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Pediatric Environmental Health

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However, the lung continues to develop alveoli, from birth to adolescence and, ... www.lungusa.org (American Lung Association) ... – PowerPoint PPT presentation

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Title: Pediatric Environmental Health


1
Pediatric Environmental Health
  • Christine L. Johnson, MD
  • Maj, USAF, MC
  • Assistant Professor of Pediatrics
  • USUHS
  • June 2001

2
Background
  • The field of Pediatric Environmental Health is
    rapidly evolving, yet, information pertinent to
    this field is widely scattered and infrequently
    evaluated by clinicians.
  • The field is still in the early stages of
    development with knowledge in some areas
    increasing and some areas where there are still
    more questions than answers.

3
Background
  • In 1995, the EPA formulated a national policy
    requiring that the health risks to children and
    infants, from environmental hazards, be
    considered when conducting environmental risk
    assessments.
  • Many new programs have been initiated to
    stimulated necessary research into the impact of
    the environment on the health of children.
  • Environmental hazards are among the top health
    concerns many parents have for their children.

4
Children Are Different Than Adults
  • Children are uniquely vulnerable to environmental
    hazards and they should not be treated as little
    adults.
  • Differences in exposure, absorption, metabolism,
    distribution, and target organ susceptibilities
    are age-specific factors affecting an
    individuals risk for an environmentally related
    illness.

5
Exposure
  • Children, depending on their developmental stage,
    will have vastly different environments.
  • Remember to consider exposures in all
    environments, throughout the day.
  • Pre-ambulating children cannot remove themselves
    from a hazardous environment.
  • The metabolic rate of children is higher, because
    of their larger surface-to-volume ratio,
    therefore they have greater exposure to air
    pollutants.
  • The amount of food consumed per kilogram of body
    weight is much higher than adults, therefore,
    they have a greater risk of exposure to ingested
    toxins.

6
Absorption
  • Absorption occurs by one of four pathways
    transplacental, percutaneous, respiratory and
    gastrointestinal.
  • Low molecular weight and lipophilic compounds
    cross the placenta easily (e.g. CO, PCBs,
    ethanol, calcium, methyl mercury and lead).

7
Absorption
  • The skin of a newborn is particularly absorptive
    because it takes time for the dermis to develop
    the protective, exterior, dead keratin layer.
  • The newborn has a three times larger, and the
    child a two times larger surface to mass ratio
    than an adult. Therefore, absorption of topical
    chemicals is 2-3 times greater than in an adult.

8
Absorption
  • The surface absorptive properties of the lung
    probably do not change during development.
    However, the lung continues to develop alveoli,
    from birth to adolescence and, therefore,
    develops increased surface absorptive area.
  • The GI tract undergoes many changes during
    development, affecting transport of particular
    nutrients, and or noxious agents.

9
Distribution
  • The tissue distribution of chemicals varies with
    developmental stage of the child. For example,
    many drugs in the newborn have higher apparent
    volumes of distribution. Lead may also be more
    readily accumulated in the bones of children.

10
Metabolism
  • Metabolism of a chemical may result in its
    activation or deactivation.
  • The activity in each step of metabolic pathways
    is determined by development and genetics.
    Therefore, some children may be more susceptible
    to certain exposures.
  • For example, those with G6PD are particularly at
    risk for developing hemolytic anemia if exposed
    to certain chemicals.
  • Enzymes may have different levels of activity
    depending on the developmental stage (e.g. P450).

11
Target Organ Susceptibility
  • Organs of children continue to undergo growth and
    differentiation.
  • These processes can be disrupted or altered by
    exposure to environmental hazards.
  • Some environmental agents may mimic hormones.
  • The brain and the lungs are especially vulnerable
    to toxic insults since they have a prolonged
    period of postnatal development.

12
The Environmental History
  • The right questions to ask!!!
  • What kind of home or other environment does the
    child live in, or spend time in?
  • What are the parents occupations? Is the child
    or adolescent employed?
  • Are there smokers in the household?
  • Does the childs diet put him or her at risk?
  • Is the child at high risk for lead poisoning?

13
Home or Environment
  • Type of dwelling (home, apartment, mobile home,
    homeless)
  • Age and condition of the home/dwelling
  • Heating sources
  • Ongoing or planned renovations
  • Indoor or outdoor pesticides and chemical use
  • School- (same questions as above)
  • Hobbies
  • Outdoor environment/ community issues

14
Occupations
  • Possible contaminants in the workplace(e.g. lead,
    asbestos, mercury, etc.)
  • The nature of the job. Is it hazardous or
    illegal?

15
Smokers in the Household
  • Children exposed to second hand smoke are at
    increased risk for SIDS, otitis media
    exacerbations, asthma exacerbations, and adult
    lung cancer.
  • Children whose parents smoke are more likely to
    smoke themselves.

16
Diet
  • Breast feeding may pass along certain drugs,
    metabolites and chemicals to the infant (e.g.
    nicotine, PCBs, PBB,s).
  • Formula-fed babies are at risk from the tap water
    used to mix the formula. One minute of boiling
    is recommended for sterilization. Prolonged
    boiling may concentrate any lead.
  • Potential exposure to pesticides and chemical
    residues exists on fresh fruits and vegetables.
    Parents should encourage intake of these healthy
    foods, but aggressive washing with water should
    occur.

17
www.epa.gov
18
Lead Risks
  • Questionnaires should be completed to identify
    children at high risk for lead poisoning. Those
    children or symptomatic children, should be
    screened for elevated lead levels.
  • Questions
  • House (lived in or visited) built before 1960
    with chipping or peeling paint
  • Sibling or friend with an elevated lead level
  • Job or hobby that involves exposure to lead
  • Live near an active lead smelter, battery
    recycling plan or other industry likely to
    release lead

19
  • Regional Resources
  • ATSDR (Agency of Toxic Substances and Disease
    Registry)
  • PEHSU (Pediatric Environmental Health Specialty
    Units)
  • EPA (Environmental Protection Agency)
  • CDC (Centers for Disease Control and Prevention)

20
Websites
  • www.epa.gov (Environmental Protection Agency)
  • www.epa.gov/iaq
  • www.epa.gov/children
  • www.aap.org (American Academy of Pediatrics)
  • www.aap.org/pubserv
  • www.nhlbi.org (National Heart, Lung and Blood
    Institute)
  • www.cmhc-schl.gc.ca (Canadian Mortgage and
    Housing Corporation)
  • www.aaaai.org (American Academy of Allergy ,
    Asthma and Immunology)
  • www.cdc.gov/nceh (Centers for Disease Control,
    National Center for Environmental Health)
  • www.lungusa.org (American Lung Association)
  • www.aanma.org (Allergy and Asthma Network,
    Mothers of Asthmatics)
  • www.njc.org (National Jewish Medical and
    Research Center)
  • www.niaid.nih.gov (National Institute of Allergy
    and Infectious Diseases)
  • www.cehn.org (Center for Environmental Health)

21
References
  • Handbook of Pediatric Environmental Health,,
    Etzel, Ruth A., Balk, Sophie J., American Academy
    of Pediatrics, 1999.
  • How are children different from adults? Bearer,
    Cynthia F., Environmental Health Perspectives,
    Sept 1995, V0l 103, Supp 6, 7-10.
  • The environmental history Asking the right
    questions. Balk, Sophie J., Contemporary
    Pediatrics, Feb. 1996, 19-36.
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