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Children's environmental health: one year in a pediatric environmental health specialty unit
Michael Shannon1, Alan Woolf, Rose Goldman
1Division of Emergency Medicine and the Program in Clinical Toxicology, Children's Hospital, Boston, Mass 02115, USA. michael.shannon@tch.harvard.edu
Insights
Pediatric environmental health centers evaluate children exposed to toxicants, with lead being the most common exposure. These specialized units address diverse environmental health concerns, highlighting a need for expanded services.
Area of Science:
- Environmental Health
- Pediatric Toxicology
- Clinical Research
Background:
- Growing demand for specialized clinical centers to assess children with environmental toxicant exposures.
- Establishment of federally funded Pediatric Environmental Health Specialty Units (PEHSUs).
Purpose of the Study:
- To profile children evaluated at a university-affiliated Pediatric Environmental Health Center (PEHC).
- To describe the types of environmental exposures and presenting complaints seen in a PEHC.
Main Methods:
- Descriptive study analyzing data from all children seen at the PEHC in 1999.
- Review of presenting complaints, diagnoses, and interventions for 281 children.
Main Results:
- Lead intoxication was the primary reason for visits (717 of 863 visits).
- Other significant chief complaints included solvent-contaminated water, pesticide exposure, and proximity to hazardous waste sites.
- Eleven children had autism or pervasive developmental delay, with suspected mercury intoxication in four.
- Families traveled long distances, and comprehensive environmental investigations were conducted for most children.
- Interventions ranged from chelation therapy to relocation and removal from school.
Conclusions:
- Pediatric environmental health units manage a wide spectrum of toxicant exposures across various environmental media.
- The extensive travel distances indicate a need for a more widespread network of these specialized centers.
- Third-party payers fully reimbursed services, demonstrating financial viability.
Background/Objective:
As a result of an increasing desire among physicians and parents for clinical centers that can evaluate children with known or suspected exposures to environmental toxicants, a network of federally funded "pediatric environmental health specialty units" has recently been created. This descriptive study profiles the children seen in one unit of this program.
Setting:
A New England, university-affiliated Pediatric Environmental Health Center (PEHC).
Methods:
Review and analysis of all children seen in the PEHC in calendar year 1999.
Results:
Over the course of the year, 281 children made 863 visits to the PEHC. Presenting complaints fell into 4 major categories: new visit for management of lead intoxication (n = 248), return visit for management of lead intoxication (n = 569), new visit for evaluation of exposure to an environmental toxicant other than lead (n = 33), and return visit for the management of exposure to a non-lead toxicant (n = 13). Among those children with new visits for a non-lead toxicant, the most common chief complaints were exposure to solvent-contaminated water (n = 7), pesticide exposure (n = 6), illness associated with proximity to a hazardous waste site (n = 6), autism from suspected mercury intoxication (n = 4), and evaluation of school-induced, building-related illness ("sick school syndrome")(n = 4). Eleven children had autism or pervasive developmental delay. Families traveled distances as great as 450 kilometers for evaluation by a pediatric environmental health clinical specialist. Every child was evaluated by a pediatrician with subspecialty training in medical toxicology. Environmental investigation of air, water, paint, dust, or land was conducted for all except 4 children (all foreign-born adoptees). Therapeutic interventions included chelation therapy, relocation to a safe environment, removal from school, and termination of chelation therapy that had been initiated by another practitioner. Third-party payors provided full reimbursement for all visits.
Conclusions:
The chief complaints of the children brought to pediatric environmental health specialty units are diverse, involving exposures to a wide range of toxicants from all environmental media (air, water, soil, and food). Parents desiring such an evaluation must often travel extensive distances, suggesting the need for a broader network of such centers. Third-party payors and health maintenance organizations are willing to provide full reimbursement for these services.
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