Clinical services in environmental pediatrics
Jerome A Paulson1, Lauren Gordon
1Mid-Atlantic Center for Children's Health and the Environment at Children's National Medical Center, Washington, DC, USA. jpaulson@cnmc.org
Insights
Pediatric providers frequently encounter environmental health issues but lack adequate training. This article offers guidance on assessing and managing pediatric environmental health problems using evidence-based resources.
Area of Science:
- Environmental Health
- Pediatric Medicine
- Public Health
Background:
- Pediatric healthcare providers frequently face environmental health concerns, including asthma triggers and community health impact assessments.
- Current medical and nursing education often inadequately prepares providers to address these complex environmental health questions.
- There is a need for structured guidance and resources for clinicians managing pediatric environmental health issues.
Purpose of the Study:
- To provide pediatric healthcare providers with a framework for addressing environmental health problems.
- To guide clinicians in history taking, physical examination, and laboratory evaluation for environmental exposures.
- To highlight evidence-based resources and caution against non-evidence-based practices in pediatric environmental health.
Main Methods:
- Review of common pediatric environmental health scenarios encountered by clinicians.
- Outline of a systematic approach to patient and environmental assessment.
- Discussion of diagnostic and management strategies, including consultation resources.
Main Results:
- Provides a comprehensive guide for pediatric providers on managing environmental health issues.
- Emphasizes the importance of evidence-based assessment and treatment strategies.
- Identifies Pediatric Environmental Health Specialty Units as key consultation resources.
Conclusions:
- Pediatric providers require enhanced training and resources to effectively manage environmental health problems.
- A systematic, evidence-based approach is crucial for accurate diagnosis and management.
- Clinicians should prioritize validated resources and avoid unproven therapies.
Abstract:
Pediatric healthcare providers are confronted with environmental health problems frequently: the child with asthma exacerbated by the odor of paint in school or mouse antigen at home, the family who wants to know the risks and benefits of using different types of sunblock, or the community that asks the provider for advice on the potential health impacts of building the new elementary school next to the on-ramp to the interstate highway. Pediatric providers have not been well trained to deal with these questions in medical or nursing schools, residency training, or continuing-education settings. This article provides guidance on history taking, the physical examination, laboratory evaluations of patients and the environment, and making an assessment about and managing environmental health problems. Pediatric Environmental Health Specialty Units are discussed as a source of consultation and referral. The identification and utilization of evidence-based resources are stressed and clinicians are cautioned about non-evidence-based assessments such as clinical ecology and hair analysis and non-evidence-based management strategies such as chelation for autism.
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