Assessing environmental exposures in children: toward a comprehensive exposome approach

Environmental exposures are major determinants of child health, particularly during critical developmental windows extending from preconception through childhood. The exposome framework provides a comprehensive and dynamic approach to studying the totality of environmental exposures and their biological consequences across the life course, moving beyond traditional single-pollutant approaches. Here, we summarize current exposure-assessment tools, including questionnaires, biomarkers, sensors, geospatial indicators, and large-scale databases. It also highlights advances in longitudinal cohort studies, multi-omics integration, and analytical methods designed to address complex exposure mixtures and critical windows of susceptibility. Recent exposome studies have improved our understanding of how chemical, physical, climatic, built-environment, and social exposures interact to influence child health and development. Large exposome cohorts have demonstrated the feasibility of integrating environmental, biological, and social data while identifying pathways linking early-life exposure to child-health outcomes. Ongoing developments in exposure assessment, harmonization, causal inference, and multi-omics integration are accelerating the translation of exposome research into prevention, clinical practice, and public health. Because many environmental determinants of health act during early development, pediatricians should play a central role in translating exposome evidence into prevention, clinical practice, and public-health action. IMPACT QUESTION: WHAT DOES THIS REVIEW ADD TO THE EXISTING LITERATURE?: This review provides a pediatric-focused overview of exposome research, emphasizing critical windows from preconception through early life and their implications for lifelong health It integrates recent advances in exposome assessment, longitudinal cohort studies, multi-omics approaches, and analytical methods, while highlighting current methodological and translational challenges. It highlights the central role of pediatricians in translating exposome research into prevention, clinical practice, and public-health actions by identifying modifiable environmental, biological, and social determinants of child health.