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The Coming of Age of Environmental Pediatrics

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Children's environmental disease has been recognized as significant for more than one hundred years. That recognition has evolved as new discoveries have refined the field.

The field of children's environmental health began with the recognition that substances in the environment could be acutely toxic to children. Lead, for example, was recognized as causing coma, convulsions, and even death. Mercury was recognized as causing the syndrome acrodynia, characterized by redness of the skin.

Consequently, researchers and clinicians recognized that there could be irreversible, residual effects of acute exposures to substances in the environment, long after the traditional symptoms of poisoning had abated. In the case of lead, for example, acute poisoning could cause long-term reductions in intelligence.

Eventually, scientists studying children's environmental health acknowledged, with the notion of "sub-clinical toxicity," that some substances could cause damage to children without producing any apparent symptoms. In the case of lead, permanent reductions in intelligence were caused by exposures that would not otherwise send a child to the emergency room or even to the doctor.

Refining the notion of sub-clinical toxicity, researchers realized that, with a substance such as lead, the exposure levels causing sub-clinical toxicity were much lower than originally thought. Some substances, researchers realized, might have toxic effects on children at any level of exposure.

Today, children are exposed to thousands of substances in the environment, most of which have never been tested for toxicity to children. Lead is perhaps the best-studied of the environmental threats to children, but there may be countless more that have never been studied. The implications of this massive experiment in exposure are unknown. Environmental toxicants are suspected to be correlated with many disorders that, until recently, have been assumed to be genetic in origin. Parkinson's Disease, attention deficit/hyperactivity disorder, and autism are among the disorders that may be linked to environmental toxicants.

At the same time, there are some disturbing patterns of childhood illness. Childhood deaths from asthma are increasing. Even as the survival rates of children with brain cancer improve, the incidence of brain cancer in children has increased substantially. Disorders of the male reproductive tract, such as hypospadias, have also risen. Birth defects continue to be the leading cause of deaths for infants in the U.S. Learning disabilities, mental retardation, and autism are diagnosed in an estimated three percent of all children born in the U.S.

Infants and children's special vulnerabilities and unique exposures to environmental toxins are only beginning to be understood. A number of recent actions point to the "coming of age" of environmental pediatrics:

The National Institutes of Health, the Environmental Protection Agency, and the Centers for Disease Control and Prevention are supporting eight research centers at universities around the country (Centers for Children's Environmental Health and Disease Prevention Research). The purpose of the Centers is to study the causes of children's disorders that are suspected to be of environmental origin and to use research findings to prevent environmentally-related conditions in children. The Mount Sinai Medical Center is studying the progression of neuro-developmental impairment in inner-city children and is exploring ways to reduce children's exposures to pesticides in city housing.

In October, the American Academy of Pediatrics (AAP) will publish the first Handbook of Environmental Health for Children, featuring over 30 chapters on prevention and treatment of environmental health problems. This desk reference for the practicing clinician-called the "Green Book" in shorthand-is intended to accompany the AAP's popular desk reference on prevention and treatment of infectious diseases in children, commonly referred to as the "Red Book."

The federal Agency for Toxic Substances and Disease Registry (ATSDR) has established six pediatric environmental health specialty units in academic health centers around the U.S. for the purpose of offering children and their families access to specialists in environmental medicine. At these units, parents receive the specialty care they need to appropriately treat their children's environmental diseases, such as asthma, thereby avoiding life-threatening complications.

The Pew Charitable Trusts-a national foundation based in Philadelphia with over $4.7 billion in assets-has established the Pew Environmental Health Commission to advise the nation on public health policies that will better protect humans from environmental harm. The first report of the Commission, which is chaired by former Senator Lowell Weicker, will focus on the nation's ability to track and prevent birth defects. The Pew Charitable Trusts have also established the nation's first academic policy center to address the particular vulnerability of children to the hazards posed by environmental pollutants. The Center for Children's Health and the Environment is headquartered at the Mount Sinai School of Medicine and is directed by Dr. Philip J. Landrigan, a pediatrician and pioneer in environmental pediatrics.

This summary was prepared by the Center for Children's Health and the Environment of the Mount Sinai School of Medicine. CCHE's mission is to promote the health of children by conducting environmental health and policy research. CCHE was established in 1998 with the support of The Pew Charitable Trusts. CCHE's director is Philip J. Landrigan M.D., M.Sc., a pediatrician who chairs the Department of Community and Preventive Medicine at Mount Sinai.

This web page is not an official publication of the Mount Sinai School of Medicine. The opinions expressed and the information presented on this page are not necessarily those of The Mount Sinai School of Medicine. Comments on the page should be directed to the page authors. Copyright � 2000, 2001, 2002 [Center for Children's Health and the Environment]. All rights reserved.
Last Revised: June 1, 2002 .