title: Children's environmental health: one year in a pediatric environmental health specialty unit.
abstract: 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.
  
  
  METHODS
  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.
authors.affiliation: Division of Emergency Medicine and the Program in Clinical Toxicology, Children's Hospital, Boston, Mass 02115, USA. michael.shannon@tch.harvard.edu
authors.forename: Michael
authors.initials: M
authors.lastname: Shannon
authors.forename: Alan
authors.initials: A
authors.lastname: Woolf
authors.forename: Rose
authors.initials: R
authors.lastname: Goldman
mesh_terms: D000367:Age Factors; D000554:Ambulatory Care Facilities / Q000706:statistics & numerical data*; D002648:Child; D002662:Child Health Services / Q000706:statistics & numerical data*; D004782:Environmental Health / Q000706:statistics & numerical data*; D006801:Humans; D020380:Needs Assessment / Q000706:statistics & numerical data*; D013997:Time Factors