Clinical services in environmental pediatrics.
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.
Mid-Atlantic Center for Children's Health and the Environment at Children's National Medical Center, Washington, DC, USA. jpaulson@cnmc.org
Jerome A
JA
Paulson
Lauren
L
Gordon
D002648:Child; D002669:Child Welfare; D004782:Environmental Health; D006801:Humans; D010372:Pediatrics