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Environmental health and the pediatric patient


The first of the ten ANA Principles of Environmental Health for Nursing Practice is “Knowledge of environmental health concepts is essential to nursing practice.” Pediatric healthcare providers require specialized knowledge to assess the impact of the environment on the health of their patients during both routine well-child checkups and sick visits.
Children are particularly vulnerable to environmental toxins exposure. Research demonstrates that over the past several decades, the prevalence of a number of health problems experienced by children, including asthma and other respiratory diseases, developmental disabailities, neuropsychological disorders, and childhood cancers, has increased.
Although there are many causes of such diseases, including genetic predisposition and demographic factors, numerous exposures to environmental toxins (such as respirable particulate matter, lead, mercury, pesticides, and tobacco smoke) have been identified as contributing factors. Additional research shows that children in lower socioeconomic-status families and children of color often reside in less environmentally friendly housing and are exposed to more environmental health risks.
Depending on their growth and developmental stage, children have unique risks and vulnerabilities, and their ability to metabolize and excrete chemicals varies significantly. Children also consume more oxygen, food, and water per pound due to higher metabolic rates. Because they have highly permeable skin and gastrointestinal systems, newborn infants are at higher risk. Infants and toddlers are at risk for exposure to vapors, dust, pesticides, and polychlorinated biphenyls (PCBs) because of their hand-mouth behaviors, proximity to the floor, and diets high in fruit, vegetables, and milk. Young children’s higher surface area–to–body mass ratio increases exposure to toxicants that are absorbed through the skin.
School-age children are exposed to toxins in their school and home environments—asbestos, PCBs, paints and chemicals in art and science projects, and wood preservatives in playground equipment, play areas, lawns, and school yards.
Adolescents increase their exposure to toxins as they enter the workforce and engage in experimental or risky behaviors (such as smoking or drug use). The rapid adolescent growth spurts related to sexual maturation and growth of body mass create a set of target tissues highly susceptible to toxic effects.
Pediatric environmental health involves the health of children ages 0 to 18; therefore, maternal and fetal exposures must also be considered. The exceptionally rapid growth of fetal tissue provides opportunities for toxins to significantly affect development. Environmental toxins may alter the maternal or paternal reproductive organs, causing mutagenesis of sperm or ova and increasing the risk of cancer or congenital defects of offspring.
Likewise, toxins stored in maternal tissues (such as lead) or maternal bone and fat (PCBs) may be released during pregnancy, disrupting fetal organ system development. Additionally, toxins to which the mother is exposed during pregnancy may cross the placenta and result in deficits. Chemicals well known for their teratogenic effects include alcohol, thalidomide, diethylstilbestrol, and mercury.
Research has shown the need to improve nurses’ knowledge and practice of pediatric environmental health. Many environmental health hazards for children are present in everyday settings, such as homes, day care centers, playgrounds, schools, even the workplace of those living with children. Healthcare providers must be proficient in environmental health principles and must include an environmental health assessment in their routine physical assessments. Knowledge of environmental health concepts allows for accurate diagnoses and treatment of illnesses related to environmental toxins exposure, and helps educate caretakers and families on the prevention of pediatric illnesses secondary to environmental toxins exposure.
The National Environmental Education Foundation has developed resources and tools, including assessment forms, for healthcare providers to assist with performing pediatric environmental histories. These are available on ANA’s website, www.nursingworld.org/MainMenuCategories/OccupationalandEnvironmental/environmentalhealth/ANAResources/OtherResources.aspx.
There is a growing body of evidence demonstrating the effects of environmental toxins exposure on human health. Healthcare providers must be knowledgeable and competent regarding environmental exposures and health implications, particularly in regard to children. It is imperative that a thorough environmental health history be a part of every pediatric patient’s assessment.

Visit www.AmericanNurseToday.com/journal for a list of selected references.

Katie E. Slavin is a Senior Staff Specialist in ANA’s Center for Occupational and Environmental Health.

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