Protect Children,
Protect Our Future
                 OOF06907

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THE  FACTS ABOUT  CHILDREN'S  HEALTH
                  20 million people, including 6.1 million children, have asthma.1
 Hospitalizations for asthma increased from 21 per 10,000 children in 1980 to 27 per 10,000 children
 in 2002.2
 In 1999, asthma was the fourth ranking cause of non-injury-related hospitalization among children
 less than 15 years of age.'
 In 2002, 187 children under 18 years of age died from asthma." The number of children ages 1-14
 dying from asthma increased 186 percent from 1979 to 2002.5
 Asthma disproportionately affects children from lower-income families and children from different
 racial and ethnic groups.6
 Asthma is the most common  chronic childhood disease in the United States.7
 Economic Impact of Asthma In 1994-1996, children with asthma missed approximately
 14 million school days  a year.8

 The direct and indirect costs of asthma to the U.S. economy were estimated at $16.1  billion in 2004.9
    • About 1/3 of the costs are associated with children's asthma.10

    • School absenteeism costs approximately $1.5 billion each year in lost productivity."

 Asthmatic patients and their  families pay a higher portion of their medical care costs than patients
 with other diseases because of heavy reliance on prescription medication combined with lower
 insurance coverage for prescription drugs.
    • They pay about 25 percent of the cost themselves compared to 10 percent for other general
      medical care costs.12

 L6dU POISOning  About 430,000 American children (approximately 2 percent) ages 1-5
 had elevated levels of  lead in their blood (that is, levels at or greater than 10 ug/dL) in 1999-2000.
 That number of lead poisoned children declined significantly from 4.7 million  in 1978.13
 Childhood lead poisoning reduces IQ, which can never be regained."
 The decline  in blood lead levels is due largely to the phasing out of lead in gasoline between  1973
 and 199515 and to the  reduction  in the number of homes with lead-based paint from 64 million  in
 1990 to 38 million in 2000.16
 Today, elevated blood lead levels are due mostly to the ingestion of contaminated dust,  paint, and soil."
 Blood lead levels are higher for children ages 1-5 from lower-income families and for certain racial
 and ethnic groups.18
 1 EPA Asthma Facts, Indoor Environments Division, Office of
  Air and Radiation, EPA 402-F-OM19, May 2006.
 2 CDC Asthma Prevalence, Hearth Care Use and Mortality,
  2002. See http:Avvm.cdc.gOT/nchiprciducts/pubs/pijbd'
  hestats/asthma/asthma.htm.
 ! America's Children and the Environment, Second Edition,
  2003, p.75. See http://yosemite.epa.gov/ochp/ocnpweb.nsf/
  content/publkations.htm.
 * CDC, httpAvww.cdc.gov'nchi'prcxiucts/pubs/pubd/nestats/
  asthma/asthma .htm
 5 American Lung Association, Trends in Asthma Morbidity
  and Mortality, May 2005, Table 4. See tmp-Jtovwi
  lurigusa.org/atf/cf/%787A8D42C2-FCCA-4604-8ADE
  7F5D5E762256%7D/ASTHMA1 .pdf.
 6 EPA, America's Children and the Environment, p. 71.
 7 National Academy of Science, Clearing the Air: Asthma and
  Indoor Air Exposures, 2000, Executive Summary, p.1.
8 D. Mannino. D. Homa, L Akinbami, J. Moorman, C Gwynn,
 and S. Redd, Surveillance for Asthma-United States, 1980-
 1999, Morbidity and Mortality Weekly Report 51(5501),
 p. 5. See httpJ/www.cdc.gov/mimvr/I>DF/SS/SS5101.pdf
9 National Institutes of Health. May 2004. Morbidity &
 Mortality: 2004 Chart Book on Cardiovascular, Lung, and
 Blood Diseases, See http://www.nhlbi.nih.gov/resourcei'
 doca04.chtbk.pdf
>« EPA, National Costs of Asthma for 1997, p. 24.
11 American lung Association, Table 20.
« EPA. National Costs of Asthma fof 1997, pp. 21-22.
13 EPA, America's Children and the Environment, Second
 Edition, 2003. p. 53. See htlpV/yosemite.epa.gov/ochp/ochp
 web.nsf/content/publications.htm

I4ATSDR, Case Studies in Environmental Medicine, Lead
 Toxicity, revised September 1992. See httpAvonder.cdc.
 gc>v/wonder/prevguicle/0000017/0000017.asp.
15 EPA, National Air Quality and Em«ions Trends Report, 1998
 (2000), p. 78. See http^/www.epa.gov/oar/aqtmd98/tochtml
" D. Jacobs, R. Clickner. J. Zhou, S. Viet, D. Marker, J. Rogers,
 D. Zeldin, P Broene, and W Friedmanm, 2002, The
 Prevalence of Lead-Based Paint Hazards in U.S. Housing,
 Environmental Health Perspectives 110(10): 59*606 (2002).
1' CDC, Screening Young Children for Lead Poisoning
 Guidance for Stale and Local Public Health Officials, 1997.
 See httpJ/www.cdc.gov/nceh/lead'guide/guide97.htm.
" CDC http/rwvwc&.cpffncchfc3cirf actsheeo/
 childhoodlead.htm.
19 President's Task Force on Environmental Health Risks and
 Safety Risks to Children, Eliminating Childhood Lead
 Poisoning: A Federal Strategy Targeting Lead Paint Hazards.
 February 2000, p. A-26. See http://yosemite.epa.gov/ochp/
 cpchpweb.nsftaTtent/leadhaz.htm/Jfile/leadhaz.pdf.

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 Economic Impact of Lead  Poisoning Reduced cognitive ability, as measured by IQ scores
 and valued in terms of forgone earnings, is estimated to be about $9,600 per IQ point lost."
 The cost of not eliminating lead exposure to children between 2000-2010 is expected to be about $22
 billion in forgone earnings.20

 ChlldhOOU  CanCGr In 2005, an estimated 9,510 cancer cases are expected to occur
 among children aged 0-14. An estimated 1,585 deaths from all cancer cases are expected in 2005.2'
 Cancer is ranked fourth as the cause of death by disease among children between 1 and 19 years of age
 behind unintentional injuries, homicides, and suicides."
 Leukemia is the most common cancer diagnosis for children under age 15, accounting for about 30 per-
 cent of all cases, followed by brain and other nervous system cancers (21 percent).23
 The causes of childhood cancer are poorly understood, though in general it is thought that different forms
 of cancer have different causes.24

 Economic Impact of Childhood Cancer The total cost per case of childhood cancer is
 estimated to be approximately $623,000 (in 1998 dollars)."
 The estimated annualized cost  of cancer for children under 15 years of age is $4.8 billion
 (in 1998 dollars).26

 Developmental  DiSOrderS Approximately 12 million children (17 percent)
 under age 18 suffer from one or more developmental disabilities, which include physical, cognitive,
 psychological,  sensory, and speech  impairments.27
 In 1997-2000 about 0.6 percent of children were reported to be diagnosed with mental retardation.28
 Between 3 and 8 percent of the babies born each year will  be affected by developmental disorders
 such as attention-deficit/hyperactivity disorder  or mental retardation.29
 Mental retardation is more common for children from lower-income families and for certain racial
 and ethnic groups.30
 The causes of developmental disorders are generally unknown.31

 Economic Impact of Developmental Disorders  During the 1999-2000 school year, the
 50 states and the District of Columbia spent approximately $50 billion on special education services,
 amounting to  $8,080 per special education student.32
 Expenditures can range from 1.6 times (for students with specific learning disabilities) to 3.1 times
 (for students with multiple disabilities)  higher than expenditures  for  a regular education student.33
 Estimated lifetime costs  in 2003 dollars are expected to total $51.2 billion for persons born in 2000
 with mental retardation.34
albid, p.A-28
2' American Cancer Society, Cancer Fads and Figures 2005.
 Atlanta. 2005.
"Ibid.
23 EPA, America's Children and the Environment Second
 Edition, 2003, p. 76. See http://yosemite.epa.goV/cx:hp/
 ochpweb.nsf/content/publications.htm.
24 Ibid.
25 P-Landrigan, C Schecter, J. Upton, M. Fahs, and 1 Schwartz.
 Environmental Pollutants and Disease in American Children:
 Estimates of Morbidity, Mortality, and Costs for Lead
 Poisonings, Asthma, Cancer, and Developmental Disabilities,
 Environmental Health Perspectives 110(7): 771-8(2002).
27 Boyle CA, Yeargin-Allsop M, Doemberg MS, Holmgreen
 P. Murphy, CC 8 Schendel, DE. Prevalence of selected
 developmental disabilities in children 3-10 year of age:
 The Metropolitan Atlanta Developmental Disabilities
 Surveillance Program. MMWR Morbidity and Mortality
 Weekly Reports 1996:45 (SS-2):M4.
28 EPA, America's Children and the Environment Second
 Edition, 2003, p. 85. See http//yosemite.epa.gov/ochp/
 ocnpweb.nsf/content/publications.htm.
29 B. Weiss and P. Landrigan, The Developing Brain and the
 Environment An Introduction, Environmental Health
 Perspectives 108 (Suppl.3): 373-4 (2000).
30 EPA, America's Children and the Environment Second
 Edition, 2003, p.85,
31 CDC httpy/vmw.cdc.gov/ncbddd/dd.
32 Chambers, JG, Parrish, T, and Harr, JJ 2002. What Are We
 Spending on Special Educations Services in the United
 States. 1999-2000? Palo Alto, CA: American Institutes for
 Research. See http://csefair.orcypublications/seep/national/
 AdvRptt.pdf.
33 Chambers JG, Shkolnik J, Perez M. Total expenditures for
 students with disabilities, 1999-2000: spending variation by
 disability. Washington, DC: American Institutes for
 Research,2003. See http://www.c5efair.orcj/publications/
 seep/nationaBFinaLSEEP.Reportj.pdf.
M CDC, http://www.cdc.gov/mmwr/preview/mmwrhtml1/
 mm5303a4.htm
 http://www.cdc.gov/mmwr/preview/mnwhtml/
 mm5303a4.htm

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                Children Need
       Protection Where They
         Live,  Learn,  and  Play
   Each day, children may be exposed to a variety of environmental contami-
nants at home, school, and outdoors. These environmental exposures can have
harmful effects on children's health and behavior, and the amount and timing
of exposure can influence the magnitude of these effects. Children need our
protection. Learning about children's environmental health is the first step to
protecting them from environmental risks.

          Children are often at risk of exposure to

              indoor air pollution.
   Poor indoor air quality can cause respiratory illness in children because their
respiratory systems are still developing. They also breathe more air than adults
in proportion to their body weight. Respiratory diseases, such as asthma, can
severely affect a child's ability to live an active life.
   Exposure to allergens and irritants, including animal dander, cockroaches,
mold, and dust mites, plays a  significant role in triggering asthma episodes in
children. Secondhand tobacco smoke is another asthma trigger that typically
occurs in the home. It may cause bronchitis, pneumonia,  and ear infections,
and is believed to be associated with sudden infant death syndrome (SIDS). Since
                            children spend a lot of their time at home,
                                 day care, and school, reducing their
                                    exposure to indoor environmen-
                                      tal triggers in these places is
                                       especially important.

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  Profecting children
from  environmental
rislfe is  fundamental
        e U.S. Environmental
    ptection Agency's (EPA)
    fforts to make the world
             a healthier place,
           now and for future
                   generations.
    Children need clean air to breathe, clean
  water to drink, safe food to eat, and a healthy
  environment to learn, grow, and thrive. Yet
  every day, children are exposed to environmental
  risks that may stand in the way of these basic
  necessities. They may even be more vulnerable
  to some environmental risks than adults for
  several reasons:

    • Children's nervous, immune, digestive, and
     other systems are still developing and their
     ability to metabolize or inactivate toxicants
     may be different than adults;
    • Children eat more food, drink more fluids,
     and breathe more air in proportion to their
     body weight than adults; and
    • Children's behavior—such as crawling and
     placing objects in their mouths—may result
     in greater exposure to environmental
     contaminants.

     Many of the health problems that result
 'from exposure to harmful environmental condi-
  tions can be prevented, managed, and treated.
  This is why EPA considers risks to children when
  setting standards to control pollution. You can
  play a role, too.


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                                ar pollution may affect

                    children more than adults.
    Outdoor activity is part of a healthy lifestyle,
but when air pollution levels are high, adverse
health effects may result. Outdoor air pollutants
that have been shown to be particularly harmful to
children include ozone and fine particulate matter.
Other air pollutants, such as sulfur dioxide (SO2),
nitrogen oxides (NOx), and toxic air pollutants, also
may affect children's health.
    Ground-level ozone (a component of smog) is
formed when NOx and other air pollutants react in
the presence of heat and sunlight. Smog can cause
coughing, throat irritation, and chest pain. It can
reduce lung function, inflame the linings of the
lungs, and trigger asthma attacks, even the day
after ozone levels are high. Repeated inflammation
over time may permanently scar lung tissue.
Children and teenagers who are active
outdoors-especially those with asthma or other
respiratory illnesses-are particularly vulnerable
to smog.                                                             	
    Some fine particles are emitted directly into the
air from combustion sources such as cars, trucks, buses, construction and farming
equipment, and electric utilities. Fine particles in  urban air also result from
chemical reactions of SO2 and NOx with other chemicals in the atmosphere.
Exposures to fine  particles have been linked to a number of children's health
problems, including bronchitis and asthma. Diesel  exhaust is a source of fine
particles and  is also a likely human carcinogen.
    SO2 is formed when fuel containing sulfur-mainly coal, oil, and diesel-is
burned, and during metal smelting and other industrial processes. The majority
of SO2 released  into the air comes from electric utilities and refineries, particu-
larly those that burn coal. SO2 contributes to respiratory disease, and may
aggravate existing heart and lung disease.
    NOx refers to a group of highly reactive gases emitted by motor vehicles,
electric utilities,  and other fuel-burning industrial and commercial sources. NOx
gases can contribute to respiratory illnesses especially in children, and as noted
above, both  SO2 and NOx can react to form harmful particles in the air.
    Toxic air pollutants, also known as hazardous air pollutants, are emitted from
combustion sources, such as motor vehicles and power plants, and industrial

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activities. A number of commonly occurring toxic air pollutants, including
solvents, organic chemicals, and heavy metals, have been shown to harm the
developing nervous system, reproductive organs, and immune system-all of
which grow and develop rapidly during the first months and years of life.
Long-term exposure to some toxic air pollutants may cause cancer.
        Lead
is a risk to children's physical and
 mental development.
    Removing lead from gasoline in the U.S. is considered by many to be one of
the great public health achievements of this generation. Lead levels in children's
                                    blood dropped dramatically from the
                                      1970s to the mid-1980s, as the use of
                                        leaded gasoline was phased out.
                                         However, lead still poses a risk.
                                             Lead was a common ingredient
                                          in household paint until it was
                                          banned in 1978. Children
                                          living in homes built before 1978
                                          may be exposed to hazards from
                                          deteriorated lead paint and lead
                                          dust. Because children play
                                          outside and frequently put their
                              ^^       hands in their mouths, contami-
                                        nated soil near automobile repair
                              shops, abandoned mines, industrial sites, and
         highways also may be a source of exposure. In addition, lead in drinking
water can contribute to overall lead exposure. Childhood exposure to lead may
result in damage to the nervous system leading to behavioral problems and
reduced intelligence, and may cause impaired growth and hearing.
                         is toxic during child development.
    Children born to women with substantially elevated blood mercury levels are
at increased risk for nervous system and developmental effects, delayed onset of
walking and talking, and abnormalities in vision, hearing, and speech. At far lower
exposures, reduced neurological and developmental test scores occur. Children
exposed to mercury after birth may be sensitive to the toxic effects of
mercury because their nervous systems are still developing.

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    Mercury is found in the environ-
ment in several forms,  but coal-fired
power electric utilities  are the
largest  source of mercury emissions
in the U.S. Mercury emitted from
plants and other combustion
sources is deposited on surface
water and transformed into
methylmercury, which  builds up
in fish.  People are exposed to
methylmercury almost  exclusively by eating
fish. Though fish is an  important part of a balanced diet, federal and state fish
advisories guide consumers to limit their intake of certain fish that contain higher
levels of mercury.
    Children may be exposed to contamination through

                 the water  supply.
    The U.S. has one of the safest water supplies in the world. Public water
systems test water for more than 90 chemical, microbial, and radiological
contaminants, and are required to treat water to remove harmful substances
under the Safe Drinking Water Act.
    While actual events of serious drinking water contamination are infrequent
and usually of short duration, it is possible for children to ingest contaminated
water from a public water system or, more commonly, from a private well or by
swimming in polluted  bodies of water. Microbial contaminants, such as bacteria
and viruses, are of special  concern because they may cause immediate or acute
reactions, such as vomiting or diarrhea. Long-term exposure to some  contami-
nants, including pesticides, minerals, and solvents, at levels above standards may
cause gastrointestinal problems, skin irritations, cancer, reproductive and develop-
mental problems,  and  other chronic health effects. High levels of nitrates in
drinking water can cause serious
illness in infants. If contamination
poses an immediate health threat,
water suppliers are required by law
to notify customers right away.
Individuals with private wells are
responsible for testing to assure
that the water is safe to drink.


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   Children may be more sensitive and more exposed to
                       pesticides.
   Children, due to their relative body size, may be more exposed to pesticides
because they drink more water, breathe more air, and eat more of certain foods
                                     compared to adults. Young children
  ^Bfc^^^                          eat three to four times more food
                                      than adults in proportion to their
                                      body size, and they often eat greater
                                      proportionate quantities of a more
                                      limited variety of foods. Children
                                      may be disproportionately exposed
                                      to certain pesticide residues that
                                      may be present in food. Still, for
                                      children and adults alike, the
                                      benefits of a diet that includes
                                      fruits and vegetables far outweigh
                                      the potential risks of  pesticides.
   Children's behavior, such as playing on lawns, floors, or carpeting recently
treated with pesticides, as well as putting their fingers or objects, including dirt
and toys that may be contaminated with pesticide residues, in their mouths, also
can lead to higher exposures. Access to containers of pesticides and other
chemicals in the house, garage, or storage sheds can result in dangerous exposures.
   The dose, toxicity, and timing of exposure can have a significant impact on
the nature and severity of the resulting health effect. During early years of
development, children's bodies metabolize substances differently than adults.
In some cases, this may make a pesticide more toxic to a child. Too much
exposure to pesticides may lead to a variety of health effects, such as acute
poisoning, disruption of the hormone and immune systems,  respiratory problems,
neurological damage, and cancer.
         Elevated levels of 1'clU.UIl in indoor air

                        may cause cancer.
    Radon is an invisible, odorless, radioactive gas that comes from the natural
breakdown of uranium in soil, rock, and water. Radon can enter into basements
or crawl spaces through cracks and porous foundations, leading to high levels in
indoor air where children may sleep or play. In some locations, well water
containing dissolved radon also may affect children's health. Testing homes for
radon is simple and inexpensive, and if discovered, radon problems can usually
be fixed.

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     Carbon  monoxide can be a risk

              to fetuses, infants, and children.
   Carbon monoxide (GO) is a colorless, odorless, tasteless gas produced
whenever any fuel such as gas, oil, kerosene, wood, or charcoal is burned.
If indoor and outdoor appliances that burn fuel are properly installed, vented,
maintained, and used, the amount of CO in the air we breathe is usually not
hazardous. However, dangerous levels of CO can accumulate where appliances
are not working with proper ventilation or are used incorrectly. If a pregnant
woman is exposed to elevated levels of CO, it may harm the fetus. Infants and
children are believed to be more susceptible to CO exposure than adults.
Exposure to very high levels of CO can result in severe injury or death.
          Unprotected Sim

 during childhood increases lifetime risk for skin cancer.

   Children spend much of their time outdoors, exposed to the sun. Overexposure
to ultraviolet (UV) radiation from the sun can cause sunburns in the short term,
but also may lead to long term health problems such as skin cancer, cataracts, and
premature aging of the skin. Just one or two blistering childhood sunburns may
double the risk of some skin cancers as an adult. Artificial sources of UV light such
as sunbeds and sunlamps also can damage the skin and unprotected eyes.
Preliminary
scientific research suggests that UV radiation also may harm the immune system.

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Children are 30% of the
world's population, but
100% of our future.

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                Take Action to  Protect
          Children Where They Live,
                       Learn, and Play
       Kisks from environmental exposure at
    home, school, and at play can be reduced if
    care is taken to assure a healthy environment.
    Governments, non-government organizations,
    private industry, educational institutions, and
    individuals can make a difference in protect-
    ing children from environmental harm.
    Through policy-making, research, and educa-
    tion we can work together to protect our
    children and our future.
     Promote Policies that Protect Children
       Communities, states, and the federal
    government can create policies that protect
    children from environmental risks and pro-
    vide proper medical care to those children
    exposed to such risks. Legislation, regulations,
    and standards in areas such as housing, trans-
    portation, education, agriculture, health, and
    the environment, should explicitly consider
    children's environmental exposures and
    health effects.
      Increase Scientific Knowledge about
       Children's Environmental Health
       Scientific evidence shows that children
    are different from adults in terms of their
    exposure and susceptibility to pollutants.
    This evidence may explain the relationship
    between environmental risks and some
    childhood illnesses. Still,  gaps exist in our
    understanding of how, and to what extent,
environmental contaminants cause or exacer-
bate childhood diseases and developmental
disorders. Children's environmental health
research should be a priority.
  Enhance Diagnosis and Treatment of
     Environment-Related Illnesses
   The public turns to health care profes-
sionals for environmental health informa-
tion. The health care community must be
trained in environmental health, and
equipped to share information about
environmental risks and children's health.
     Educate the Next Generation
   Youth involvement in recycling programs
created a cultural change in the way we man-
age our trash. Programs aimed at children and
youth will create a new generation of experts
on environmental health—a generation that
will be prepared to answer the new questions
that our ever-changing world poses.
  Protect Children Beyond Our Borders
   Children's environmental health issues
span the globe and transcend political bound-
aries. The priorities of developed countries may
not be the same as those in developing coun-
tries, but they are similar enough to warrant
international cooperation and collaboration
for technical, scientific, and economic reasons.
For more information about children's environmental health and ways you can
   get involved, visit EPA's Office of Children's Health Protection Web site at
             www.epa.gov/children or call toll-free 1-877-590-KIDS.

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   EPA's  Mission to  Protect Children

In  1995, EPA made it a  priority to explicitly and consistently take  into account environmental
health risks to infants and children in all risk studies and public health standards set for the U.S.

The President's  Executive Order on Environmental Health  Risks and  Safety Risks to Children
requires all federal  agencies to address health and safety risks to children, coordinate research
priorities on children's health, and ensure that their standards take into account special risks to
children.

EPA established the Office of Children's Health Protection (OCHP) to support  and facilitate
Agency efforts to protect children's health from environmental risks. The mission of OCHP is to
make the protection of children's health  a fundamental goal of public health and environmen-
tal protection in the U.S.

EPA's mission is to protect human health  and to safeguard the natural environment.  Protecting
children where they live, learn, and play is essential to ensuring that our environment  is safe and
healthy, now and for future generations.
                      oEPA
 United States
 Environmental Protection
i Agency

 Office of Children's
 Health Protection (1107A)

 EPA100-F-04-900
                                  Recycled/ Recyclable
                                  Printed with Vegetable Oil-Based
                                  Inks on Recycled Paper
                                  (Minimum 50% Post consumer)
                                  Process Chlorine Free

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