CHILDREN'S ENVIRONMENTAL HEALTH AND THE NORTH AMERICAN
       PEDIATRIC  ENVIRONMENTAL  HEALTH  SPECIALTY UNITS:
     practical access to pediatric environmental health expertise
   CRITICAL ROLE OF THE ENVIRONMENT IN
   CHILD DEVELOPMENT NOT WELL UNDERSTOOD

   Children breathe more air, drink more water, and
   eat more food than adults per unit of body weight;
   this higher rate of intake results in greater
   exposure to pathogens and pollutants and makes
   children uniquely vulnerable to environmental
   toxins. In addition, children's body systems are
   still developing, often compromising their ability to
   metabolize or inactivate toxicants.

   Worldwide, five million children under age 5 die
   annually from environmentally-related factors,
   while many more suffer needlessly and
   permanently.

   Environmental pollution is known to cause many
   illnesses. For example, some heavy metals,
   polychlorinoted biphenyls (PCBs) and certain
   pesticides have been shown to cause brain damage,
   especially when exposure occurs in the pre-natal
   and perinatal period, contributing to learning
   disabilities and disruptive behaviors; air pollution
   contributes to asthma and other respiratory
   diseases in children; unsafe water leads to
   diarrhea; untreated and recurrent diarrhea
   impairs normal childhood growth and development
   and can cause stunting. All of these toxins and
   conditions can not only cause diseases and chronic
   disability, but can be fatal.

   Studies show that children who grow up in
   environments where they are at risk for
   malnutrition as a result of poverty are more likely
   to be affected by environmental toxins and are
   more likely to have more serious effects as a
   result of limited available health care and
   education resources.
One affected child is a family issue;  a
community of children similarly affected
is a problem  that requires national
leadership and  benefits from
international  collaboration.

HEALTH CARE PROVIDERS NEED TRAINING AND
RESOURCES TO  ADDRESS ENVIRONMENTALLY -
RELATED ILLNESSES IN CHILDREN

Most health care professionals, however, are not
trained to prevent, recognize, manage and treat
environmentally-related conditions, especially for
children.

Many of the environmental factors related to ill
health can be
prevented with
proper education
and              1IT  --  *
communication;
such messages
are best
delivered by
trained health care professionals.  These
professionals can train others to increase medical
literacy on pediatric environmental health and they
can teach parents and communities how to protect
their children.

NORTH AMERICAN NETWORK OF PEDIATRIC
ENVIRONMENTAL HEALTH SPECIALTY UNITS

One practical and concrete approach to these
issues in North America is the Pediatric
Environmental Health Specialty Units. These
Units, first created in 1998, bring together many
disciplines, such as occupational and environmental
health physicians, pediatric practitioners, medical
toxicologists, nurses and other specialists.

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PEHSUs increase the number of health care
providers trained on children's environmental
health and act as a focal point for all issues
related to children's environmental health. The
Units operate as a network, cutting costs and
creating efficiencies of scale.

PEHSUs assist primary health care professionals
in a wide range of exposures such as lead, arsenic,
carbon monoxide, pesticides, air pollutants, mold,
waterborne contaminants, toxic waste, agricultural
pollution and household chemicals. They also assist
in site specific cases, such as school and day care
environments, and deal with diagnostic dilemmas,
where the etiology of problems are possibly
environmental in nature. Parents and other public
health professionals often enlist the aid of
PEHSU's directly. Clinical consultation is offered
electronically, by phone, and in person.  PEHSU's
educate health care providers and the general
public about children's health issues  related to
exposure to environmental contaminants.

The environmental health  expertise represented
by the North American PEHSU network is critical
to increasing the number of health care providers
who are trained in pediatric environmental health
issues. Expanding the PEHSU model to other parts
of the world will enhance the network, allow
greater collaboration among health care providers
and result in greater protections for children.
             Pediatric Environmental
              Health Specialty Units
v»EPA
     United States
     Environmental Protection
     Agency
PEHSUs were first created by the US Agency for
Toxic Substances and Disease Registry, and the
Environmental Protection Agency. The Association
for Occupational and Environmental Clinics, a non-
governmental organization, manages the Units.
Visit these websites to learn more:
  Unidad Pediatrica Ambiental Cuemavaca, Morelos, Mexico
  www.upa-pehsu.org

  Misericordia Child Health Centre Edmonton, AB, Canada
  mchhc. enviro @cha. ab. ca

  New England PESHU www.childrenshospital.org/pehc

  Mount Sinai Pediatric Environmental Health Unit
  www.mssm.edu/cpm/peds_environ.shtml

  Mid-Atlantic Center for Children's Health & the
  Environment  www.health-e-kids.org

  The Southeast Pediatric Environmental Health Specialty
  Unit  www. sph.emory.edu/PEHSU

  Great Lakes Center for Children's Environmental Health
  www.uic.edu/sph/glakes/kids

  Southwest Center for Pediatric Environmental Health
  www.swcpeh.org

  Mid-America Pediatric Environmental Health Specialty
  Unit  www2. kumc. edu/mapehsu

  Rocky Mountain Regional Pediatric Environmental
  Health Specialty Unit www.rmrpehsu. org

  University of California Pediatric Environmental Health
  Specialty Unit  www.ucsf.edu/ucpehsu or
   www.coeh.uci.edu/pehsu

  Northwest Pediatric Environmental Health Specialty Unit
  www. depts .Washington, edu/pehsu
         A
Office of Children's Health Protection
November 2005
EPA 100-F-05-046

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