There is increasing evidence that environmental toxicants affect kids' health. Given this reality, pediatricians need to know the most important environmental health questions to ask, and what resources to draw from.
DR. BALK is professor of clinical pediatrics at the Albert Einstein College of Medicine in the Bronx, New York.
DR. FORMAN is associate professor of pediatrics and community and preventive medicine at the Mount Sinai School of Medicine in New York.
DR. JOHNSON* is a Commander in the United States Navy's Medical Corps at the Naval Medical Center, San Diego.
*The opinions or assertions contained herein are the private ones of the authors, and are not to be construed as official or reflecting the views of the Naval Medical Center, San Diego, the Department of Defense, or the United States Navy.
Fortunately, our knowledge about environmental health-the field of science that concerns how the environment influences human health and disease-has expanded greatly in the past decade.1 Research has shed light on the relationship of children's health and developmental conditions to toxicants (a "toxicant" refers to a chemical agent; "toxin" is often used for a biological agent) in the air they breathe, the water they drink, and the food they eat. Many questions about these relationships, however, remain unanswered.
Science is increasingly recognizing that gene-environment interactions can shift the balance between health and disease. Olden's line is often quoted, "Genetics loads the gun, but environment pulls the trigger."2 Our children's health is influenced by the interaction of genetic susceptibility and environmental exposures-and these gene–environment interactions are influenced by behavior, gender, age, and developmental stage.
Pediatricians are well positioned to identify children's environmental exposures, counsel on ways to help prevent exposures, and where the evidence supports it, give abatement advice. As trusted family advisors, we can also answer questions about what is known and not known about environmental exposures and health.
FIRST THINGS FIRST
The first step in evaluating a child's environment is taking an environmental history. During much of the last century, when it was common for doctors to make house calls, doctors could observe a child's environment. Since house calls are no longer standard practice, asking about surroundings is the necessary starting point. For some areas of environmental health-counseling smokers to stop smoking, and certain aspects of sun safety-scientific evidence supports the importance of taking a history and giving advice in promoting behavior change.