Pediatric Environmental Health Specialty Units
How do you bridge the gap between concern over environmentally related pediatric health problems, and the fact that many physicians feel inadequately educated to address such concerns? With a Pediatric Environmental Health Specialty Unit (PEHSU).
With locations at leading academic medical centers across the country, Pediatric Environmental Health Specialty Units (PEHSUs) draw upon and bring together a unique combined expertise of pediatric and occupational environmental medicine in order to improve environmental health for children by:
- educating health professionals and others about environmental health risks children face,
- consulting with pediatric health care providers on how best to address known or suspected exposures to toxic hazards in the environment, and
- responding with environmental health guidance, during natural disasters such as hurricanes and wildfires that impact children.
In the Beginning
PEHSUs were created in the 1990s in response to two disastrous events which highlighted the need for medical expertise in children's environmental health.
The first occurred during 1995–1996 in New Jersey, when a factory was converted to apartments and the families residing there became sick from mercury vapor exposure. Physicians involved in their care failed to recognize symptoms of elemental mercury poisoning of the children. The second event occurred during 1996–1998, when homes in nine states were illegally sprayed with the pesticide methyl parathion and over 400 children became ill. In the vast majority of cases, health providers failed to identify the toxic exposure as the cause of the resulting illnesses.
In 1998, PEHSUs were established in Boston and Seattle to address the inadequacies made apparent by these incidents. From this start, ATSDR and the Environmental Protection Agency (EPA) built a national network of PEHSUs over the next several years. Today, 12 units serve the 10 federal regions in the United States. (Regions 9 and 5 have 2 PEHSUs sites.) Units were also created, without ATSDR funding, by Misericordia Hospital and the University of Alberta in Canada, and by the National Institute for Public Health and the Children's Hospital of Morelos in Mexico. These PEHSUs are linked together forming a North American PEHSU Network of pediatric environmental medicine specialists.
How It Works
PEHSUs provide direct consultations to health care providers, parents, public officials, and others about known or suspected toxic exposures and ways to prevent, reduce, or medically manage exposure illnesses. PEHSUs also offer education on the effect of chronic, low-level toxic exposures to substances like lead, mercury, mold, plastics, and pesticides. In addition, PEHSUs give child health guidance during:
- disasters, such as floods, wildfires and oil spills,
- national health news events such as melamine and arsenic in food products, and
- community hearings on issues like building new schools or daycare centers in environmentally safe areas.
PEHSUs are staffed by a variety of environmental medicine and health experts, including pediatricians, occupational environmental physicians, medical toxicologists, nurses, and industrial hygienists. Having all of these experts within one network allows PEHSUs to provide the unique services required for the many environmental health threats children face.
Contact the national PEHSU program at 623-533-6340. To find PEHSU experts near you, go to the PEHSU website.
Environmental exposures of concern for children include biological, chemical, and radiological hazards.
Success Story: Rainy Day
In March 2010, heavy rains led to an accumulation of about a foot of floodwater on the first floor of an elementary school in New Jersey. When the sump pump backed up, the floodwater, which had a strong odor of petroleum fuel, leaked into the school. Tests were performed, and results showed not only levels of petroleum in excess of New Jersey Department of Environmental Protection (NJDEP) limits, but also elevated levels of benzene, PCE, and 1,4 dichlorobenzene. Parents were concerned about long-term exposure, as the petroleum smell had been present for years, even causing headaches and nausea among some children and teachers.
After the PEHSU was mentioned at a parent meeting as a potential resource, New Jersey Department of Health and Senior Services' (NJDHSS) assistant director of Consumer and Environmental Health Services contacted the PEHSU in April 2010. PEHSU staff explained testing recommendations, the need to remove the children from the sources of exposure, and necessary follow-up procedures.
Collaboration between the PEHSU, NJDHSS, and NJDEP greatly increased knowledge of environmental exposures for affected families. Because of these efforts, approximately 800 children experienced reduced risk of exposure or future cases of illness.
PEHSUs are also engaged in expanding child health protection into the earliest stages of development. Working at the healthcare system level in late 2012, the Region 5 PEHSU held a meeting of health care professionals, academic faculty, and federal agencies involved in reproductive health care and research. The meeting focused on strategic actions to improve reproductive environmental health and participants priority actions needed. One important action the President-Elect of the American College of Obstetricians and Gynecologists (ACOG) identified and volunteered to lead was development of an ACOG committee opinion on the importance of addressing reproductive environmental health in prenatal and preconception patient care. As the clinical leader in obstetrics and gynecology ACOG's opinion on reproductive environmental health greatly influences the reproductive health care all women receive. ACOG, in collaboration with the American Society for Reproductive Medicine (ASRM), led in releasing the committee opinion in September 2013. To enable clinicians to adopt this guidance, the PEHSUs are listed as a resource to provide reproductive health care professionals education and technical assistance on assessing, preventing and treating toxic environmental exposures during preconception and prenatal care periods.
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