Introduction

An important role of the pediatrician (and of allied health professionals in their office) is to provide information on how parents can prevent harmful environmental exposures to their children. [Sattler et al. 2003]

Preconception and Prenatal Counseling

Preconception and prenatal counseling sessions present opportunities to prevent exposures that could lead to possibly devastating and lifelong effects. The March of Dimes and the U.S. Surgeon General recommend that preconception and prenatal counseling be done by all primary care physicians (March of Dimes 2008; Office of Surgeon General 2008).

General pediatricians providing preconception and prenatal counseling should include a screening environmental exposure history to assess basic environmental information about the home, occupations, and hazardous hobbies of parents and other adults living in the home. This can guide discussion about the risks for the developing child in the particular home, neighborhood, or school.

Prenatal Environmental Checklist

Pediatricians should provide parents with a prenatal environmental hazards checklist to be used to prepare the home for the arrival of the baby. The checklist should include.

• Discuss hazards associated with remodeling (e.g., lead poisoning or asbestos exposure).
• Discuss adverse effects to the fetus if a mother smokes during pregnancy and the dangers of second-hand smoke (SHS).
• Warn parents about the intake of potentially contaminated foods, such as mercury-contaminated fish. Resources for this topic include local public health advisories or those provided by the U.S. Food and Drug Administration, the Agency for Toxic Substances and Disease Registry, or the U.S. Environmental Protection Agency http://www.epa.gov/mercury.
• Counsel parents and other caregivers about the use of
  • prescribed and over-the-counter medications (e.g., Tylenol, aspirin, and cough suppressants that contain alcohol),
  • alternative remedies, and
  • other “natural” treatments during pregnancy.
• Review and discuss the hazards of alcohol and controlled substance use and abuse during pregnancy. Additionally, SHS can adversely affect fetal health [AAP, 2003].

For the Well Child

For the well child, a developmentally appropriate environmental checklist may be used to identify the child’s potential exposure risks. Age-appropriate environmental anticipatory guidance should be provided, and risk-based screening tests for lead poisoning should be performed according to the Centers for Disease Control and Prevention (CDC) [1997] guidance. All Medicaid-eligible children must be screened with a blood lead test at 1 and 2 years of age (AAP 2005).

More extensive guidance can be found in [AAP] American Academy of Pediatrics Committee on Environmental Health. 2003. Pediatric Environmental Health. Elk Grove Village, IL: American Academy of Pediatrics.

Progress Check