How the Environment Impacts Childrens Health

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How the Environment Impacts Childrens Health

• Marilyn Crumpton, MD, MPH
• Growing Well Cincinnati

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Environmental Contaminants

• Outdoor Air Pollutants
• Indoor Air Pollutants
• Drinking Water Contaminants
• Pesticide Residues
• Land Contaminants

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CHILDREN ARE NOT LITTLE ADULTS Until recently,
childhood environmental health risks were
considered as scaled down risks from adult
occupational risks Giotto, National Gallery,
Washington DC
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Stature and Breathing Zone
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NeurodevelopmentContinues Through Puberty

• Dynamic Developmental Physiology
• Growth 417 yrs in fiber tracts for motor and
  speech
• Activity alters architecture
• Adolescence extensive elimination of some
  synapses
• Redistribution of neurotransmitters

Rice, EHP, (2000) 108 (3), 511
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• Dynamic Developmental Physiology
• Respiratory Development
• Deficits in Pulmonary Function Tests
• Related to exposure to particulates, oxides of
  nitrogen and inorganic acid vapors (Gauderman Am
  J RespirCritCare Med, 2000, 162 (4) 1383)
• Exposure to second-hand tobacco damages pulmonary
  function (Tager.NEJM,1983,309 (12) 699)
• Dirty Air Stunts Lung Growth
• Study of 3000 children since 1993 showed impaired
  lung growthmay be linked to asthma and emphysema
  in adults (Gauderman.Am J RespirCritCare Med,
  2000, 162 (4) 1383)

WHO 6/28/2005
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Childrens Health Issues Impacted by Environment

• Respiratory Diseases
• Neurodevelopmental Disorders
• Cancer
• ? Multiple Chemical Sensitivities or Idiopathic
  Environmental Intolerance

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Outdoor Air Pollutants

• Small Particles
• Ozone

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Outdoor Pollutants and Air Quality Measures
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Outdoor Air Pollutants Small Particles

• Smoke
• Dust
• Car Emissions
• Industrial Emissions
• Power Plant Emissions

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Ozone

• Ozone occurs naturally in the stratosphere (upper
  atmosphere)
• In the troposphere (lower atmosphere), ozone is
  formed primarily from photochemical reactions of
  man-made air pollutants

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Ozone Impact on Children

• Younger adults (teens to thirties) experience
  larger lung function changes than older adults
  (fifties to eighties)
• Children likely do not have larger responses than
  young adults, though they may be at risk of
  higher exposure and larger acute responses
  because they tend to be more active and spend
  more time playing outdoors
• Very young children may be at special risk of
  effects upon respiratory system development

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Indoor Air Pollutants
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• Carbon Monoxide
• Second-hand Smoke
• Molds
• Nitrogen Dioxide
• Pesticides
• Other Toxic Chemicals
• Allergens
• Dust Mites
• Insects
• Animal dander
• Pollens

Indoor Air Pollutants
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Indoor Pollutants

• How to Reduce Impact

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• Carbon Monoxide Poisoning
• Have fuel-burning appliances, furnace flues, and
  chimneys checked once a year.
• Never use gas ovens or burners for heat never
  use barbecues or grills indoors or in the garage.
  
• Never sleep in rooms with unvented gas or
  kerosene space heaters.
• Don't run cars or lawnmowers in the garage.
• Install in sleeping areas a CO alarm that meets
  UL, IAS, or Canadian standards.

Indoor Air Pollutants
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• Second Hand Smoke
• Inflammation of the lower respiratory tract's
  bronchioles (bronchiolitis)
• Nearly four times higher in children who live in
  a passive smoking environment
• Bronchitis and pneumonia risk
• 1.73 times greater for child with one parent
  smoking
• 2.6 times greater with both parents smoking

Indoor Air Pollutants
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• Mold
• Dry damp materials within 2 days
• Keep indoor humidity low (30 -50)
• Correct any leaks that keep materials wet

Indoor Air Pollutants
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• Nitrogen Dioxide (NO2)
• Byproduct of appliances that burn fuels such as
  gas, kerosene or oil (furnaces, gas stoves,
  fireplaces, wood burning stoves)
• Ensure proper venting, use exhaust vents, open
  window slightly, use recommended fuels
• Chemical Irritants
• Ventilate when using
• Avoid use around people with asthma

Indoor Air Pollutants
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Pesticides

• Minimize Use by Prevention Measures
• Apply Chemicals as a Final Option
• Use Least Toxic Chemicals
• If Toxic Chemicals Only Option, Apply When
  Students Are Not Exposed

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Radon Gas

• Long Term Risk for Smokers

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Dust Mites

• Vacuum carpets and rugs
• Wash stuffed toys often in hot water
• Dust often with moist cloth
• Vacuum regularly
• Use high efficiency vacuums

Indoor Air Pollutants
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• Cockroaches (body parts, secretions, and feces)
• Do not leave food or garbage out.
• Store food in airtight containers.
• Clean all food crumbs or spilled liquids right
  away.
• Wash dishes as soon as you are done using them.
• Keep counters, sinks, tables and floors clean and
  clear of clutter.
• Fix plumbing leaks and other moisture problems.
• Seal cracks or openings around or inside
  cabinets.
• Remove piles of boxes, newspapers and other
  hiding places for pests from your home.
• Make sure trash is stored in containers with lids
  that close securely, and remove trash daily.
• Try using poison baits, boric acid or traps first
  before using pesticide sprays.
• Use pesticides only with precautions

Indoor Air Pollutants
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Health Effects of Indoor Air Pollution

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General Symptoms of Indoor Air Pollution

• Headaches
• Dry Eyes
• Nausea
• Fatigue

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Asthma

• The prevalence of asthma has doubled in the U.S.
  in the last 20 years, with more than 20 million
  Americans now reporting having the disease
• Higher rates of asthma are reported among
  children under 17, minorities, and inner-city
  populations

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Asthma Action Plan

• Asthma triggers for child.
• Instructions for asthma medicines.
• What to do if child has an asthma attack.
• When to call the health provider.
• Emergency telephone numbers.
• www.noattacks.org

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Neurodevelopmental Effects

• Lead
• Mercury
• PCBs (Polychlorinated Biphenyls)

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Neurodevelopmental Effects

• Likely Permanent When Exposure Early in Life
• Physical
• Cognitive
• Sensory and speech impairments
• learning disabilities
• intellectual retardation

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Body Burdens

• Lead concentrations in blood
• Get kids tested for lead by their doctor or
  health care provider.
• Test for lead paint hazards if it was built
  before 1978.
• Wash children's hands before they eat wash
  bottles, pacifiers, and toys often.
• Wash floors and window sills to protect kids from
  dust and peeling paint contaminated with lead -
  especially in older homes.
• Run cold water until it becomes as cold as it can
  get. Use only cold water for drinking, cooking,
  and making baby formula.

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Body Burdens

• Mercury concentrations in blood
• Eat a balanced diet but avoid fish with high
  levels of mercury.
• Replace mercury thermometers with digital
  thermometers.
• Don't let kids handle or play with mercury.
• Never heat or burn mercury.
• Contact your state or local health or environment
  department if mercury is spilled - never vacuum a
  spill.

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Body Burdens

• PCBs Polychlorinated Biphenyls
• No longer made in the United States
• Possible Sources of Exposure
• Dust from old industrial sites
• Contaminated water
• Old electrical equipment
• May be associated with
• Skin conditions like chloracne (Yushenko)
• Neurobehavioral and immune changes in children
• Liver problems
• Stomach problems
• Thyroid problems
• Cancer, liver

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Multiple Chemical Sensitivities or Idiopathic
Environmental Intolerance

• Triggered by low level exposure to chemicals,
  foods and other agents
• Adverse reaction to chemicals that is not
  antibody driven
• Symptoms Headaches, nausea, dizziness,
  anaphylactic shock, rashes, difficulty breathing,
  neurological symptoms, memory loss, body aches