ATSDR-Office of Children's Health

Agency for Toxic Substances and Disease Registry

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Contents

Pediatric Toxicology References - Div. of Toxicology

Children Living Near Hazardous Waste Sites - Div. of Health Assessment and Consultation

Investigation of Cancer and Other Health Conditions - Div. of Health Studies

Health Promotion and Education - Div. of Health Education and Promotion

Setting Priorities - Agency Roundtable on Child Health

Child Health Reports

Special Report
Soil Pica

Childrens' Health

An estimated 3-4 million American Children live within one mile of at least one hazardous waste site. However, children are not simply small adults! Children who live near waste sites often have greater exposure and greater potential for health problems.

Presidential Executive Order	Children's Health Insurance Program

ATSDR Gives Special Emphasis to Children's Health

ATSDR's Child Health Program emphasizes the ongoing examination of relevant child health issues in all of the agency's activities, and stimulates new projects to benefit children.

Pediatric Toxicology References

ATSDR - Division of Toxicology

ATSDR is reformatting its Toxicological Profiles series and Medical Management Guidelines to expand coverage of the specialized toxicology of children, from the womb through late adolescence. Special emphasis is devoted to the effect of toxic substances on sensitive developing systems, such as the immune, nervous, and reproductive systems. Important new pediatric and developmental toxicology data are being reported from the Great Lakes Human Health Effects Research Program and the Substance Specific Applied Research Program.

Future issues of toxicological profiles will have five new sections. Each profile will have a section on child health in Chapter 1 (Public Health Statement), which is designed for the lay public. ATSDR also distributes these Public Health Statements separately as a compendium. A section on children's susceptibility will be added to Chapter 2 and a section on children's exposure will be added to Chapter 5. Data gaps found in analyzing the literature for these child health sections will be explicitly discussed in a new Data Needs section that will be a blueprint for future research to protect child health. Priority data needs documents, developed from the data needs section in the toxicological profiles, will have a child health section as well. The profiles will address, at a minimum, the following issues.

Are children being exposed or likely to be? Are the parents' work clothes likely to be source of exposure to children?
Are unique exposure pathways for children known or possible?
Are children different than adults in their weight-adjusted intake of the toxicant?
Is the developmental process altered by the toxicant? What health effects have been observed in children? In immature animals from embryos up through maturity? In relevant in vitro developmental models?
Are pharmacokinetic and pharmacodynamic parameters known or suspected to be different in children?
Does the susceptibility of children to health effects differ from that of adults? In what way? Why?
Are there any biomarkers of exposure or effect unique to children?
Are there any interactions with other chemicals that are unique to children?

ATSDR's widely distributed Fact Sheets are an even more condensed summary for the lay public and also have discussions of child health issues derived from the public health statements. Priority Data Needs documents, developed from the Data Needs section in the Toxicological Profiles, are adding child health sections as well.

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Children Living Near Hazardous Waste Sites

Division of Health Assessment and Consultation

ATSDR continues to direct and apply substantial resources to child-focused concerns through its mandated public health assessment activities. Children have been the primary focus of public health assessment evaluations, especially at sites where direct contact with contaminated soils and dusts is an important pathway of exposures. Because of their activity patterns and greater sensitivity to metals, pesticides, nitrates, and other substances that may cause long-term harm, children are usually considered the most sensitive populations at sites and are the initial focus of investigations.

ATSDR is working to further improve the manner in which health assessors evaluate issues relating to children. For example, ATSDR's training course on basic public health assessment had an increased focus on evaluating the impact of hazardous substances in the environment on children. Topics discussed in the course, which is taken by agency and state health assessors, include children's behaviors that influence exposure frequency, physiologic and biochemical factors that might lead to greater sensitivity to hazardous substances, the role of exposure investigations, and the influences of culture, diet, and nutritional status. The course emphasizes that caution must be exercised in trying to extrapolate information from adults to children, because children are not simply small adults. ATSDR plans to modify its Public Health Assessment Guidance Manual to reflect the increased emphasis on evaluating children's health issues and methods for making those evaluations.

ATSDR also recognizes the need to expand its HazDat database to include data on children's issues at hazardous waste sites, so we can learn more about the characteristics of children that influence exposure and the potential development of adverse health effects. There is also an increased emphasis on the use of exposure investigations to confirm present exposures.

In addition, at sites where biologic or environmental data are limited and unlikely to be obtained, modeling and relational geographic information systems are used to obtain more accurate estimates of past exposure. These tools will increasingly be used at sites and will assist in conducting epidemiological studies of people who may have been exposed as children. ATSDR has used geographic information systems to estimate the number of children living near National Priority List (NPL) sites. On the basis of data from 1,255 sites, there were 1,127,563 children under 6 years of age living within 1-mile borders of the sites, or about 11% of the potentially affected population. Women of child-bearing age account for about 24% of the population near waste sites. The average site population at these sites was 8,073 people, and the average number of children under 6 years of age was 898.

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Investigations of Cancer and Other Health Conditions

Division of Health Studies

The Division of Health Studies (DHS) is responsible for evaluating the relationship between exposures to hazardous substances and adverse human health effects. Children have been emphasized frequently in studies because of their greater sensitivity to toxic effects and their greater likelihood of exposure, from play and other behavior patterns. For example, past studies have demonstrated excess exposures to metals, lead, and arsenic, as well as elevated risks of adverse reproductive outcomes among children born to mothers exposed to solvent-contaminated drinking water.

ATSDR is seeking new databases to evaluate adverse health effects in children. National registries of childhood illnesses, especially cancers, are under consideration. ATSDR plans to develop environmental assessment procedures for a national children's environmental cancer registry, in cooperation with other federal agencies. ATSDR also continues to evaluate its existing data collection systems for their ability to address children's health issues, for example, the National Exposure Registry. Currently, registrant cohorts exposed to trichloroethylene (TCE), trichloroethane (TCA), benzene, and dioxin are followed. This registry is identifying databases that provide the necessary comparative rates for generating testable hypotheses for a broader range of health end points that are directed at the health of children. The registry also is giving additional emphasis to including adequate numbers of children in the sub-registries. ATSDR also is continuing several key health studies (see following list) to identify information needs and initiate research, and improve program activities to focus more specifically on children's health. ATSDR is improving the review of health studies and extramural awards by including more pediatricians in the peer review process and by promoting children's health issues when announcing requests for proposals. Additional health outcomes specific to children are being identified to make health studies more sensitive to illnesses experienced by children, and ATSDR seeks to identify health outcome databases that record these outcomes.

Ongoing Studies

Birth Defects and Reproductive Disorders
Hanford Infant Mortality and Fetal Death Analysis, Washington
Case Control Study of Neural Tube Defects, New Jersey
Cardiovascular Malformations and Maternal Exposure, New York
Birth Defects in Children of Color, California
Drinking Water Contamination and Birth Outcomes, NJ
Volatile Organic Compounds in Drinking Water and Adverse Pregnancy Outcomes, Camp Lejeune, North Carolina
Public Drinking Water Contamination and Birth Outcomes, Iowa
Lung and Respiratory Diseases
Residential Exposure to Urban Air Toxicants and Childhood Asthma
Immune Dysfunction
Determining Immunotoxicity of Lead Exposure in Children in the Tri-State Mining District, Illinois, Kansas, Missouri
Reference Ranges for Immune Function Test Battery Results in Children
Neurotoxic Disorders
Impact of TCE Exposure on Oral and Motor Function and Speech and Hearing in Children
Exposure and Biomedical Testing
Coeur D'Alene River Basin Environmental Health Exposure Assessment, Idaho
Lead Screen Study, Silver Valley (Bunker Hill), Idaho
Biomedical Test Batteries Emphasizing Children

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Health Promotion and Education Activities

DHEP Child Health Activities

DHEP has recently been working with the American Academy of Pediatrics (AAP) to conduct the innovative "Environmental Safety Net for Children" workshop and follow-up activities. The 100 attendees at the March 2001 workshop included practicing local pediatricians, internationally known speakers, and collaborating government agency experts concerned with pediatric environmental health. The workshop proceedings will be published as a supplement to the AAP journal Pediatrics. For additional information on the AAP project, please contact Lourdes Rosales-Guevara, MD, the AAP Technical Project Officer, at 404-498-0295.

Although there are many other on-going DHEP child health-related activities, including the pediatric Case Study in Environmental Medicine and the children's risk perception study, the rest of this section will focus on the Pediatric Environmental Health Specialty Unit (PEHSU) Program.

The PEHSU Program

The PEHSU Program was designed to promote children's health by encouraging medical specialists with environmental expertise to work collaboratively with pediatricians to develop pediatric environmental medical expertise and to improve the ability of locally practicing health care providers and parents to access this expertise. Starting in 1998, through a partnership with the Association of Occupational and Environmental Clinics (AOEC), three pilot units were established in Seattle, Boston, and New York City. These units focused on conducting activities in the areas of (1) medical education and training, (2) telephone clinical consultation and outreach, and (3) clinical evaluation of children who may have been exposed to hazardous substances in the environment.

From this modest beginning, in FY 01 the Program had grown to include:

• national network of 11 operating units
• inclusion of EPA as a partner in all of these units
• increasing international interest in establishing similar units
• continuing and increasing interest and demand for these services from governmental agencies at all levels and from the public
• opportunities to collaborate with additional partners, such as NIEHS/EPA/CDC Centers of Childrens Environmental Health and Disease Prevention Research
• impact on field of pediatric environmental health
• development of a body of published articles, curricula, and educational materials

There is at least one PEHSU in each of the 10 EPA/ATSDR regions. Most of the PEHSU have websites. Links are provided here: Region 1 ; Region 2 ; Region 3 ; Region 4 ; Region 5 ; Region 6 ; Region 7 ; Region 8 and 9 (currently no links); Region 10. These units facilitate linkages between environmental medicine and pediatric specialists to build regional and national referral networks, thus improving environmental health services for children exposed to hazardous substances.

For additional information on the PEHSU Program, call Katherine Kirkland, MPH, Executive Director, AOEC (202-347-4976) or Christine Rosheim, DDS, MPH, Project Officer, ATSDR (404-498-0323).

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Setting Priorities

Agency Roundtable on Child Health

Many ATSDR scientists have a particular interest in child health issues and have assisted in the development of ATSDR's Child Health Initiative. ATSDR formed an internal Agency Roundtable on Child Health (ARCH), through which staff can exchange information and findings from existing child-relevant projects and generate proposals for new ones. The ARCH is composed of representatives of different divisions and offices of the agency. It provides a basis for information exchange and a mechanism for internal review and advice. In addition, ARCH members are contacted individually from time to time, to help prepare, review, and present information to ATSDR senior management and outside agencies and groups.

Many thanks to Stephanie Rubin and the ATSDR Web Site Content Committee

This page last updated on November 12, 2003

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