Pediatric Environmental Health Toolkit Endorsed by:

Environmental Health
Reference Card
Please refer to the AAP’s Pediatric Environmental Health handbook for more detailed information on these topics.

Topic Health Effects Summary Sources and Routes of Exposure Prevention Strategy
Arsenic
A heavy metal found naturally in the earth’s crust, Acute high dose exposures can cause nausea, Arsenic is ingested or inhaled; not usually Test water (especially well water) for arsenic
as well as incorporated into certain products. vomiting, hematemesis, diarrhea, abdominal cramp- absorbed through the skin. and filter/remediate if necessary. Reverse osmosis
ing, and shock. Lower dose exposures can cause GI A common contaminant of drinking water (either filtration systems can remove arsenic, but they
upset followed by a more protracted course of bone naturally or as a by-product of mining, smelting, are expensive.
marrow suppression, hepatic dysfunction, myocardial or the manufacturing of chemicals and glass). Wash children’s hands after playing on CCA-treated
depression with cardiac conduction disturbances, and wood (“pressure-treated wood”).
A component of the wood preservative chromated
a peripheral sensimotor neuropathy that can mimic
copper arsenate (CCA), widely used to treat outdoor- Seal CCA-treated wood structures every 1-2 years
Guillain-Barre Syndrome.
use wood (decks, playground equipment, fences, with sealant such as an oil-based stain or poly-
Chronic exposures produce fatigue, malaise, and low- porches). urethane, not paint.
grade bone marrow depression. Skin changes include
Added to poultry feed as an antimicrobial, Avoid using CCA-treated wood for growing fruits/
Mee’s lines (white, transverse creases across finger-
released into the environment through manure. veggies or anything for human consumption.
nails), hyperkeratosis, hyperpigmentation, and ecze-
matoid eruptions. Chronic exposure is also associated Never burn CCA-treated wood.
with heart disease, peripheral neuropathy (paras- Notes: In 2002, the Environmental Protection Agency (EPA), reduced the
thesias, pain, ataxia). Arsenic is also a known carcin- maximum contaminant level of arsenic in public water from 50ppb to
10ppb. Complete compliance is due by 2006. As of 2004 manufacturers no
ogen with dose-response increases in bladder, lung, longer treat wood with CCA (existing stocks can be sold until depleted) but
and skin cancer as well as links with acute myelogen- because these structures will remain intact for decades, children will be at
ous leukemia, and cancer of the kidney and liver. risk for continued exposure even in the absence of new wood sales.

continued —>

For more information: Visit our website for links to additional resources:
Physicians for Social Responsibility www.psr.org
1875 Connecticut Avenue, NW, Suite 1012
Washington, DC 20009 - 202.667.4260 - www.psr.org
Pediatric Environmental Health Toolkit
Environmental Health Reference Card
Please refer to the AAP’s Pediatric Environmental Health handbook for more detailed information on these topics.
Topic Health Effects Summary Sources and Routes of Exposure Prevention Strategy
Mercury
A neurotoxic metal that exists in several different forms: Methylmercury is a known teratogen causing Mercury in contaminated fish is the major source of In Waste Stream:
Organic mercury – Includes methylmercury found in disruption of normal patterns of neuronal migration human exposure to methyl mercury. Keep mercury out of the waste stream, dispose of
contaminated fish. and histology in the developing brain. Unlike elemen- The largest contributors of mercury to the environ- mercury-containing products during hazardous waste
tal mercury, methyl mercury is absorbed from the ment are runoff from mines, industries that burn days or at waste sites in community.
Elemental mercury – “Quicksilver” – A liquid
gastrointestinal tract and readily crosses the placenta fossil fuels like coal, medical and municipal waste
at room temperature, volatilizes readily to a color- Exchange mercury thermometer for digital at
and blood brain barrier. Appears in human milk. incinerators that burn mercury-containing products,
less and odorless vapor. Used in thermometers, community recycling centers.
thermostat switches, sphygmomanometers, dental High-level fetal exposures may cause psychomotor and chlor-alkali plants that make caustics. In addition,
Never vacuum up mercury from broken thermometers –
amalgams, fluorescent light bulbs and button batteries. retardation, blindness, deafness, and seizures. some mercury is released from natural sources.
carefully sweep up and dispose of as hazardous
It is also used in magico-religious rituals such as in the Lower level fetal exposures, such as those resulting Elemental mercury released into the air eventually waste.
Santeria religion, and in some folk remedies for from regular maternal fish consumption, have been falls to earth contaminating waterways. Bacteria that
In Food:
gastrointestinal problems (empacho). Elemental implicated in language, attention, and memory live in water convert elemental or inorganic mercury
mercury is also sometimes used by people who pan for impairments. to organic mercury, such as methyl mercury. Serve children a variety of fish and seafood low in
gold as a hobby. mercury and other contaminants: Haddock, pollock,
Methylmercury bioaccumulates in the lean muscle
and shrimp are among the low fat, low mercury
Inorganic mercurial salts – Have been used in a mass of fish, with large predatory fish like swordfish,
choices. Fish sticks are usually made from fish that
number of consumer products ranging from teething tuna, and shark having higher mercury levels.
are low in pollutants. Do not feed children swordfish,
powders to skin lightening creams. While banned in the Less common sources of exposure include the direct
shark, mackerel (king), and tilefish. Follow any fish
US, they remain available on the world market. exposure to elemental mercury via inhalation of
advisories released by health officials at state or
mercury vapors, e.g. broken thermometers,
local level.
Santeria rituals.
Choose “chunk light” canned tuna instead of
canned “solid white” albacore and fresh tuna. Limit
the amount of each child’s serving based on age and
body weight. A toddler should eat a serving of only
1-2 ounces, while an older and larger child may be
served 2-3 ounces.
Other inexpensive, low fat sources of protein include
beans, lean chicken, turkey, and eggs without the yolk.

Lead
A heavy metal and a proven neurotoxicant to the Fetal or early childhood exposure linked with lower Unintentional ingestion of lead containing particles In Paint – Should be removed by trained professionals.
developing brain. IQ scores, language and attention difficulties, and such as indoor house dust, paint, water, soil or Never sand or remove yourself. If you can’t safely
increased aggression and delinquency. foreign bodies. remove, cover with wallpaper, tile, etc.
Other possible health effects: decreased growth, Lead is found in paint in homes built before 1978 In Dust – To control exposure to lead dust, wash
decreased hearing acuity, elevated blood pressure, and tapwater may contain lead from pipes or lead child’s hands after playing, wash floors and other
and renal disorders. solder or if originating from a lead-contaminated surfaces regularly, especially window sills.
Centers for Disease Control (CDC) guidelines issued in source. Less common exposures include certain In Water – With lead pipe/solder concerns, consider
1991 define a blood lead level > 10ug/dl as elevated imported cosmetics and ceramic ware; vinyl mini- running cold tap water for 1-2 minutes first thing in the
but recent research indicates that health effects may blinds made before 1997; certain candle wicks and morning or after a long period of non-use to clear
be present at much lower levels. crayons; soft vinyl lunch boxes; and certain tradi- pipes, or consider filtration systems that will remove
tional/herbal remedies and foods. Occupations or lead regardless of its source.
hobbies like painting and refinishing, cleaning and
In Products – Don’t buy or use products with lead in them.
shooting of firearms, battery repair, stained glass
making, and ceramics may result in lead poisoning. In Soil – Don’t grow food in soil with lead, or add a
min. 6" layer of clean topsoil for gardening. Don’t
let children play in lead-contaminated soil. continued —>
For more information: Visit our website for links to additional resources:
Physicians for Social Responsibility www.psr.org
1875 Connecticut Avenue, NW, Suite 1012
Washington, DC 20009 - 202.667.4260 - www.psr.org
Pediatric Environmental Health Toolkit
Environmental Health Reference Card
Please refer to the AAP’s Pediatric Environmental Health handbook for more detailed information on these topics.

Topic Health Effects Summary Sources and Routes of Exposure Prevention Strategy
Polychlorinated biphenyls (PCBs), Dioxins, and Furans
PCBs were used as an insulating material and were Fetal exposure to low-levels of PCBs in the mother’s Both PCBs and dioxins are called persistent organic The best way to minimize exposure is to select lean
banned from manufacture in the United States in diet increases the risk of IQ deficits, hyperactivity, and pollutants (“POPs”) because they do not degrade cuts of meat, low or nonfat dairy products, and to
1977 because of possible links with cancer. attention deficits. easily and they persist for years in the environment. abide by local and state fishing advisories.
Dioxins and furans are chemicals that form during Dioxins can also adversely affect reproductive health Both are lipid soluble and bioaccumulate in fatty
the incineration of waste, especially plastics. They can and brain development and are associated with tissue. Exposures are mainly through dietary fat,
also be made during the bleaching of paper pulp and ectodermal defects including abnormalities of skin, including fish, meat, and dairy products.
during the manufacture of products containing hair, teeth, and nails. Dioxins are also known to cause PCBs and dioxins are now found ubiquitously in the
chlorine. cancer in humans. environment. All of us have small amounts of PCBs
and dioxins in our tissues.
Asbestos
A fireproofing, insulating, and soundproofing material The association between asbestos and both lung Exposures via inhalation generally occur when Removal should be performed only by EPA or state-
widely used in the U.S. during the 1940s-70s in the cancer and mesothelioma has been well documented, buildings containing asbestos are in poor condition certified asbestos contractors.
construction of homes, schools, public buildings. particularly for occupationally-exposed persons. Risk or when asbestos is removed improperly.
is higher in those exposed who are also smokers. Vermiculate, produced from mined ore, is used for
agricultural, construction and insulation purposes,
and can be contaminated with asbestos.

Water Pollutants
For metals, pesticides, and solvents – see Bacteria – Gastroenteritis. Exposure can occur through drinking water. Know your water source (e.g., surface water,
relevant section. Viruses – Gastroenteritis or hepatitis. Inhalation or dermal exposures via showering/ groundwater, well water, and bottled water). Work
Bacteria – E coli, campylobacter, salmonella, shigella, bathing can be significant. Exposure can also occur to protect it in your community.
Parasites – Gastroenteritis.
vibrio species. through swimming and other recreational activities. Read annual Community Consumer Confidence
Nitrates – Methemoglobinemia in infants.
Viruses – Enterovirus, hepatitis A, rotavirus. Water for irrigation of crops may be contaminated. Reports on public water supply quality. Test well
Bottle-fed infants are at greatest risk.
Bottled water and well water are less regulated than water regularly. Filter or take community action if
Parasites – Giardia, cryptosporidium, entamoeba Perchlorate – Blocks iodine uptake into

Pediatric
municipal tap water. necessary.
histolytica. thyroid gland.
In the absence of known microbial contamination, For more extensive evaluation, treatment and
Nitrates – Nitrogen-oxygen chemical units. Chlorination by-products – Spontaneous boiled water is not necessary. Boiling can prevention consult EPA, CDC, and state and local
Perchlorate – Salt containing chlorine and oxygen. abortion, spermatotoxicity, bladder cancer, concentrate some chemical contaminants such health departments.
Chlorination by-products – Chloroform, haloacetic rectal cancer. as nitrates, heavy metals, and perchlorate.
acids, trihalomethanes. Toxins – Hepatotoxicity, neurotoxicity. Nitrates – Usually from well water that has

Environmental
Toxins – Pfiesteria toxin, microsystins. been contaminated through agricultural practices
and substandard septic systems.
Perchlorate – From rocket fuel, fireworks manu-
facture. Is persistent in water and difficult to remove.
Chlorination by-products – Mostly a problem

Health Toolkit
when unfiltered surface water with dissolved organic
material is treated with chlorine.

continued —>

For more information: Visit our website for links to additional resources:
Physicians for Social Responsibility www.psr.org
1875 Connecticut Avenue, NW, Suite 1012
Washington, DC 20009 - 202.667.4260 - www.psr.org
Pediatric Environmental Health Toolkit
Environmental Health Reference Card
Please refer to the AAP’s Pediatric Environmental Health handbook for more detailed information on these topics.
Topic Health Effects Summary Sources and Routes of Exposure Prevention Strategy
Indoor Air Pollutants
Carbon monoxide – An odorless, colorless gas In General – Typically associated with respiratory Poor ventilation may exacerbate exposures. In General – Keep indoor environments clean and
produced by appliances or heaters that burn natural problems and may contribute to the development well ventilated.
gas, oil, wood, propane, or kerosene. A major and exacerbation of asthma. But other organ systems ETS – Don’t smoke inside building or in the car.
component of car exhaust. may also be affected (see below).
Carbon Monoxide – Use CO monitors in the home
Environmental tobacco smoke (ETS) is composed Carbon monoxide – Intoxication is associated with to ensure no leaks.
of more than 3,800 different chemical compounds. neurologic, cardiovascular, and pulmonary pathology.
Radon – Consider testing for radon; if unknown or
Radon – An odorless, colorless radioactive gas that ETS – Prenatal exposure has been associated with high (above 4 pCi/L), ventilate well, avoid sleep and
comes from the natural breakdown of uranium in rock decreased birth weight, increased risk of SIDS and play areas in basement level – if high, consider
and soil. It can seep into homes through cracks in the decreased pulmonary function. Postnatal exposure remediation – Call 1-800-SOS-RADON.
foundation, floors, walls. Can be found in water. is associated with an increased risk of asthma,
Molds – Keep mold at bay by preventing excess
Molds – Require moisture to grow and tend to respiratory tract infections, otitis media, breast
moisture/water leaks and ensuring good ventilation.
be found in damp basements, refrigerators, air and lung cancer, and heart disease.
Solvents – Replace products that contain volatile
conditioners, humidifiers, mattresses, carpeting, under Radon – After smoking, radon is the most
(typically petroleum-based) ingredients with those
ceiling panels, or behind walls (if there are chronic common cause of lung cancer in the U.S.
containing safer “nontoxic” ingredients, such as
water leaks). Molds – Molds can trigger allergic reactions, water-based glues or paints, and citrus-based
Solvents – Household cleaners, degreasers, arts and exacerbate asthma or cause infection in the solvents. Avoid volatile adhesives.
craft supplies, glues, “off-gassing” from newly immune compromised.
Pesticides – Avoid spraying pesticides in the home,
installed carpets, flooring, particle board, and Solvents – Most are neurotoxicants. Some, garden, and on pets. If necessary, use only licensed
furniture. such as formaldehyde, are respiratory irritants. professionals. Avoid sprays and dusts (esp. where
Pesticides – Residues of some pesticides volatilize Others are reproductive toxicants. there are carpets, soft fabrics) – baits/traps/gels
after application, and may concentrate at floor level. Pesticides – See pesticide section. leave less residues. Never spray near kids’ pillows,
(See the section on pesticides for more information.) bedding, and primary spaces where kids crawl and
play. (See AAP’s Pediatric Environmental Health
handbook for specific guidance if using pesticides.)

Outdoor Air Pollutants

Ozone (O3) – A free radical of oxygen (smog). Ozone – Triggers asthma attacks, and may cause Ozone – Produced by a chemical reaction of sunlight The Air Quality Index (AQI) is reported in newspapers,
Particulate matter (PM) – Sooty particles that are asthma in active children. Airway inflammation, on other air pollutants (nitrogen oxides and volatile on television, and radio and at www.epa.gov/airnow.
most toxic when they are small (<10 microns). decreased lung function. organic compounds). Follow the associated activity recommendations
PM – Linked to premature mortality, cardiovascular PM – Combustion byproduct produced by industrial (e.g., limit outdoor activities etc.), particularly if your
Sulfur dioxide/sulfuric acid (SOx) – Key
and respiratory disease. sources and motor vehicles. child has asthma or respiratory illness.
component of acid rain.
SOx – Airway irritant, decreases lung function in SOx – Emitted from power plants and other sources Avoid wood fires and backyard burning, whenever
Carbon monoxide – Product of incomplete
asthmatics. that burn coal and oil. possible.
combustion.
CO – Binds irreversibly to hemoglobin, reduces CO – Produced outdoors mainly by automobiles. Avoid driving on “Spare the Air” days.
Nitrogen oxides (NOx) – Common pollutants from
burning of fossil fuels. oxygen carrying capacity of the blood. Hypoxia, NOx – Produced by diesel vehicles, other petroleum Community Measures:
adverse reproductive outcomes. combustion. Promote “no idling” ordinances locally to limit
Diesel exhaust – A mixture of particles, gases, and
other chemicals. NOx – Increased respiratory symptoms and illness in Diesel exhaust – Produced by trucks, buses, trains, motor vehicle emissions.
children, ozone precursor. boats, heavy equipment, and generators. Replace old diesel school buses with cleaner
Polycyclic aromatic hydrocarbons (PAHs) –
Chemical constituents of soot. Diesel exhaust – Human carcinogen, associated PAHs – Produced from fires, other combustion alternatives whenever possible.
with asthma attacks and may potentiate effects of processes. Avoid construction of schools adjacent to major
allergens. roadways, rail yards, and ports.
PAHs – Human carcinogens.
continued —>

For more information: Visit our website for links to additional resources:
Physicians for Social Responsibility www.psr.org
1875 Connecticut Avenue, NW, Suite 1012
Washington, DC 20009 - 202.667.4260 - www.psr.org
Pediatric Environmental Health Toolkit
Environmental Health Reference Card
Please refer to the AAP’s Pediatric Environmental Health handbook for more detailed information on these topics.

Topic Health Effects Summary Sources and Routes of Exposure Prevention Strategy
Sun Exposure
Sunlight is comprised of visible light (400- Short and long term exposure to UV radiation have Children and teens are exposed through direct Cover up with tightly woven, light-colored clothing
700nm), infrared (>700nm and also known been linked with sunburn, tanning, skin aging contact to skin and eyes while outdoors or while and wide-brimmed hat. Wear sunglasses with
as heat) and UV radiation (<400nm) with (wrinkles, weakening elasticity), non-melanoma using sunlamps and sunbeds. UVB is more intense 99-100% protection against both UVA/UVB.
UV radiation further divided into: UV-A skin cancer (basal cell, squamous cell), malignant during summer than during winter, at midday For children older than 6 months, use sunscreen
(320-400nm), UV-B (290-320nm), which melanoma, phototoxicity and photoallergy, compared with early morning or late afternoon, with an SPF of 15 or greater, and re-apply every
is more skin-penetrating, and UVC cataracts, and immunosuppression. in places closer to the equator than in temperate 2 hours. Also consider using lip balm or lip cream
(<290nm). UVB is responsible for most UV radiation is the single most preventable zones, and at high altitudes. Sand, snow, concrete, containing sunscreen.
of the acute and chronic sun damage to cause of melanoma, the U.S. incidence of and water reflect up to 85% of sunlight, resulting
Do NOT use sunscreens that are combined with
normal skin. UVB has increased on the which has risen more rapidly than any other in greater exposure. Approximately 25% of lifetime
DEET or other insect repellant.
earth’s surface due to damage to the cancer, with the exception of lung cancer in sun exposure occurs before the age of 18 years.
earth’s protective stratospheric Watch for the UV Index on local weather forecasts in
women. In 1930, the lifetime risk of melanoma was
ozone layer. your area. Remind families that even on cloudy
1 in 1500; in 2001, it was 1 in 75.
winter days, children can get sunburn.
Avoid sunlamps and tanning salons/booths.
Note: Babies with limited sun exposure and who are
exclusively breastfed or receive less than 500 ml/day
of formula may benefit from supplementation with
vitamin D 200 iu/day.

Solvents
A solvent is capable of dissolving another sub- Most are skin irritants and defatting agents, upper Solvents are volatile compounds and are readily Replace products that contain volatile (typically
stance. It is usually a liquid that is water-based or respiratory irritants, and hepatoxic at sufficient doses. absorbed through the lungs, as well as through the petroleum-based) ingredients with those containing
hydrocarbon-based. Examples include: benzene, Acute and chronic neurotoxicity can occur and is skin. They penetrate many types of gloves. safer, “nontoxic” ingredients, such as water-based
toluene, trichloroethylene, formaldehyde, MtBE dose-related. Maternal exposure can contaminate human milk. glues or paints, and citrus-based solvents. Avoid
(methyl tertiary butyl ether). volatile adhesives. If using solvents, ventilate area.
Some are known or probable carcinogens Found in gasoline, degreasers, arts and craft
(eg. benzene has been linked to leukemia). supplies, nail products, paints, glues, varnishes, Avoid dry cleaning clothes. Air dry-cleaned clothes
“off-gassing” from newly installed carpets, outdoors before putting them in the closet.
Some are reproductive toxicants associated with
spontaneous abortion or birth defects. flooring, particle board, and furniture. Read annual Community Consumer Confidence
Also found in dry cleaning products and freshly Reports on public water supply quality or check your
dry-cleaned clothes. well water if there are industrial sites nearby.
Common indoor and outdoor air, drinking water Handle solvents with nitrile or butyl rubber gloves
contaminants. and a respirator, and keep them away from children.

continued —>

For more information: Visit our website for links to additional resources:
Physicians for Social Responsibility www.psr.org
1875 Connecticut Avenue, NW, Suite 1012
Washington, DC 20009 - 202.667.4260 - www.psr.org
 Pediatric Environmental Health Toolkit
Environmental Health Reference Card
Please refer to the AAP’s Pediatric Environmental Health handbook for more detailed information on these topics.

Topic Health Effects Summary Sources and Routes of Exposure Prevention Strategy
Pesticides
Pesticides are chemicals that are made to kill or Exposure to high levels of pesticides can cause acute Major sources of exposure include use in households, In Food:
reduce unwanted rodents, insects, weeds, bacteria or poisoning. Pesticides can also cause rashes, and may on gardens and lawns, in schools, agriculture, drift Peel or wash fruits and veggies.
molds. There are over 900 pesticides registered in the cause respiratory irritation. from spraying, and pesticide residues on certain
Buy organic if possible (look for USDA organic label).
US, most of which fall into the following categories: Low-dose exposure to pesticides may have chronic fruits and vegetables. Other:
Children that eat an organic diet have lower exposure
Insecticides – Organophosphates, carbamates, effects. Animal data suggest that even transient, • “Run-off” and inappropriate disposal of pesticides to certain pesticides, especially foods that children
pyrethrum and synthetic pyrethroids, organochlorines, low-dose exposure to certain classes of pesticides that contaminates drinking water. eat most.
and boric acid and borates. during brain development may cause hyperactivity • Pesticides in some lice removal shampoos. In Home, Outdoors:
Herbicides – Glyphosate (Roundup, Rodeo), and permanent changes in neurotransmitter receptor
• Pesticides in drinking or bathing water. Avoid spraying pesticides in the home, garden, and
Bipyridyls, Chlorphenoxy Herbicides (2,4-D, levels of the brain. Links have also been made with
birth defects, mutations, adverse reproductive on pets. Keep unwanted insects or animals out of
Weed-be-gone).
effects (primarily spontaneous abortion). Human your house or apartment by sealing cracks and holes
Fungicides – Substituted benzenes, thiocarbamates, around doors, windowsills, and around baseboards.
epidemiologic studies have associated pesticide
ethylene bisdithiocarbamates, copper, organotin,
exposure with increased risk for leukemia, Get rid of standing water that helps breed insects,
cadmium compounds, elemental sulfur, and
lymphomas, and brain cancers. Some studies repair drips and holes. Clean up food crumbs and
miscellaneous compounds such as captan,
link chronic pesticide exposures to neuro- spills and put away all food that will attract
benomyl, and ipriodine.
degenerative diseases such as Parkinson’s Disease. unwanted insects or animals.
Wood preservatives – Chromated copper arsenate
Remove shoes worn outdoors. Use a commercial-
(CCA), Pentachlorophenol.
grade doormat.
Rodenticides – Anticoagulants, cholocalciferol.
Use “Integrated Pest Management” (IPM) techniques
Insect repellants – N, N-diethyl-m-tolouamide that use pesticides as a last resort. If using pesticides,
(DEET), Permethrin (Permanone, Duranon). choose baits, traps, gels instead of sprays, dusts, or
pest strips (esp. indoors and where there are carpets,
soft fabrics), and keep out of reach of children. Never
spray near kids’ pillows, bedding, and primary spaces

graphics/illustration: www.stephenburdickdesign.com
where kids crawl. Avoid “preventive” or scheduled
lawn applications. Use only licensed professionals.
(See AAP’s Pediatric Environmental Health handbook
for specific guidance if using pesticides.)
© 2008 Physicians for Social Responsibility

Try organic gardening methods.

On Pets:
For more information: Do not use chemical tick-and-flea collars, flea baths
or “dips” on your pets. Do not use lindane. Wash pets
Physicians for Social Responsibility
and their bedding frequently to keep away fleas. Do
1875 Connecticut Avenue, NW, Suite 1012
Washington, DC 20009
not use “flea bombs” in your home.
202.667.4260 On Children:
Visit our website for links to additional resources: www.psr.org Don’t use lice shampoo containing lindane
on children.