The pediatrician's role and responsibility in educating parents about environmental risks.

Pediatricians are fully aware of the major environmental causes of observable childhood morbidity and mortality (Table 1). It is also important for pediatricians to be aware of the variety of parental concerns regarding exposures to environmental chemicals. During their training and practice, one of their tasks is to counsel and educate parents on how to reduce or prevent the more common environmental risks (Table 1), but they have to be knowledgeable about the presence of environmental chemical and physical toxicants and the emerging literature on potential effects of low-level exposures of these agents to answer patients’ questions and provide reassurance or warnings about the valid risks of some of these toxicants. This article focuses on areas of counseling for which the pediatrician can feel assured that we have sufficient information so that attention to these issues and concerns will improve child health. Some of the material in this article can be found in more detail in the excellent Handbook of Pediatric Environmental Health.1 We have also used a format for categorizing children’s environmental risks in various age categories that was used by Napier2 in Chapter 13 of Juberg’s text on environmental chemicals.2 There has been some very good news concerning population exposures to environmental toxicants published by the Centers for Disease Control and Prevention (CDC) in 2003.3 The report indicated that there has been “encouraging signs that levels of lead, pesticides, and other chemicals in the body generally have declined over the past decade or so.”3 The report included 27 substances that included lead, mercury, cadmium, other metals, metabolites of organophosphorous pesticides, cotinine, phthalates, polycyclic aromatic hydrocarbons, dioxins, furans, coplanar polychlorinated biphenyls, noncoplanar polychlorinated biphenyls, phytoestrogens, selected organophosphate pesticides, carbamate pesticides, herbicides, pest repellants, and disinfectants. The cotinine levels that represent exposure to tobacco smoke and “pesticides,” however, are higher in children than in adults and in children from lower socioeconomic backgrounds. Richard Jackson, the head of the CDC branch supervising these studies and a pediatrician, summarized the status of the risk of these potential toxicants as follows: “For most of the chemicals in the report, well-established guidelines are not available.”3