Michael Shannon1, Alan Woolf, Rose Goldman. 1. Division of Emergency Medicine and the Program in Clinical Toxicology, Children's Hospital, Boston, Mass 02115, USA. michael.shannon@tch.harvard.edu
Abstract
BACKGROUND/ OBJECTIVE: As a result of an increasing desire among physicians and parents for clinical centers that can evaluate children with known or suspected exposures to environmental toxicants, a network of federally funded "pediatric environmental health specialty units" has recently been created. This descriptive study profiles the children seen in one unit of this program. SETTING: A New England, university-affiliated Pediatric Environmental Health Center (PEHC). METHODS: Review and analysis of all children seen in the PEHC in calendar year 1999. RESULTS: Over the course of the year, 281 children made 863 visits to the PEHC. Presenting complaints fell into 4 major categories: new visit for management of lead intoxication (n = 248), return visit for management of lead intoxication (n = 569), new visit for evaluation of exposure to an environmental toxicant other than lead (n = 33), and return visit for the management of exposure to a non-lead toxicant (n = 13). Among those children with new visits for a non-lead toxicant, the most common chief complaints were exposure to solvent-contaminated water (n = 7), pesticide exposure (n = 6), illness associated with proximity to a hazardous waste site (n = 6), autism from suspected mercury intoxication (n = 4), and evaluation of school-induced, building-related illness ("sick school syndrome")(n = 4). Eleven children had autism or pervasive developmental delay. Families traveled distances as great as 450 kilometers for evaluation by a pediatric environmental health clinical specialist. Every child was evaluated by a pediatrician with subspecialty training in medical toxicology. Environmental investigation of air, water, paint, dust, or land was conducted for all except 4 children (all foreign-born adoptees). Therapeutic interventions included chelation therapy, relocation to a safe environment, removal from school, and termination of chelation therapy that had been initiated by another practitioner. Third-party payors provided full reimbursement for all visits. CONCLUSIONS: The chief complaints of the children brought to pediatric environmental health specialty units are diverse, involving exposures to a wide range of toxicants from all environmental media (air, water, soil, and food). Parents desiring such an evaluation must often travel extensive distances, suggesting the need for a broader network of such centers. Third-party payors and health maintenance organizations are willing to provide full reimbursement for these services.
BACKGROUND/ OBJECTIVE: As a result of an increasing desire among physicians and parents for clinical centers that can evaluate children with known or suspected exposures to environmental toxicants, a network of federally funded "pediatric environmental health specialty units" has recently been created. This descriptive study profiles the children seen in one unit of this program. SETTING: A New England, university-affiliated Pediatric Environmental Health Center (PEHC). METHODS: Review and analysis of all children seen in the PEHC in calendar year 1999. RESULTS: Over the course of the year, 281 children made 863 visits to the PEHC. Presenting complaints fell into 4 major categories: new visit for management of lead intoxication (n = 248), return visit for management of lead intoxication (n = 569), new visit for evaluation of exposure to an environmental toxicant other than lead (n = 33), and return visit for the management of exposure to a non-lead toxicant (n = 13). Among those children with new visits for a non-lead toxicant, the most common chief complaints were exposure to solvent-contaminated water (n = 7), pesticide exposure (n = 6), illness associated with proximity to a hazardous waste site (n = 6), autism from suspected mercury intoxication (n = 4), and evaluation of school-induced, building-related illness ("sick school syndrome")(n = 4). Eleven children had autism or pervasive developmental delay. Families traveled distances as great as 450 kilometers for evaluation by a pediatric environmental health clinical specialist. Every child was evaluated by a pediatrician with subspecialty training in medical toxicology. Environmental investigation of air, water, paint, dust, or land was conducted for all except 4 children (all foreign-born adoptees). Therapeutic interventions included chelation therapy, relocation to a safe environment, removal from school, and termination of chelation therapy that had been initiated by another practitioner. Third-party payors provided full reimbursement for all visits. CONCLUSIONS: The chief complaints of the children brought to pediatric environmental health specialty units are diverse, involving exposures to a wide range of toxicants from all environmental media (air, water, soil, and food). Parents desiring such an evaluation must often travel extensive distances, suggesting the need for a broader network of such centers. Third-party payors and health maintenance organizations are willing to provide full reimbursement for these services.
Authors: Chiara De Luca; Desanka Raskovic; Valeria Pacifico; Jeffrey Chung Sheun Thai; Liudmila Korkina Journal: Int J Environ Res Public Health Date: 2011-07-01 Impact factor: 3.390
Authors: Philip J Landrigan; Alan D Woolf; Ben Gitterman; Bruce Lanphear; Joel Forman; Catherine Karr; Erin L Moshier; James Godbold; Ellen Crain Journal: Environ Health Perspect Date: 2007-10 Impact factor: 9.031