Robert W. Amler

Agency for Toxic Substances and Disease Registry (ATSDR), U.S. Department of Health and Human Services, Atlanta, USA


      An estimated 1.3 million children under 6 years of age live within 1 mile of at least one of the 1,300 (national priority list) hazardous waste sites in the USA. But children are not simply small adults; they often have greater exposures, greater potential for health problems, and less ability to avoid hazards. Children have greater exposures than adults because they are more likely to come into contact with contaminated media. They play vigorously outdoors and often bring food into contaminated areas. They are shorter than adults, breathing dust, soil, and heavy vapors close to the ground; and they are smaller than adults, getting higher doses per kilogram. If exposed during critical times in development, they can sustain permanent damage out of proportion to the expected dose response. They also are completely dependent on adults for risk management decisions.

      Most pediatricians are not trained to recognize how exposures to environmental contaminants can can cause, trigger, or exacerbate pediatric diseases. After widespread illegal spraying of >2,000 homes with a highly toxic pesticide in 1996-1997, most clinicians misdiagnosed the respiratory, gastrointestinal, and neurological problems that occurred in the children exposed to the toxic spray. Anticipating future incidents of this kind, ATSDR has established pediatric environmental medicine units and initiated development of clinical guidelines so children with unusual exposures or unusual clinical signs can be assessed. ATSDR=s child health programs incorporate applied research and epidemiology, community involvement and risk communication, and specialized training and referral guidelines for pediatric health care providers. ATSDR has formed a nationwide collaborative partnership among >25 professional, voluntary, and grassroots organizations to address the special environmental risks of children. Education programs are sponsored for children and their parents in targeted communities to promote healthy environments, and prevent exposure of children to hazardous substances.