The following stories are selected case studies presented in the interactive Pediatric Environmental Health Toolkit (PEHT) Training Module. This module and the PEHT reviews children’s unique vulnerabilities to environmental hazards, sources of exposure, and offers suggestions for incorporating anticipatory guidance in well-child visits. The animated stories below are part of the free online 1 1/2 hour continuing education (CE) course for physicians, nurses, health educators, and other health professionals interested in pediatric environmental health. The entire PEHT Training Module and access to the free CE given by the CDC are found at Dr. Mark Miller from the UCSF PEHSU was the lead author working in collaboration with the Agency for Toxic Substances and Disease Registry (ATSDR) and Physicians for Social Responsibility (PSR) to develop this course, which supports use of the PEHT. The PEHT materials are available at


It is important to understand the unique vulnerabilities of children. Children are often at higher risk from toxic exposures because of diet, certain behaviors, key windows of vulnerability, and physiologic factors.

From birth, children breathe more air, drink more water, and eat more food per kilogram of body weight than adults. An infant’s respiratory rate is more than twice that of an adult’s.

Children may be more prone to carcinogenic effects of some chemicals due to rapidly proliferating tissues, their susceptibility and their young age, which allows many years in which latent effects may manifest.

This video discusses how children’s unique susceptibilities puts them at higher risk than adults from toxic exposures.

(From ATSDR eLearning course: Pediatric Environmental Health Toolkit Training Module

Nail Solvents

A good intake form that deals with patient and family environmental history will alert you to at work exposures that could harm children.

There are many potential health dangers in a nail salon, such as chemical fumes, equipment, and fluids. Growing children may be particularly vulnerable to pollutants.

(From ATSDR eLearning course: Pediatric Environmental Health Toolkit Training Module

Lead with Walking Toddler

This scenario is based on an actual case reported in the newsletter of the California Department of Health Services Childhood Lead Poisoning Prevention Branch.

The case illustrates how an environmental illness can be indicative of a larger public health problem. Where one person is exposed, there may be many others. Identifying the source of an exposure can result in mitigating illness in many succeeding workers, tenants, neighbors, etc. Note how children were affected in this case.

(From ATSDR eLearning course: Pediatric Environmental Health Toolkit Training Module

Mercury in Fish

Some fish have higher levels of mercury and suggested it’s best to serve children a variety of fish and seafood that have low levels of mercury, which include haddock, pollock, wild salmon, shrimp, canned chunk light tuna, and catfish. Fish sticks are also usually made from fish that are low in mercury.

By following the recommendation for selecting and eating fish or shellfish, women and young children will still receive the benefits of eating fish and shellfish, and can be confident that they have reduced their exposure to mercury.

(From ATSDR eLearning course: Pediatric Environmental Health Toolkit Training Module

Healthy Food and Exercise

Outdoor play time, especially unstructured, imaginative and exploratory play is increasingly recognized as an essential component of wholesome child development. Play in natural settings seems to offer special benefits.

Children are more physically active when they are outside, a plus at a time of sedentary lifestyles and an epidemic of children being overweight. Studies at the University of Illinois show that children with Attention-Deficit Disorder have fewer symptoms, and enhanced ability to focus, after outdoor activities. Children focus better when camping, exploring and fishing as compared to indoor activities such as watching t.v. and playing video games.

(From ATSDR eLearning course: Pediatric Environmental Health Toolkit Training Module