Healthy Environment, Healthy Child

Trusted health information in easy to use mobile format

Parents say they are concerned about environmental health threats, yet most pediatric care providers don’t offer prevention strategies during office visits. Why?  Many providers report that they feel ill-equipped to educate families about common exposures. Now, the new FREE Pediatric Environmental Health Toolkit (PEHT) mobile application, endorsed by the American Academy of Pediatrics (AAP), provides this trusted information.

We know that health care providers can play an important role in changing patterns of patient behavior. With the new Toolkit app, you can access simple ways to incorporate anticipatory guidance on environmental health during well child visits.  Easily view, on any mobile device or computer, evidence-based overviews on health hazards related to air, water, food and products.  Quickly scroll to anticipatory guidance you can offer patients keyed to age, from prenatal through teen years, on topics from how to avoid toxicants in the home to healthy eating practices.

The Toolkit application provides examples of how and where we live, eat, sleep, work, and play can impact our health, and what we can do about it. Beginning in the womb and continuing throughout life, multiple environmental factors are strong determinants of health, even decades later, making it ever more important to provide the most current and scientifically-based advice to patients on how to have healthy families. Research shows that parents are anxious to have this information. Now, the Toolkit makes it easy for clinicians to provide.

Three key sections cover the basics:

  • Briefs of environmental hazardsto health found in the air, water, food and consumer products;  includes sections on health effects, routes of exposure and prevention strategies.

Example: Water pollutant routes of exposure:

Exposure can occur through drinking, formula preparation, and cooking water, but also inhalation of volatile compounds and radon gas during bathing and showering. Exposure can also occur through swimming and other recreational activities. Inhalation or dermal exposures via showering/bathing can be significant.

  • Key concepts including the unique vulnerability of children, how the chemical, built and food environments influence health, and environmental justice.

Example: Workers can carry harmful residues home on their clothes, shoes, bodies, and tools. Storage of work chemicals at home, such as industrial cleaning products, can also expose children and other family members to toxicants. Physicians can protect their pediatric patients by taking occupational and hobby histories of parents and caregivers, and offering appropriate recommendations.

  • Anticipatory guidance keyed to thirteen age groups from prenatal through teen years.

Example: at 12 months:

Healthy eating habits: 5-6 portions fruits, vegetables daily. Limit junk food, processed/high fat food. Avoid fish high in mercury, PCBs/dioxins while maintaining the nutritional benefits of fish; heed local fishing advisories. Refer to Mercury Prevention strategies.

Lead Exposure:Screen all children with a blood lead test at 1 year of age and again at 2 years. “At risk” children may need to be screened earlier, and more frequently.

TV:AAP recommends no TV for children 2 or younger. Encourage physical activity and active play.

Want to dig deeper? Check out the trusted resources and references with links such as to the Pediatric Environmental Health Specialty Units who you can contact for help to answer your questions about environmental health issues.

“Like the ‘pocket guides’ of the past, this new web-based reference is at your fingertips on your mobile device.  You can feel confidence in the concise information and guidance provided as it was created and peer-reviewed by experts in the field nationwide,” says Dr. Nick Newman, a pediatrician and the Medical Director of the Pediatric Environmental Health and Lead Clinic in Cincinnati. “It is also free of charge and without advertising so there is no reason not to download it and use it.”

The PEHT app is a joint project between the Pediatric Environmental Health Specialty Units and Physicians for Social Responsibility. It is based on material in the AAP “Green Book.”

Also available: Free PEHT online course offered for free Continuing Education credit through the Agency for Toxic Substances and Disease Registry.

Interactive Pediatric Environmental Health Toolkit (PEHT) Training Module


This module 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 here. 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 here.


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)


Created by: PSR - Physicians for Social Responsibility PEHSU

Endorsed by:         American Academy of Pediatrics