Screenshot of PEHT Module

The FREE Pediatric Environmental Health Toolkit (PEHT), endorsed by the American Academy of Pediatrics (AAP), provides trusted information on environmental health threats. Parents often say they are concerned about environmental health challenges. Yet, many pediatric care providers report feeling ill-equipped to educate families about common exposures and thus aren’t as well positioned to offer prevention strategies during office visits. Our tool can help!

Health care providers play an important role in changing patterns of patient behavior. With this Toolkit  you can access simple ways to incorporate anticipatory guidance on environmental health during well child visits and other patient encounters. The PEHT has evidence-based overviews on health hazards related to air, water, food and consumer products. The tool also features anticipatory guidance 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, as well as key actions we can take to optimize health. Beginning in the womb and continuing throughout life, environmental factors are strong determinants of health, even decades later, making it vital to provide current and scientifically-based advice to patients on how to have healthy families.

The three main branches of the PEHT are:

  • Environmental hazard briefs on found air, water, food and consumer products;  includes sections on health effects, routes of exposure and prevention strategies. For 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. For 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. For 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.

For more information, check out trusted resources and references such as the Pediatric Environmental Health Specialty Units that can be contacted with questions about environmental health issues.

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


The PEHT Training Module can be found here. 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. 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.


Children’s unique susceptibilities put them at higher risk than adults from toxic exposures. 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 also 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.

Nail Solvents

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

Lead with Walking Toddler

This 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 mitigate illness for many additional workers, tenants, neighbors, etc. Note how children were affected in this case.

Mercury in Fish

Some fish contain higher levels of mercury. It’s best to serve children a variety of fish and seafood that have low levels of mercury, including haddock, pollock, wild salmon, shrimp, canned chunk light tuna, and catfish. Fishsticks are also usually made from fish that are low in mercury.

Healthy Food and Exercise

Outdoor play time, especially unstructured, imaginative and exploratory play is 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. After outdoor activities, studies indicate that children with Attention-Deficit Disorder have fewer symptoms, and enhanced ability to focus. Children focus better when camping, exploring and fishing as compared to indoor activities such as watching T.V. and playing video games.

Created by:

PSR - Physicians for Social Responsibility PEHSU

Endorsed by:

        American Academy of Pediatrics