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Environmental Health Hazards: How Children Are Different from Adults


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In policymaking on environmental health, it is often assumed that the entire population is exposed to and reacts to environmental contaminants in a similar manner. However, this assumption is misguided, especially where children are concerned. This article presents the scientific basis for the impacts of the environment on children, showing how children are different from adults in the ways in which they are exposed to environmental contamination and the ways in which they react to it when exposed. Specifically, the article examines the changing physical and biological environments of children. Children at different stages of development have unique physical risk factors for certain types of exposure because of changing location, levels of mobility, oxygen consumption, eating patterns, and behavior. When children are exposed to contaminants, their developing biological makeup--the way in which they absorb, distribute, and metabolize chemicals--will also affect how their bodies deal with the foreign substance. Each of these factors, along with the customs, laws, and regulations that affect the way in which children are exposed to the contaminants, had implications for the well-being of children in the years to come.
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Environmental Health
Hazards: How Children Are
Different from Adults
Cynthia F. Bearer
In policymaking on environmental health, it is often assumed that the entire popula-
tion is exposed to and reacts to environmental contaminants in a similar manner.
However, this assumption is misguided, especially where children are concerned. This
article presents the scientific basis for the impacts of the environment on children,
showing how children are different from adults in the ways in which they are exposed
to environmental contamination and the ways in which they react to it when exposed.
Specifically, the article examines the changing physical and biological environments
of children. Children at different stages of development have unique physical risk
factors for certain types of exposure because of changing location, levels of mobility,
oxygen consumption, eating patterns, and behavior. When children are exposed to
contaminants, their developing biological makeup—the way in which they absorb, dis-
tribute, and metabolize chemicals—will also affect how their bodies deal with the for-
eign substance. Each of these factors, along with the customs, laws, and regulations
that affect the way in which children are exposed to the contaminants, has implica-
tions for the well-being of children in the years to come.
s the human population increases, its demands on the earth also
increase. Today, the demand for food, potable water, clean air,
energy, and manufactured goods; the need for solid and liquid
waste disposal; and the requirement for habitable land are all expanding.
With this expansion, increasing amounts of pollutants are released into
the environment, and more and more people come into contact with
polluted environments.
Interaction with polluted environments can have an adverse impact on
the health of humans and other living creatures. This impact is felt first
among the most vulnerable members of a population. Children, because of
their unique physical, biological, and social characteristics, are among the
most vulnerable members of our population.
We have become increasingly aware of the dangers posed by the
accumulation of pollutants in the environment and have looked to policy
No. 2 – Summer/Fall 1995
Cynthia F. Bearer, M.D.,
Ph.D., is asssistant pro-
fessor of pediatrics in the
Department of Pediatrics
at Case Western Reserve
in the form of legislation, regulation, and private, voluntary action for pro-
tection. It may, however, be costly to identify and effectively deal with envi-
ronmental hazards, particularly when there are benefits to be gained from
the use of hazardous materials. Under these circumstances, effective poli-
cymaking depends on honest and accurate assessment of the risks posed
to all members of society, including children. For a variety of reasons, spe-
cial consideration should be given to protecting children in formulating
environmental policies: children are less able than adults to protect them-
selves, may be more vulnerable to particular toxins, and are not consid-
ered responsible for pollution. Crafting environmental policies responsive
to the special needs of children requires a thorough consideration of
these special needs and an understanding of how these needs may change
as children grow and develop.
This article presents the scientific basis for the impacts of the envi-
ronment on children. It describes the differences between adults and
children in physical, biological, and social environments, and highlights
why children should not be treated as “little adults” in developing envi-
ronmental policy.
Human Environments
Children exist within three broad types of
environments: physical, biological, and
social (see Figure 1). Each affects their
well-being, is at risk of degradation, and is
amenable to policy intervention. The
physical environment is anything that
comes in contact with the body. Air, for
example, is in constant contact with our
lungs and skin, and is a large part of our
physical environment. To define the phys-
ical environment precisely, it may be nec-
essary to divide a large environment into
smaller units, called microenvironments.
For example, in a room contaminated
with radon, the radon will not be evenly
dispersed; air near the floor has a higher
radon concentration while air near the
ceiling has a lower radon concentration.
Therefore, the environment of an infant
playing on the floor would be much dif-
ferent from that of an adult standing in
the room. These microenvironments can
differ enormously between adults and chil-
dren in many situations.
The biological environment consists of
the internal physiological workings of the
body as it takes up, processes, and inter-
acts with the substances it contacts. The
body has specific chemical pathways used
to digest, process, and excrete substances
found in air, food, and water. The multiple
steps by which a toxic hazard may result in
adverse health effects help illustrate the
complexity of the biological environment.
The steps are (1) absorption (how the
chemical gets into the body), (2) distribu-
tion (once inside the body, how the chem-
ical gets to each of the organs and in what
amount), (3) metabolism (how the body
processes the chemical), and (4) the toxic
action (how the chemical interacts with
the biochemistry of the body). Each of
these steps depends on the developmental
stage of the child because the child’s bio-
logical environment changes over time.
The social environment includes the
day-to-day circumstances of living in a fam-
ily or other setting as well as the laws and
regulations that affect day-to-day living.
Children, because of their continued devel-
opment and their different physical and
biological environments, are a unique
group of individuals in relation to toxic
hazards. If laws, regulations, policies, and
behavior do not reflect this fact, then chil-
Children are less able than adults to protect
themselves, may be more vulnerable to
particular toxins, and are not considered
responsible for pollution.
Environmental Health Hazards: How Children Are Different from Adults
dren may be unwittingly exposed to envi-
ronmental hazards. In time, children may
become bodies of evidence that environ-
mental degradation can have severe
impacts on the health of societies.
This article concentrates largely on the
physical and biological environments of
children at various developmental stages.
The social environment is discussed in
detail in the article by Landrigan and
Carlson in this journal issue.
Developmental Stages
A child’s vulnerability to environmental
exposures is closely related to his or her
developmental stage. Changes in growth,
hormonal levels, and biochemical makeup
continually occur. Developmental stages
are periods in a child’s life characterized
by the achievement of certain intellectual
and physical milestones. For organization-
al purposes, this article recognizes five
stages: the newborn (from birth to 2
months of age), the infant/toddler (2
months to 2 years of age), the preschool
child (2 to 6 years of age), the school-age
child (6 to 12 years), and the adolescent
(12 to 18 years). The fetus is considered as
a single separate stage, although there are
multiple critical stages of development
for the fetus.
The Physical Environment
Exposure to an environmental agent is the
first step in a sequence of environmentally
related health effects. Exposure may occur
at any point as people move through sev-
eral environments during the course of a
day. Adult environments include home,
work, and errands outside home and
work. Infants and children spend time at
home, school, day care, and play. Because
the environments of children are typically
different from those of adults and may
vary according to the age of the child, chil-
dren’s exposure to environmental agents
may be different from exposures of adults
and may vary with the developmental stage
of the child. In addition, different patterns
of exposure to a toxin may yield different
Figure 1
A Child’s Environments
health effects. For example, nitrates in
well water may cause the hemoglobin in
blood to become methemoglobin. If too
many nitrates are ingested, this chemical
change can cause insufficient oxygen to
reach the body tissues.
However, if the
nitrates are ingested at a rate that is slow
enough for the enzymes in the blood to
convert the methemoglobin back to
hemoglobin, no health effect will occur.
Exposure Before Birth
Exposures that have profound health
effects on an individual may occur before
birth. Even exposures that occur to women
before the conception of a child may have
an effect on that child (see Table 1). For
example, women who conceived after eat-
ing cooking oil contaminated with poly-
chlorinated biphenyls (PCBs) gave birth to
infants with a pattern of abnormal physical
characteristics called yusho.
In another
case, a woman inadequately treated for
lead poisoning in childhood gave birth to
an infant with congenital lead poisoning.
An individual can also be affected by
exposures that had direct effects on the
ovum and sperm prior to conception. The
ovum, formed within the fetus of the
future mother, is affected by the exposures
both of the grandmother and the future
mother. Studies have measured chemicals
foreign to the human body in the fluid
that bathes the ova prior to ovulation,
showing the potential for exposure.
Sperm, in contrast, are created only a few
hours to a few days prior to conception.
Thus, harmful effects to the sperm are
most likely the result of the father’s expo-
sure in the period immediately before
In most instances, exposures after con-
ception are dependent on exposures to
the mother. Infants may experience the
result of exposure to many of the toxins
mothers come into contact with during
the pregnancy. For example, maternal
smoking during pregnancy is associated
with reductions in forced expiratory flow
rates for the child.
Exposure from Birth to
Exposures for newborns, infants and tod-
dlers, preschool children, school-aged
children, and adolescents depend on their
physical location, breathing zones, oxygen
consumption, food consumption, types of
foods consumed, and normal behavioral
development (see Table 2)—all of which
change as the child develops.
Physical Location
That the physical location of children
changes with development has large impli-
cations for a child’s exposure. Premature
and sick newborn infants are exposed to
noise, light, compressed gases, intravenous
solutions, and benzyl alcohol, among
other things, during their stay in neonatal
intensive care.
Most newborns, however,
are usually near their mothers, so expo-
sures will be similar to those experienced
by the mothers. Moreover, a newborn fre-
quently spends prolonged periods of time
in a single environment, such as a crib.
Infants and toddlers, on the other hand,
are frequently placed on the floor, carpet,
Table 1
Periconceptual Exposures of Possible Importance
Grandmother Exposures to ova developing in mother while a fetus
Father Preconception exposures to sperm
Father-mediated exposures to pregnant mother
Mother Preconception exposures to ova
Exposures during pregnancy
Environmental Health Hazards: How Children Are Different from Adults
or grass. They therefore have more expo-
sure to chemicals associated with these sur-
faces, such as formaldehyde and volatile
organic chemicals from synthetic carpets
and pesticide residues from flea bombs.
Children who are not yet able to walk
or crawl may also experience sustained
exposure to noxious agents because they
cannot remove themselves from hazardous
environments. The infant who is badly sun-
burned because of his or her inability to
escape from the sun is a good example.
Many preschool children spend part of
their day in a day-care facility, which can be
located anywhere from church buildings
to private homes. In addition, preschool
children may spend a significant period of
time in outdoor environments such as
playgrounds and backyards.
School-aged children spend a signifi-
cant period of time at school, a very differ-
ent physical environment from a house or
an apartment. Schools are sometimes built
on relatively undesirable land. School sites
may be near highways (resulting in expo-
sure to auto emissions and lead), under
power lines (resulting in exposure to elec-
tromagnetic fields
), or on old industrial
sites (resulting in exposure to benzene
and arsenic).
Adolescents may not only have a new
school environment, but also select for
themselves other physical environments
in which they misjudge or ignore the
Attendance at concerts with dam-
aging sound levels is a relatively benign
example of a situation in which adoles-
cents willingly put themselves at risk.
Many adolescents also have part-time jobs
that place them in physical environments
which may be hazardous because of occu-
pational exposures.
Breathing Zones
Breathing zones, the places in space where
individuals breathe, are also closely related
to development. The breathing zone for
an adult is typically four to six feet above
the floor. However, for a child, it will be
closer to the floor. It is within these lower
breathing zones that heavier chemicals
such as mercury and large breathable par-
ticulates settle out
and radon accumu-
The presence of mercury in a
child’s breathing zone which came from
latex house paint accounted for a Michigan
child’s case of acrodynia, a form of toxicity
from mercury exposure.
(See the article
by Goldman in this journal issue.)
Oxygen Consumption
Because children are physically smaller
than adults, their metabolic rate is higher
than that of adults and they consume
more oxygen relative to their size than do
adults. As a result, a child’s exposure to an
air pollutant may be greater than an
adult’s. For example, if radon is present, a
six-month-old child with an average oxy-
gen consumption rate will, over a given
period of time, receive twice the exposure
to radon as will an adult with an average
oxygen consumption rate.
Quantity and Quality of Food
Similar to their need for proportionately
more oxygen than adults, children’s high-
er metabolic rates mean that they need to
consume more calories per pound of
body weight than adults. Quite simply, the
amount of food that children consume
per pound of body weight is higher than
that of adults.
The reason for this differ-
ence is that children not only maintain
homeostasis, as adults do, but also grow.
Consider the amount of water that an
infant who receives formula reconstituted
in boiled tap water drinks every day. The
average infant consumes six ounces of for-
mula per kilogram of body weight. For the
average male adult, this is equivalent to
drinking 35 cans of soda pop a day. If the
water contains a contaminant, then infants
will receive more of it relative to their size
than will an adult. Because of this differ-
ence, lead in tap water is of particular con-
cern for formula-fed infants. High blood
lead levels (greater than 10 mcg/dl) have
The average infant consumes six ounces of
formula per kilogram of body weight. For the
average male adult, this is the equivalent to
drinking 35 cans of soda pop a day.
Developmental Developmental Exposure Pathways Biological Vulnerabilities Appropriate Responses in
Stage Characteristics (Physical Environment) the Social Environment
Nonambulatory Food Brain Need for newborn-sensitive programs
(0 to 2 months) Restricted environment Breast milk Cell migration and regulations regarding:
High calorie/water intake Infant formula Neuron myelination Polychlorinated biphenyls (PCBs)
High air intake Indoor air Creation of neuron synapses Lead in drinking water
Highly permeable skin Tap/well water in home Lungs Environmental tobacco smoke
Alkaline gastric secretions Developing alveoli Need to educate parents and policymak-
(Low gastric acidity) Bones concerning environmental hazards
Rapid growth and hardening
Infant/Toddler Beginning to walk Food Brain Need for child-sensitive programs
(2 months to 2 years) Oral exploration Baby food Creation of synapses and regulations regarding:
Restricted environment Milk and milk products Lungs Radon in the home
Increased time away from Air Developing alveoli Residential pesticide use
parents Indoor Lead abatement
Minimal variation in diet Layering effects
Environmental tobacco smoke
Tap/well water in home Need to educate parents and policymak-
and day care concerning environmental hazards
Table 2
Environmental Risk Factors for Children at Different Stages of Development
Environmental Health Hazards: How Children Are Different from Adults
Developmental Developmental Exposure Pathways Biological Vulnerabilities Appropriate Responses in
Stage Characteristics (Physical Environment) the Social Environment
Preschool Child
Language acquisition Food Brain Need for child-sensitive programs
(2 to 6 years) Group and individual play Fruits, vegetables Dendritic trimming and regulations regarding:
Growing independence Milk and milk products Lungs Food pesticides
Increased intake of fruits Air Developing alveoli Environmental tobacco smoke
and vegetables Day care/preschool Increasing lung volume at home and at preschool
Outdoor Need to educate parents and policymakers
Water concerning environmental hazards
Water fountains
School-Aged Child Beginning of school Food Brain Need for child-sensitive programs
(6 to 12 years) Playground activities At home and school Specific synapse formation and regulations regarding:
Increased involvement in Air Dendritic trimming Asbestos abatement
group activities School air Lung Lead in school drinking water
Outdoor air Volume expansion Hazards in arts and crafts materials
Water Need to educate parents and policymakers
School water fountains concerning environmental hazards
Arts and crafts supplies
Adolescent Development of abstract Food Brain Need for adolescent-sensitive programs
(12 to 18 years) thinking Air Continued synapse formation and regulations on child labor
Puberty Water Lung and other issues
Growth spurt Other Volume expansion Need to educate parents and policymakers
Occupation Gonad maturation concerning environmental hazards
Self-determination Ova and sperm maturation
Breast development
Layering effects occur when a particle in the air is distributed in layers in a room. Radon, for example, is more concentrated closer to the floor, where infants and toddlers are likely to be.
been found in infants with heavy expo-
sure to tap water from reconstituted for-
Adults consuming the same tap
water would suffer no adverse health
effects because they would ingest much
less lead relative to their body weight.
In addition, the types of food children
consume differ from those consumed by
The diet of many newborns is lim-
ited to breast milk, which may contain
environmental pollutants including lead,
PCBs, and dioxins.
The diet of chil-
dren also contains more milk products,
fruits, and vegetables than the typical adult
diet, and as a result, children may be
exposed to more dangerous levels of pesti-
cides and other chemical residues than
Normal Behavioral Development
The normal behavioral development of a
child will also influence environmental
exposures. Infants and young children may
not be able to remove themselves from
noxious environments. Normal children
pass through a developmental stage of
intense oral exploratory behavior from
about age six months to two years, when
most objects grasped will be placed in the
mouth. This behavior is one common
cause of lead poisoning in environments
with high levels of lead dust, such as hous-
es painted with lead-based paint.
It also
places the child at risk in environments
that have not taken the oral orientation of
young children into account. For exam-
ple, some wood used in playground equip-
ment is treated with arsenic and creosote.
In the course of normal play, children will
frequently place their mouths on play-
ground equipment, inadvertently expos-
ing themselves to these toxic chemicals.
The ability to walk often places chil-
dren in play situations that have the poten-
tial for dangerous exposures, such as near
empty lots, mud puddles, and used con-
tainers holding oil or other liquid sub-
stances. As children become adolescents,
they gain more and more freedom from
the parental supervision that might other-
wise protect them from some exposures.
Their physical strength and stamina are
well developed, but they are still acquiring
abstract thinking.
They do not consider
cause and effect, particularly delayed
effects, in the same way that adults do.
Because of this lack of perception, they
often place themselves in situations with
greater risk than an adult would willingly
face. An example is the higher incidence
of farm injuries among adolescents than
among adults.
The Biological Environment
The biological environment—the internal
physiological workings of the body as it
takes up, processes, and interacts with the
chemicals it contacts—is another impor-
tant part of a child’s overall environment.
The body has specific chemical pathways
used to digest, process, and excrete sub-
stances found in air, food, and water,
which vary at different stages of develop-
ment. A chemical that comes into contact
with the biological systems of a child’s
body can produce adverse health effects or
be processed into nonharmful substances.
Absorption is the way a chemical enters
the body. Absorption generally occurs in
one of four ways: through the placenta,
the skin, the respiratory tract, or the diges-
tive tract. Each of these portals of entry is
dependent on the developmental stage of
the child.
Through the Placenta
During the fetal stage, the placenta is a
major pathway of absorption.
classes of compounds readily cross the pla-
centa, including compounds with low mo-
lecular weight, those that are fat-soluble,
and other specific compounds such as cal-
cium and lead. Carbon monoxide, a poi-
sonous compound of low molecular
weight, crosses the placenta readily. When
carbon monoxide enters the blood, it
binds to hemoglobin, creating carboxyhe-
moglobin. This bond prevents hemoglo-
bin from binding to oxygen and delivering
The diet of children also contains more
milk products, fruits, and vegetables than
the typical adult diet.
19Environmental Health Hazards: How Children Are Different from Adults
it to the cells. Because carbon monoxide
has a higher affinity for fetal hemoglobin
than it does for adult hemoglobin, the
concentration of carboxyhemoglobin is
higher in the fetus than in the mother.
Therefore, the infant may have reduced
oxygen delivered to tissues, with subse-
quent organ damage.
Fat-soluble, or lipophilic, compounds,
such as polycyclic aromatic hydrocarbons
(found in cigarette smoke) and ethanol
(found in alcoholic beverages), readily
gain access to the fetal circulation and
thereby may cause toxic effects in the
fetus. Also, mechanisms in the placenta
actively transport specific nutrients and
toxins to the fetus. Lead, for example, is
found in equal concentrations in the
mother and the fetus.
Through the Skin
The skin undergoes enormous changes
with development which affect its absorp-
tive properties. Pathways of absorption
through the skin are particularly impor-
tant for fat-soluble compounds. Because
the skin is mainly composed of fatty chem-
icals, fat-soluble chemicals generally cross
it more readily than other chemicals.
The outside skin layer of a fetus lacks
the rough exterior dead skin layer called
and thus is without one of the
major barriers of the skin.
The acquisi-
tion of keratin occurs over the initial three
to five days following birth. Therefore, the
skin of a newborn is a particularly absorp-
tive surface, and absorption of chemicals
through the skin has caused many cases of
illness in newborns. For example, hypothy-
roidism has resulted from iodine in beta-
dine scrub solutions used for sterilization
of the skin prior to birth or other skin pen-
etrating procedures, such as obtaining
blood or starting intravenous fluids.
Neurotoxicity has occurred from hexa-
chlorophene solutions which were used to
bathe infants following birth,
and hyper-
bilirubinemia has resulted from a pheno-
lic disinfectant used to clean equipment
between use for different patients.
An additional factor in the absorption
of these chemicals through the skin is the
larger surface-to-volume ratio of newborns
compared with older children and adults.
This means that for the same amount of
skin covered with a chemical, the younger
child may receive up to three times the
dose received by an adult.
Through the Respiratory Tract
During prenatal life, the fetus makes
breathing motions. Although the net flow
of fluid is from the lungs out of the tra-
© Courtesy of California Department of Health Services
chea into the amniotic fluid, some chemi-
cals in amniotic fluid may come in contact
with the lining of the respiratory tract.
Studies on this pathway of exposure to for-
eign chemicals are limited.
The surface absorptive properties of
the lung do not change during develop-
ment; the lungs continuously absorb air-
borne chemicals in the same manner.
However, from birth to adolescence, the
lung continues to develop more alveoli,
the terminal air sacs through which
humans breathe.
The increase in the
number of alveoli increases the size of the
absorptive area in the lungs. Thus, some
airborne chemicals may gain greater
access to the body through the lungs as the
child ages.
Through the Gastrointestinal Tract
The gastrointestinal (digestive) tract, at all
stages of development, provides many
opportunities for exposure to environ-
mental toxins. The fetus actively swallows
amniotic fluid.
Chemicals, including cer-
tain pesticides as well as chemicals from
tobacco smoke, can be present in amniot-
ic fluid, but it is not known if the fetus
absorbs those chemicals by swallowing the
fluid. Following birth, stomach acid secre-
tion is relatively low, but it will achieve
adult levels by several months of age.
the infant grows, the difference in acidity
will markedly affect absorption of chemi-
cals from the stomach.
The small intestine in the newborn can
respond to increased nutritional needs by
increasing absorption of a particularly
needed nutrient. For example, because
children’s bones are still growing, they
require more calcium than adults. Thus,
children absorb more calcium than adults
do from the same food sources. However,
this enhanced absorption can create prob-
lems. Lead, because it is absorbed in place
of calcium when it is present, is absorbed
to a greater extent in children than in
adults. An adult will absorb 10% of ingest-
ed lead, whereas a one- to two-year-old
child will absorb 50% of ingested lead.
The distribution of chemicals, the process
by which chemicals get to body organs,
varies with the developmental stage of the
child. For example, many drugs become
more diluted in newborns than they do in
adults, spreading out so that more of the
body has contact with them at lower lev-
In animal models, it has been shown
that lead is retained to a larger degree in
the infant animal brain than in the
Lead also accumulates more
rapidly in children’s bones than in adult
bones, doubling between infancy and the
late teen years.
Metabolism is the way the body processes
chemicals using a series of steps, or path-
ways, to alter chemicals for use as fuel or
for waste. It may result in activation or
deactivation of the chemical by the body.
The metabolism of chemicals depends on
the child’s developmental stage, and the
end result may either protect or harm the
child, depending on the chemical in
The activity in each step of a metabolic
pathway is determined by developmental
stage and the genetic background of each
individual. Therefore, some people are
more susceptible to adverse effects from
certain exposures. There are also large dif-
ferences in the ways enzymes work in
metabolic pathways between developmen-
tal stages.
The same enzyme may work
more or less depending on the age of the
In some instances, the lack of certain
pathways can be a protective factor. In the
adult, high levels of acetaminophen may
cause fatal liver poisoning, because adult
metabolism breaks down the drug into
subcomponents that are harmful to the
liver. However, infants are not as easily hurt
by acetaminophen. Infants born to moth-
ers with high acetaminophen levels will
also have high acetaminophen levels in the
blood, but they will not have liver damage.
An adult will absorb 10% of ingested lead,
whereas a one- to two-year-old child will
absorb 50% of ingested lead.
21Environmental Health Hazards: How Children Are Different from Adults
The reason for this lack of damage is that
the metabolic pathways of the fetus have
not yet developed enough to break down
the drug into harmful subparts.
Target Organ Susceptibility
Children are also different from adults
because their organs are undergoing
growth and maturation, a process that may
be adversely affected by exposure to harm-
ful chemicals. Responses of children’s
bodies to harmful exposures may differ
from responses of adults’ bodies to these
exposures in both the nature and the
severity of the effect. Examples of such
outcomes are poor fetal growth, poor
growth in childhood, diminished intelli-
gence quotient (IQ), precocious puberty,
small head size, and diminished lung
The body experiences three types of
growth: multiplicative, where cells divide;
auxelic, where existing cells become larg-
er; and accretionary, where ground sub-
stance and nonliving structural compo-
nents accumulate.
Multiplicative growth
is complete around six months after con-
ception for tissues that do not undergo
continual turnover throughout life, such
as skin cells. After that point, all growth is
accretionary or auxelic.
Cells undergo two further processes to
become the adult organism: differentia-
tion and migration. Differentiation occurs
when cells take on their individual tasks
within the body and lose the ability to
divide. The trigger for differentiation may
be hormones, so when chemicals mimic
hormones they can alter the differentia-
tion of some tissues. Because the organ
systems in children, including the repro-
ductive system, are continuing to differ-
entiate, a chemical that mimics a hor-
mone can have drastic effects on the
development of those organ systems.
Chlorinated insecticides are an example
of this mechanism. Studies have shown
effects on the adult rat reproductive sys-
tem from neonatal exposure to chlorde-
including abnormal growth of the
vagina and sterility.
Cell migration is necessary for certain
cells to reach their destination for func-
tion. Neurons, for example, originate in a
structure near the center of the brain,
then migrate out to a predestined location
in one of the many layers of the brain.
Chemicals such as the ethanol in alcoholic
beverages may have a profound effect on
this process, as shown in children with
fetal alcohol syndrome. Prenatal exposure
to ethanol may result in interruption in
this process severe enough to cause obvi-
ous malformations of the brain.
Some organs continue to develop for
several years. The brain and the lungs
both have prolonged periods of postnatal
development which are not complete until
This protracted period of
growth and development increases the vul-
nerability of these organs. For example,
brain tumors are frequently treated by
radiation therapy in adults, with uncom-
fortable but reversible side effects. However,
in infants, radiation therapy needs to be
minimized when possible because of pro-
found and permanent effects on the devel-
oping central nervous system.
Another example of the unique vulner-
ability of children is the toxic effects of
lead on the brain and nervous system. The
current blood lead concentration of con-
cern for children is 10 mcg/dl,
based on
which found that children with
blood lead concentrations above that level
may have measurable decreases in intelli-
gence quotient. Because of differences in
developmental stage, the occupational
limit for exposure to lead for adults is six
times higher than the limit for children.
The Social Environment
For every developmental stage, there are
unique combinations of developmental
characteristics, physical environment, and
biological environment that place children
at special risk of harm. To protect children
from the harms caused by exposure to
Responses of children’s bodies to harmful
exposures may differ from responses of adults’
bodies to these exposures in both the nature
and the severity of the effect.
environmental toxins, it is necessary also to
consider the customs, laws, and regulations
that help define children’s environments.
In many ways, regulatory policies have
not taken the characteristics of children
into account. For example, for infants who
are formula-fed, the amount of water con-
sumed is enormous, and yet our water
safety policies do not always take the
increased consumption and special vul-
nerabilities of newborns into account
when they are determined. Standards for
radon testing and reentry times listed on
the label of home pesticides should allow
adequate protection for infants who spend
so much of their time on the floor, but
such considerations may not be reflected
in recommended practice. Similarly, pesti-
cide regulations should be made with the
special diet of children in mind. Adequate
laws to prevent exposure to environmental
tobacco smoke for children attending day-
care facilities could prevent the exposure
of many children to environmental tobac-
co smoke.
For the school-aged child, regulation
of the school environment is of particular
concern. The drinking water at the tap in
schools should be judged safe for a child’s
consumption. Arts and crafts supplies
should be designed and purchased keep-
ing in mind a child’s unique way of han-
dling these materials. For adolescents who
are beginning to work, child labor laws
should be adequate not only to protect
them from occupational risks, but also to
ensure that their ability to learn in school
is not adversely affected.
These are only a few examples of the
potential effects of laws and regulations on
the environments of children. These social
environment effects are discussed more
thoroughly in the article by Landrigan and
Carlson in this journal issue.
There are many reasons children cannot
be considered little adults in the area of
environmental health. Important differ-
ences exist between children and adults in
exposures, absorption pathways, tissue dis-
tribution, ability to transform and elimi-
nate chemicals, and body response to envi-
ronmental chemicals and radiation. Each
of these differences is dependent on the
developmental stage of the child, and all
children are not the same during each
stage (see Table 2). When considering the
health impacts of a particular exposure on
the population and potential policies to
alleviate those impacts, each of these dif-
ferences must be heeded.
What can be done to alleviate the
harm—both potential and actual—done
to children by environmental pollution?
Health care providers, policymakers,
teachers, community leaders, parents, and
children all have roles to play in prevent-
ing children’s exposure to harmful agents
in their environment and in addressing
the consequences for children who are
Education about the unique vulnera-
bility of children to environmental pollu-
tion is one powerful tool for change.
Teaching parents and children how to
avoid harmful exposures and therefore
prevent environmental illnesses is an
important piece of prevention, which can
occur at many levels and in different set-
tings. However, education can and should
go beyond parents and children. Clinicians
can be especially helpful when serving as
educators, investigators, and advocates for
children. Most environmentally caused
diseases have been diagnosed by alert,
environmentally aware clinicians, and
publication of case studies has allowed fur-
ther education of other clinicians about
environmentally mediated diseases.
Increased awareness of the effects of envi-
ronmental hazards on children can influ-
ence both exposure and treatment for
Community leaders and policymakers
can use information presented by par-
ents, clinicians, scientists, and other advo-
Health care providers, policymakers,
teachers, community leaders, parents, and
children all have roles to play in preventing
children’s exposure to harmful agents in
their environment.
Environmental Health Hazards: How Children Are Different from Adults
cates for children and the environment to take the unique vulnerability of children
into account when establishing regulatory policy. To bring about change, policymak-
ers must understand the basis for this unique vulnerability—that children are not lit-
tle adults.
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... Also, some of them tend to spend more time at home than the rest of the population, and thus are more exposed to health risks associated with poor housing conditions [22], in particular environmental noise and extreme high and low temperatures. Infants and children are also more susceptible to environmental toxicants, such as indoor lead, due to their developmental state [23]. Additionally, according to WHO [7], there is a 60% probability that a new home will be occupied at one point by a person with a functional disability; the issue of accessibility to housing is therefore essential. ...
... Several variables are scored according to indices available online, such as: protection against natural and technological hazards, radon, air pollution, outdoor soils (variables 4,5,23,26,28). For natural and technological hazards, the availability of data is dependent on the entry into force of the corresponding hazard prevention plans, which, in turn, partly depends on local decisions. ...
Full-text available
Background: Despite evidence of the major impact housing carries on health, many individuals still live in unhealthy dwellings. In France, the Domiscore has been proposed as a tool to assess the quality of dwellings with regard to their health impact, to allow for a better detection of unsafe housing and to improve dwellings. The aim of this paper is to present the method used to construct the Domiscore and test its relevance and usability. Methods: The Domiscore grid, inspired by the Nutriscore, consists of 46 variables-such as air quality, light or outdoor view. Each variable is scored on a four-point scale using in situ observation, mandatory diagnostics and open access data. The sum of each variable's score results in an overall risk score for the dwelling. The Domiscore was tested in two phases. During the first testing phase, 11 real estate professionals, health professionals and social workers used the Domiscore for on-site visits in different geographic areas of France. They then participated in a semi-structured qualitative interview. The second phase consisted in a public consultation with diverse stakeholders such as public authorities, housing activists and social workers, using an online survey to collect their opinions on the Domiscore's relevance, understandability and usability. Results: The Domiscore was tested on 28 homes. Variables completion rates were high irrespective of tester profile for all home visits (91%, SD = 4.7%). The mean time needed to fill in the grid was 1.5 h. The public consultation returned 151 responses. The Domiscore was deemed easy to understand, relevant, and rather easy to fill out. Most participants found the Domiscore useful for information gathering, awareness raising, detecting at-risk situations and agreed that it could contribute to enhance housing conditions. Its length was noted, although the inclusion of additional variables was also suggested. Conclusions: The results of this study suggest that the Domiscore is accessible to housing specialists and other professionals for the evaluation of a dwelling's health impacts and the standardized detection of dangerous situations. The testing process allowed for improvements in the grid and training materials for future users.
... Exposures to environmental toxins can cause a host of acute-and long-term consequences on brain structure and function, which can have cascading effects on cognition, behavior, and mental wellness. This is especially true for children and adolescents [1,2]. It is well-established that youths face unique, sometimes more severe costs relative to adults following exposure to toxicants due to modes of toxicant delivery and consumption, breathing and eating habits, and biological vulnerability during periods of rapid development [1,3]. ...
... This is especially true for children and adolescents [1,2]. It is well-established that youths face unique, sometimes more severe costs relative to adults following exposure to toxicants due to modes of toxicant delivery and consumption, breathing and eating habits, and biological vulnerability during periods of rapid development [1,3]. Indeed, a growing body of work has linked exposure to various toxicants, ranging from ingested heavy metals (e.g., lead) to inhaled pollutants (e.g., particulate matter), with sensory dysfunction [4], atypical patterns of structural brain development [5], incidence of specific neurodevelopmental disorders like attention-deficit/hyperactivity disorder (ADHD; [6,7]), cognitive delays and deficits [8,9], and risk for mood and anxiety disorders [10,11]. ...
Full-text available
Children are particularly vulnerable to the deleterious impacts of toxic environmental exposures, though the effects of some rather ubiquitous toxins have yet to be characterized in youths. One such toxin, radon gas, is known to accumulate to hazardous levels in homes, and has been linked with the incidence of lung cancer in aging adults. However, the degree to which chronic home radon exposure may impact risk for health problems earlier in life is unknown. Herein, we explored the degree to which chronic home radon exposure relates to biomarkers of low-grade inflammation in 68 youths ages 6- to 14 years old residing in an area of the United States prone to high home radon concentrations. Parents completed a home radon test kit, and youths provided a saliva sample to assess concentrations of five biomarkers. Using a multiple regression approach, we found that greater radon exposure was specifically associated with higher levels of C-reactive protein (β = 0.31, p = 0.007) and interleukin-1β (β = 0.33, p = 0.016). The data suggested specificity in associations between chronic home radon exposure and different biomarkers of inflammatory activity and highlight a pathway which may confer risk for future mental and physical health maladies.
... On the contrary, (Bearer, 2013) has stated that the entire population is exposed to and reacts similarly to environmental pollutants in making environmental health policies. Nevertheless, this statement is misleading, especially when it comes to children. ...
The mobility of children going to school plays an important role in their quality of life. Hence, spatial planning and the development of city infrastructure should meet the needs of children. Home, school, and the surrounding city influence children’s character and growth. Children’s spatial mobility in the Archipelago of Indonesia is still not fulfilling the framework of a child-friendly environment. This study aims to review the parameters of children’s spatial mobility in Indonesia’s archipelago, suggesting the degree of fulfilment of a child-friendly environment. A review of seven local and national electronic media coverages to elicit the parameters of Indonesia’s children’s environment. The coverages include Liputan6, Radar Sriwijaya, Medan Headlines, Detiknews, Hipwee, CNN Indonesia, and from 2015 to 2021. Three themes were identified from the coverage, including (1) basic services (education and transport), (2) safety and security, (3) family, kin, peers, and community. It is found that education and transport are the essential services that are not equipped for the children’s mobility, especially those living on the islands. Thus, the lack of transportation infrastructure is a strong influence and appears in the dynamics of the development of the spatial mobility of children in the Indonesian Archipelago.
... This is concerning since the potentially harmful health effects of inefficient ventilation and indoor air pollution have resulted in an increase in the number of illnesses associated with sick building syndrome [34,35]. Considering children may be more vulnerable to environmental contaminants and the consequences of indoor toxins may be more severe than adults [36,37], attention to cross ventilation is crucial to avoid extreme heat levels and poor indoor air quality inside classrooms. ...
Full-text available
Children in developing countries such as India will experience severe consequences of climate change. Primary school students, in particular, are the most vulnerable to extreme weather conditions, such as heat waves intensifying due to climate change. This will adversely impair their development, well-being, and learning outcomes. However, significant research gaps exist in understanding and mitigating children’s vulnerabilities. There is an urgent need for a deeper understanding of the impact of heat waves on children’s health and well-being in India. Further, the discussion on the state of heat safety in Indian primary schools is limited. This study addresses these gaps by surveying 335 primary school teachers in seven Indian cities. The data gathered from the field survey offers a better understanding of classroom experiences and challenges encountered by children and teachers during heat waves. It underscores several aspects of students’ vulnerability to heat exposure and its adverse impact on their health, such as absence from school, physical symptoms of heat distress, etc. Furthermore, it highlights the pressing need for classroom heat risk management in light of climate change and makes several policy prescriptions in primary schools.
... In addition, unlike the adult population, in pediatrics, the immune system is developing, there is a higher respiratory rate and the skin is thinner, increasing its risk in comparison to adult population. 6,7 In fact, there is growing evidence of the detrimental effect of THS on increasing pediatric asthma exacerbations and other respiratory tract diseases. 8 In this sense, tobacco control legislations have been implemented in workplaces and in public places with children present, but legislation regulating private homes and cars are still very scarce. ...
... Some studies conclude that people near waste collection points were at a higher risk of suffering from health effects than those staying further (Munyai and Nunu, 2020). The poor management of solid waste at the household level may have adverse effects on adults and children (Guerrero et al., 2013;Bearer, 1995). As Bhopal is considered one of the cleanest state capitals in the country, it is essential to know what people are thinking about the present management and what they expect from different stakeholders. ...
The study identifies solid waste management (SWM) problems in Bhopal, India. Awareness of the segregation 1 , daily waste collection, willingness to use non-plastic products, and willingness to reduce waste at the source has a low positive correlation with a willingness to pay. Only 52.15% of respondents know something about SWM. 39.67% of respondents were not happy about the present SWM. The habit of throwing waste from people is the major problem after irregular sanitary work, harmful consumption patterns and governance. 50.27% of respondents segregated waste, and 94% of the respondents are willing to segregate. 65.76% of respondents have a daily waste collection, and 86.41% of respondents are willing to have a daily collection. 66.12% of respondents were willing to pay extra money for improvement in the SWM. Segregated collection with bins and containers (31.45%) and proper disposal of the solid waste (23.92%) were the top-ranked demands in the existing SWM. 89.50% of the respondents were willing to use non-plastic products. 88.17% of respondents said they are willing to reduce waste at the source.
Background: Limited human studies have investigated the impact of indoor air pollution on early childhood neurodevelopment among the US population. We aimed to examine the associations between prenatal and postnatal indoor air pollution exposure and early childhood development in a population-based birth cohort. Methods: This analysis included 4735 mother-child pairs enrolled between 2008 and 2010 in the Upstate KIDS Study. Indoor air pollution exposure from cooking fuels, heating fuels, and passive smoke during pregnancy, and at 12 and 36 months after birth were assessed by questionnaires. Five domains of child development were assessed by the Ages and Stages Questionnaire at 4, 8, 12, 18, 24, 30, and 36 months. Generalized estimating equations were used to estimate odds ratios (ORs) and 95% confidence intervals (CIs), adjusting for potential confounders. Results: Exposure to unclean cooking fuels (natural gas, propane, or wood) throughout the study period was associated with increased odds of failing any development domain (OR = 1.28, 95% CI 1.07, 1.53), the gross motor domain (OR = 1.52, 95% CI: 1.09, 2.13), and the personal-social domain (OR = 1.36, 95% CI: 1.00, 1.85), respectively. Passive smoke exposure throughout the study period increased the odds of failing the problem-solving domain by 71% (OR = 1.71, 95% CI 1.01, 2.91) among children of non-smoking mothers. No association was found between heating fuel use and failing any or specific domains. Conclusion: Unclean cooking fuel use and passive smoke exposure during pregnancy and early life were associated with developmental delays in this large prospective birth cohort.
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Background The presence of aluminium (Al) in the human body may impact brain neurodevelopment and function, and it is thought to contribute to autism spectrum disease (ASD). The main objective of this study was to assess the association between urinary Al and the development of ASD among Malaysian preschool children in the urban city of Kuala Lumpur. Method This was an unmatched case–control study in which children with ASD were recruited from an autism early intervention center and typically developed (TD) children were recruited from government-run nurseries and preschools. Urine samples were collected at home, assembled temporarily at study locations, and transported to the laboratory within 24 h. The Al concentration in the children’s urine samples was determined using inductively coupled plasma mass spectrometry (ICP-MS). Result A total of 155 preschool children; 81 ASD children and 74 TD children, aged 3 to 6 years, were enlisted in the study. This study demonstrated that ASD children had significantly higher urinary Al levels than TD children (median (interquartile range (IQR): 2.89 (6.77) µg/dL versus 0.96 (2.95) µg/dL) ( p < 0.001). Higher parental education level, non-Malay ethnicity, male gender, and higher urinary Al level were the significant ASD risk factors (adjusted odds ratio (aOR) >1, p < 0.05). Conclusion A higher urine Al level was discovered to be a significant risk factor for ASD among preschool children in the urban area of Kuala Lumpur, Malaysia.
This introductory chapter serves to highlight the progressive shift in international law as to environment, intended as the physical surroundings in which humans exist, from an object (value, interest and competence) to be protected, preserved in international environmental law and international human rights law and practice as well as even improved (at the EU level) in its natural dimension and utilitarian character—also in its temporal representation transcending generations and individual human lives to signify the perpetuation of the human species amid all number of environmental temporalities. This shift in fact has operated towards an environmental right(s)-based approach which has recognized environment-related rights in international human rights, more recently expanded to a right to healthy environment, though only by the Human Rights Council and at some regional level but with still some difficulties at the European one. Building upon these premises, the chapter highlights the links between a safe and healthy environment on the one hand and children’s rights on the other evoked with increasing insistence both by children and international bodies, but so far failed to be comprehensively considered by legal scholars; and purports to fill that gap in the existing literature by considering the contribution a group-specific perspective can make to the fruitful development of children’s environmental rights.KeywordsenvironmentEU lawinternational lawinternational human rights lawright to a healthy environmentanthropocentrismecocentrismchildren
Youth growing up in places with more greenspaces have better developmental outcomes. The literature on greenspace and youth development is largely cross-sectional, thus limited in terms of measuring development and establishing causal inference. We conducted a systematic review of prospective, longitudinal studies measuring the association between greenspace exposure and youth development outcomes measured between ages two and eighteen. We searched Cochrane, PubMed, CINAHL, Scopus, and Environment Complete, and included prospective cohort, quasi-experimental, and experimental studies on greenspace and youth development. Study quality was assessed using a 10-item checklist adapted from a previously published review on greenspace and health. Twenty-eight studies met criteria for review and were grouped into five thematic categories based on reported outcomes: cognitive and brain development, mental health and wellbeing, attention and behavior, allergy and respiratory, and obesity and weight. Seventy-nine percent of studies suggest an association between greenspace and improved youth development. Most studies were concentrated in wealthy, Western European countries, limiting generalizability of findings. Key opportunities for future research include: (1) improved uniformity of standards in measuring greenspace, (2) improved measures to account for large latency periods between greenspace exposure and developmental outcomes, and (3) more diverse study settings and populations.
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PCDD and PCDF levels were monitored in human milk obtained through the Women, Infants and Children Program of the Los Angeles County Public Health Department. The milk samples were from three groups with different fresh fish consumption. Only 2,3,7,8-substituted PCDD and PCDF isomers were detected in human milk at levels comparable to those previously reported in other regions of the world. PCDD and PCDF levels could not be used to distinguish the dietary groups. However, the Southern California and Swedish human milk analyzed by our methods could be distinguished form each other. The level of 2,3,4,7,8 PeCDF was 3 to 4 times lower in human milk from Southern California than in Swedish milk. Additionally, chlorinated naphthalenes were detected in both Swedish and California human milk at levels estimated to be 10 to 100 times that of the PCDD's and PCDF's.
1, 1-Dimethylhydrazine (UDMH) is a breakdown product of daminozide (tradename “Alar”), a plant growth regulator which was used on fruit, most notably apples. The carcinogenic activity of UDMH was first reported in 1967 when lung tumors were noted in UDMH-exposed mice, and then was confirmed in the early 1970s when both lung tumors and hemangiosarcomas were observed in mice. These early findings were again confirmed; hemangiosarcomas in hamsters and lung adenomas in rats were also observed. Because the early studies did not follow good laboratory practice procedures instituted in 1979, the early results were discounted, particularly for quantitative risk estimation, and regulation of daminozide as a carcinogen delayed. In 1987, the EPA published a cancer potency value for UDMH derived from the early mouse study. Using this potency estimate, the Natural Resources Defense Council (NRDC) predicted that average risks to preschoolers from daminozide use approached 1/1000, and widely publicized this finding as unacceptable. As a consequence, apples were soon removed from the luncheon menus of elementary schools and the public voiced general skepticism about the safety of the food supply. In response, EPA, various state agencies and other groups developed their own risk estimates. We discuss the EPA and NRDC assessments and the basis for the differences in their risk estimates, including assumptions concerning risks from early-in-life exposure, the fraction of UDMH derived from daminozide, appropriate subpopulations, representative parameters of the potency distribution, and corrections for bioassay length. It is demonstrated that some plausible estimates of risk, derived from conservative, reasonable assumptions, exceed those developed by EPA and NRDC.
The document is the fourth revision of the statement on Preventing Lead Poisoning in Young Children by the Centers for Disease Control (CDC). The recommendations continued herein are based mainly on the scientific data showing adverse effects of lead in young children at increasingly lower blood lead levels. They are tempered, however, by practical considerations, for example, of the numbers of children who would require followup and the resources required to prevent this disease. It is possible that further scientific data and development of infrastructure and technology will result in a lowering of the blood lead level at which interventions are recommended at a future time. The statement is a departure from previous ones in several ways. Perhaps most important is the emphasis on primary prevention and the need for coordination between pediatric health-care providers and public agencies. The statement reflects the vision expressed in the Department of Health and Human Services' Strategic Plan for the Elimination of Childhood Lead Poisoning, which calls for a concerted, coordinated societywide effort to eliminate this disease. The authors identified several areas where better data are needed in order to provide scientifically sound guidance. These range from evaluating the efficacy of chelation therapy at lower blood lead levels in terms of preventing the adverse effects of lead to developing science-based criteria for determining when an abated unit is cleaned up enough for rehabilitation.
THE LANDMARK ARTICLE1 reprinted in this issue of The Journal was written by a pediatric resident, Hunter Comly, MD, who was encouraged by Robert Jackson, MD, to seek out the cause of cyanosis in two infants referred to Iowa City from the surrounding countryside. Central to the mystery's solution was a theory advanced by the father of the first patient that implicated well water in his daughter's recurrent episodes of cyanosis. Respecting Dr Jackson's "open minded attitude" toward the "cock and bull theory," the young Comly had water from the suspect well analyzed and in so doing demonstrated that well-water nitrates were a cause of methemoglobinemia in infants. A survey of the nitrate content of water from Iowa wells clearly demonstrated the public health dimension of the problem. Neither Comly nor Jackson pursued their interest in methemoglobinemia: Comly became a child psychiatrist, while Jackson distinguished himself as a pediatric