“Pediatric Environmental Health: Putting It Into Practice” symposium hosted by the Baylor College of Medicine, City of Houston Department of Health and Human Services, Southwest Center for Pediatric Environmental Health and Texas Children’s Hospital brought experts in the fields of pediatrics and environmental medicine together to inform doctors, nurses and other health care providers about environmental health issues in treating children. The speakers discussed the importance of exposure history in a pediatric practice, environmental health in the health care community, reimbursement for environmental health services and the environmental health tracking network.

In opening remarks, Stephen Greenberg, MD, professor and chair, Department of Medicine, Baylor College of Medicine, said interest in pediatric environmental health is growing. He noted that Pub Med, an Internet medical literature site, listed 1,700 citations and that there are 100 publications on the topic.

Lynn Goldman, MD, MPH, pediatrician and epidemiologist, professor in the Department of Environmental Health Sciences at the Johns Hopkins University Bloomberg School of Public Health, was the first speaker of the evening. Goldman grew up in Galveston and said one of the experiences that helped her decide on a career in pediatrics and epidemiology was looking at a cancer mortality rate map and noticing that the Galveston-Houston area lit up because of the high number of cancer death cases in the area. She added that these cases are “likely to be environmentally related.”

Goldman explained the importance of taking an environmental history of each child as part of the medical history. Her presentation included a detailed list of questions that should be included in an environmental history. She emphasized asking about the home and school environment, as well as occupations of parents and teens.

Goldman also expressed concern about exposure to UV radiation. “We are exposed to more UV radiation than any other generation because of the depletion in the protective high level ozone layer, and it will be decades before it comes back down,” she said. Skin cancer screening information and tools were included in the symposium notebook for participants.

Barbara Sattler, RN, DrPh, FAAN, is the director of the Environmental Health Education Center at the University of the Maryland School of Nursing where she is an associate professor. She talked about the need for health care professionals to push for legislation regarding protection of the environment. “There is no better group to talk to legislators, no one is better listened to than doctors and nurses,” she said.

The country needs public health studies on an annual basis especially sampling body fluids and hair for persistent and non-persistent toxins, Sattler said. She also recommended that safety standards, now based on a 160-pound white male, need to consider children.

The use of pesticides and emissions of mercury from coal-fired power plant is impacting growth and development of children, according to Sattler. Children are exposed to these toxins in the air, water and in food. The American Nursing Association is active in urging the Environmental Protection Agency (EPA) to set more strict policies regarding regulations of mercury and power plants.

Another threat to the health of children, as well as adults, is the use of bovine growth hormone in milk, said Sattler. Antibiotics are now used in animal feed to promote growth. “The medical community fears the loss of antibiotics as a treatment for infection,” Sattler said. The overuse of antibiotics has led to a growing resistance of bacterial infection to treatment with antibiotics. The American Nursing Association is calling for a ban of all non-therapeutic uses of antibiotics. To reduce child exposure to bovine growth hormone, pesticides and other toxic substances, Sattler suggested promoting organic food in schools.

Stephen Williams, MEd, MPA, City of Houston Department of Health and Human Services director, discussed the need for more research regarding the connection between life-threatening chronic diseases and environmental pollution.

Williams said nationally and locally there is an environmental health gap, which includes a lack of basic information that could document possible links between environmental hazards and chronic disease. He also described a lack of critical information needed to reduce and prevent negative environmental exposures. “While overt poisoning from environmental toxins has long been recognized, the environmental links to a broad array of chronic disease of uncertain causes is unknown,” Williams said.

The Environmental Public Health Tracking Network (EPHTN) was established to address these gaps in local and national knowledge, according to Williams. Houston’s Department of Health and Human Services is one of only three local sites in the nation to receive funding for this study.

The EPHTN grant objectives are to:

• Identify populations at risk and respond to outbreaks, clusters and emerging threats
• Establish the relationship between environmental hazards and disease
• Guide intervention and prevention strategies including lifestyle improvements
• Identify, reduce and prevent harmful environmental risks
• Improve the public health basis for policy making
• Enable the public’s right to know about health and the environment
• Track progress in achieving a healthier nation and environment

Williams concluded by requesting assistance and input from the medical community on this project.

The following morning, Dr. Lynn Goldman presented Grand Rounds at Baylor College of Medicine on “Persistent Bioaccumulative Chemicals in the Environment as Neurotoxins.” Later that morning, symposium participants had the opportunity to take a tour of Houston’s “good, bad and ugly” environmental sites – from the wonderful School of Nursing building, LEED certified for its environmentally-friendly features, to the 5th Ward MDI Superfund site, is one of 16 National Priority Listing Superfund sites in the region.

Symposium program director Winifred Hamilton, PhD, SM, assistant professor, Departments of Medicine and Neurosurgery, Baylor College of Medicine, said she was surprised and pleased with the interest in the program. Registration was higher than expected with 140 participants.