The paediatric environmental history
Recording children's exposure to environmental health threats: A "green page" in the medical record
Children may be exposed to physical, chemical and biological environmental risks during crucial periods of growth and development. Information about these exposures is crucial for improving the quality of care and facilitating surveillance. Furthermore, this information allows the health professional to educate the family, promote prevention, and increase the knowledge-base about environmentally related diseases in children. However, few health care providers are able to include environmental data into the clinical records of children.
How may this problem be solved?
Taking the paediatric environmental history (PEH) allows health care providers to incorporate into the clinical records a description of environmental conditions, behaviors and risk factors relevant to a child's health. For example, about the characteristics of the home/school/playground; potential exposure to pesticides; proximity to waste sites, polluting industries or traffic. Eliciting these together with other information improves the capacity to identify, assess and follow up potentially exposed children at risk and respond with effective measures. It builds the evidence base required for effective interventions and facilitate research. Overall, the PEH taking provides an opportunity for closer interaction between the health professional, the parents and the community.
What is the paediatric environmental history?
A series of basic, concise questions that enables health professionals to identify children’s potential exposure to environmental factors and special vulnerabilities. Some questions are applicable throughout the world but others are more specific and/or tailored to the local situation and population covered. A concise version of the PEH, called the GREEN PAGE is being field-tested and is available together with PEH guidance materials.
Who takes the PEH, where, when and how?
Paediatricians, family doctors, primary health care workers, nurses, residents, medical and nursing students, midwives or other health care providers dealing with infants, children and adolescents. The PEH may be taken on symptomatic or asymptomatic children seen at a medical facility or during a home visit. It follows a harmonized questionnaire, and may require several sessions and updating.
Key areas covered by the PEH
- Potential environmental hazards: physical, biological, chemical (e.g. pesticides, lead, mercury, solvents, UV radiations, …), and their sources.
- Where, how and when are children exposed? – in the home, streets, fields, …, in urban and rural areas; through contaminated water, air, food, soil; high-risk behaviours.
- Effects of exposures in utero, postnatal, in toddlers, infants, school age children and adolescents; clinical or sub clinical effects on organs, systems or functions, and on development.