COMMENTARY

What to Do When a Child Has a Toxic Exposure

Jessica Weiland, MD

Disclosures

July 17, 2017

Editorial Collaboration

Medscape &

I'm Dr Jessica Weiland, a toxicology fellow at the Agency for Toxic Substances and Disease Registry and a practicing physician. I am pleased to join you today as part of the CDC Expert Commentary Series on Medscape. Although taking a thorough environmental exposure history may not be a regular part of your general patient assessment, the rapid and widespread development of industry and its use of newly developed chemicals over recent decades has led to an increasingly contaminated environment.[1] This means that there is a growing need for including an environmental exposure history when doing a patient assessment. The American College of Obstetricians and Gynecologists (ACOG) and the American Academy of Pediatrics (AAP) both recognize the importance of timely and accurate assessment of patient exposures to toxic environmental agents.[2,3] When encountering a patient who may have toxic environmental exposures in your community, there is a free, regionally based national network of experts available to help you: the PEHSU.

PEHSU, the Pediatric Environmental Health Specialty Units, are dedicated to increasing knowledge about environmental medicine among primary care providers and helping to protect children from environmental harm, from conception through childhood. The PEHSU network comprises experts in pediatrics, allergy and immunology, neurodevelopment, toxicology, occupational and environmental medicine, nursing, maternal-fetal medicine, and other specialized areas.

This network service is available without a subscription and is free of charge. The PEHSUs are located in academic medical centers in 12 regional locations to ensure that expert advice on local environmental exposures that your patients may be facing can be provided to meet your needs.

Let's review a common scenario. You're a pediatrician working in a free-standing clinic. A routine screening heelstick of a 12-month-old boy reveals an elevated blood lead level (BLL) of 40 µg/dL. After ordering a confirmatory venous BLL, you begin to anticipate your next steps in management. Referencing the PEHSU website, you find up-to-date recommendations for addressing lead toxicity. You decide to contact your regional PEHSU for further guidance and are connected to a pediatric environmental health specialist to ensure that the child recovers appropriately, and that any sequelae of the poisoning are identified without delay. When the venous testing confirms lead toxicity, you are able to provide a detailed outline of the management plan to the child's parents and ensure that they have the necessary resources to help obtain the best possible outcome.

While this is a fairly common clinical scenario, the PEHSUs form a network that is capable of responding to requests for information throughout North America and offering advice on prevention, diagnosis, management, and treatment of most environmentally related health effects in children.

Many of the environmental risks that can lead to poor health outcomes could be prevented or mitigated by taking an exposure history and providing anticipatory guidance to patients. You, as a provider, are well positioned to deliver the guidance and care needed to protect children and families from environmental threats. With the help of the PEHSU, all clinicians have access to specialized knowledge and guidance that address the pervasive threat of hazardous substances in the environment.

For more information on PEHSU or to request an expert consultation, please visit http://www.pehsu.net.

Web Resources

Agency for Toxic Substances and Disease Registry – Environmental Health and Medicine Education

Agency for Toxic Substances and Disease Registry – Education and Training (CEUs and other tools)

Dr Jessica Weiland has served as a medical toxicology fellow with the Agency for Toxic Substances and Disease Registry and Emory University School of Medicine since 2015, and also practices Emergency Medicine in the Atlanta area.

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