Welcome to our resource page for clinical professionals. These resources include information on specific environmental hazards, emerging issues, and broader programs to protect children and families from environmental exposures.
Our Child Health Specialist Team is lead by Dr. John Moeschler. Dr. Moeschler's team draws on a diverse group of health care providers with specialized expertise in perinatology, pediatrics, immunology, practice-based methods, occupational medicine, reproductive epidemiology, nursing and public health practice. Our Child Heath Specialist Team facilitates and maintains meaningful interactions to reduce adverse child health outcomes related to environmental arsenic exposure, and in conjunction with the Center Director and Associate Director, assures success of our Center.
A major initiative of the Community Outreach and Translation Core is to identify best practices
for integrating important environmental screening into the clinical care setting. Through our partnership with the
Dartmouth CO-OP Project, we are studying how to most effectively include well water testing for arsenic and other
health related contaminants into routine pediatric preventive visits. Participating practices will be provided free
well testing kits for families at well child visits under one year of age, and who use a private well for their drinking water.
Clinical staff will use materials developed by the Children's Center to educate themselves and their patients about the importance
of testing wells for arsenic and what to do if arsenic levels are found to be elevated.
The Dartmouth Primary Care Cooperative Information Project (The Dartmouth CO-OP Project) is a voluntary and cooperative network of nearly 300 primary care practices through out Northern New England. Many of these are rural practices serving populations who rely on private wells for their drinking water and are in regions known to have a greater likelihood of elevated groundwater arsenic levels.
The Agency for Toxic Substances and Disease Registry began to develop pediatric environmental health specialty units (PEHSUs) after noting the scarcity of practitioners
who could evaluate and manage children with exposures to environmental health hazards. The Environmental Protection Agency subsequently joined in providing support
for what has developed into a network of 13 PEHSUs in North America.
PEHSUs provide services to families, act as consultants to clinicians and public agencies, develop educational materials, and respond to natural disasters, including hurricanes and wildfires.
Links to PEHSUs in North America.
Abstract: Drinking water for approximately one sixth of US households is obtained from private wells. These wells can become contaminated by pollutant chemicals or pathogenic organisms, leading to significant illness. Although the US Environmental Protection Agency and all states offer guidance for construction, maintenance, and testing of private wells, there is little regulation, and with few exceptions, well owners are responsible for their own wells. Children may also drink well water at child care or when traveling. Illness resulting from children's ingestion of contaminated water can be severe. This report reviews relevant aspects of groundwater and wells; describes the common chemical and microbiologic contaminants; gives an algorithm with recommendations for inspection, testing, and remediation for wells providing drinking water for children; reviews the definitions and uses of various bottled waters; provides current estimates of costs for well testing; and provides federal, national, state, and, where appropriate, tribal contacts for more information. Link to full statement
Abstract: The US market for organic foods has grown from $3.5 billion in 1996 to $28.6 billion in 2010, according to the Organic Trade Association. Organic products are now sold in specialty stores and conventional supermarkets. Organic products contain numerous marketing claims and terms, only some of which are standardized and regulated. In terms of health advantages, organic diets have been convincingly demonstrated to expose consumers to fewer pesticides associated with human disease. Organic farming has been demonstrated to have less environmental impact than conventional approaches. This clinical report reviews the health and environmental issues related to organic food production and consumption. It defines the term 'organic,' reviews organic food-labeling standards, describes organic and conventional farming practices, and explores the cost and environmental implications of organic production techniques. It examines the evidence available on nutritional quality and production contaminants in conventionally produced and organic foods. Finally, this report provides guidance for pediatricians to assist them in advising their patients regarding organic and conventionally produced food choices. Link to full statement
Abstract: Pesticides are a collective term for a wide array of chemicals intended to kill unwanted insects, plants, molds, and rodents. Food, water, and treatment in the home, yard, and school are all potential sources of children’s exposure. Exposures to pesticides may be overt or subacute, and effects range from acute to chronic toxicity. In 2008, pesticides were the ninth most common substance reported to poison control centers, and approximately 45% of all reports of pesticide poisoning were for children. Organophosphate and carbamate poisoning are perhaps the most widely known acute poisoning syndromes, can be diagnosed by depressed red blood cell cholinesterase levels, and have available antidotal therapy. However, numerous other pesticides that may cause acute toxicity, such as pyrethroid and neonicotinoid insecticides, herbicides, fungicides, and rodenticides, also have specific toxic effects; recognition of these effects may help identify acute exposures. Evidence is increasingly emerging about chronic health implications from both acute and chronic exposure. A growing body of epidemiological evidence demonstrates associations between parental use of pesticides, particularly insecticides, with acute lymphocytic leukemia and brain tumors. Prenatal, household, and occupational exposures (maternal and paternal) appear to be the largest risks. Prospective cohort studies link early-life exposure to organophosphates and organochlorine pesticides (primarily DDT) with adverse effects on neurodevelopment and behavior. Among the findings associated with increased pesticide levels are poorer mental development by using the Bayley index and increased scores on measures assessing pervasive developmental disorder, inattention, and attention-deficit/hyperactivity disorder. Related animal toxicology studies provide supportive biological plausibility for these findings. Additional data suggest that there may also be an association between parental pesticide use and adverse birth outcomes including physical birth defects, low birth weight, and fetal death, although the data are less robust than for cancer and neurodevelopmental effects. Children's exposures to pesticides should be limited as much as possible. Link to full statement
The Toolkit is a combination of easy-to-use reference guides for health providers and user-friendly health education materials on preventing exposures to toxic chemicals and other substances that affect infant and child health. The materials are visually appealing, practical and easy to use. The Toolkit is endorsed by the American Academy of Pediatrics (AAP). The Greater Boston and San Francisco Bay Area chapters of Physicians for Social Responsibility (GBPSR), in partnership with the Pediatric Environmental Health Specialty Unit at the University of California, San Francisco, and a team of pediatricians from around the country, developed the Pediatric Environmental Health Toolkit. The Toolkit fills the need for environmental health education and information. http://www.psr.org/resources/pediatric-toolkit.html
The NH Department of Health and Human Services (NH DHHS) has provided voluntary blood testing for perfluorochemicals (PFCs) to adults and children who may have consumed water at the Pease Tradeport, a former Air Force Base in the Portsmouth, NH region where well contamination with PFC’s was detected in 2014. In June 2015, results of these blood tests are being provided to those tested and this may prompt questions to regional health care providers. Perfluorochemicals (PFCs) are a group of man made chemicals found in a large number of consumer and industrial products. Their chemical structure enables them to persist in the environment. At this time, there is limited data on human health effects of exposure to PFCs. Complete information about this investigation and the testing program can be accessed from this link. Specific resources for providers, including a webinar regarding how to interpret lab reports are listed here. http://www.dhhs.nh.gov/dphs/investigation-pease.htm