Protecting the children.

Media attention to environmental health and safety risks to children is increasing. A recent study suggests that cancer rates in children are increasing at the rate of about one percent a year, a trend that apparently began more than a decade ago. While the study acknowledges that a cause-effect relationship has not been identified, the authors speculate that environmental factors may play a significant role in the increasing rates.

What is unique about children's susceptibility to environmental risks? First, children are sensitive to chemical injury before birth, during the critical stage of organ development and growth. Exposure of the mother usually leads to exposure of the child, through the placenta. After birth, children are at particular risk for environmental exposure to chemicals because their consumption of food, water, and air is, relative to body weight, greater than that of adults. Children in the first six months of life drink seven times more water per pound of body weight than the average adult. Children one to five years of age eat three to four times more food per pound of body weight than the average adult.

Research shows that children's metabolic pathways are immature compared with those of adults and that in the first years of life, organ systems are undergoing rapid development. The result is that children are less able than adults to metabolize and detoxify environmental chemicals. Furthermore, organs like the lungs and nervous system are unable efficiently to repair damage caused by environmental chemicals such as lead and other metals or solvents.

A report released by the Agency for Toxic Substances and Disease Registry (ATSDR), "Healthy Children - Toxic Environments," identifies several chemicals as particularly important to children's health: benzene; lead; mercury; nitrates and nitrites; pesticides; polychlorinated biphenyls (PCBs); trichloroethylene (TCE); and triggers of childhood asthma such as environmental tobacco smoke, ozone, and smog. ATSDR is particularly interested in these chemicals, because many of them are commonly released from uncontrolled hazardous waste sites.

A report by the U.S. Environmental Protection Agency (EPA), "Environmental Health Threats To Children," proposes a national agenda to protect children from environmental health threats. The report makes the following recommendations:

1. Develop a national policy to ensure that EPA standards are protective of children.

2. Expand research opportunities.

3. Establish policies to address cumulative and simultaneous exposures faced by children.

4. Continue the dramatic decreases in emissions of toxic pollutants.

5. Encourage parents, teachers, and community leaders to take personal responsibility for helping protect children at home, school, and play.

6. Expand the work of environmental professionals to identify, prevent, and reduce environmental health threats to children.

7. Provide funding to make children's environmental health issues a top priority in the federal budget.

In the policy arena, several states and Congress have been asked to consider bills addressing children's environmental health protection. It is expected that more such initiatives will be introduced during future legislative sessions.

Children represent an important and sensitive population that deserves priority consideration. The challenge is to develop a sound scientific basis for intervention and the expenditure of resources. Decisions to protect children must also be balanced with the need for resources to address other environmental health issues. It is clear that more research is necessary to confirm suspected connections between environmental hazards and health effects in children. Even without definitive data, however, steps can be taken to improve protection on the basis of public health and prevention concepts like the EPA recommendations listed above.

Specific actions might include reducing the sources of exposure through the use of pollution prevention techniques. Identification of exposure pathways for children can facilitate interventions to reduce the risk of exposure. Increased awareness and education of parents and other care givers, as well as modeling of healthy behaviors by adults (e.g., not smoking), can also reduce risk while more is learned about the specific dangers posed by environmental toxicants.

Risks to children have always been high priorities in public health. For the foreseeable future, however, a new emphasis on chemicals in the environment and the risk to children is likely to be prominent on the agendas of agencies such as the Centers for Disease Control and Prevention, ATSDR, and EPA.