Pediatric Environmental Health Section

Question 1

What are some climate related risks for children and youth (6)

Answer 1

Heat and cold related morbidity and mortality
Natural hazards and extreme weather events
Increasing air pollution
Increasingly contaminated water sources
Infection risks associated with insects, ticks and rodents
Stratospheric ozone depletion- increased UV radiation

Question 2

what is the largest global health threat of the 21st century

Answer 2

climate change is the largest global health threat of the 21st century
pollution is the main driver of current climate change effects

Question 3

Who should you consider testing for lead poisoning?

Answer 3

lived in a house <1960 within the last 6 months, especially if water supply is lead piping or original pain
sibling, housemate or playmate with lead poisoning
pica or have eaten paint chips
emigrated from a country where population lead levels are higher
any of the above risk factors and neurodevelopmental disorder

Question 4

what lab investigations should you do for suspected lead exposure (4)

Answer 4

CBC
blood level (venous sample)
ferritin
Calcium, Protein, Albumin

Question 5

what is the gold standard to confirm recent lead exposure

Answer 5

elevated venous blood level

Question 6

what is the half life of lead in red blood cells

Answer 6

45 days
then it is stored in other body tissues
therefore blood lead levels are most useful for recent exposures

Question 7

when should you repeat a level if blood lead level is:
5-14
15-44
>44

Answer 7

5-14: repeat level within 1- 3 months
Perform routine health maintenance, including neurodevelopmental screening, and assess nutrition.
Take a careful PEHH to identify potential sources of exposure
Provide preliminary advice about reducing or eliminating exposure source
Provide nutritional counselling related to calcium and iron
Complete a full neurodevelopmental assessment and follow-up.

15-44: repeat levels in 1-4 weeks
Additional, specific evaluation of the child, such as abdominal x-ray should be considered based on the PEHH.
>44: repeat level within 48 hours, consider hospitalization and/or chelation therapy in consultation with poison control

Question 8

Pediatric environmental health history (PEHH) criteria (5)

Answer 8

HCFOF

Home/Child care/ School- building <1960, lead paints, lead water pipes
Consumer products- costume jewelry, candles, imported painted toys
Food- contains with pewter or ceramic (leaded glaze), wild game shot with lead bullets, imported sugar, candy and baking supplies
Occupation and hobby related- battery manufacturing, welding
Family factors- mother may have been exposure in pregnancy, lived in a place with higher population lead levels

Question 9

what are some signs of acute or subacute lead toxicity

Answer 9

headache, abdominal pain, anemia, constipation, vomiting, clumsiness, somnolence, stupor, renal failure, seizures or possible death.