Environmental Issues in Global Pediatric Health: Technical Report.

Pediatricians and pediatric trainees in North America are increasingly involved in caring for children and adolescents in or from low- and middle-income countries (LMICs). In many LMICs, toxic environmental exposures-notably outdoor and household air pollution, water pollution, lead, hazardous waste disposal, pesticides, and other manufactured chemicals-are highly prevalent and account for twice as great a proportion of disease and deaths among young children as in North America. Climate change will likely worsen these exposures. It is important that pediatricians and other pediatric health professionals from high-income countries who plan to work in LMICs be aware of the disproportionately severe impacts of environmental hazards, become knowledgeable about the major toxic threats to children's health in the countries and communities where they will be working, and consider environmental factors in their differential diagnoses. Likewise, pediatricians in high-income countries who care for children and adolescents who have emigrated from LMICs need to be aware that these children may be at elevated risk of diseases caused by past exposures to toxic environmental hazards in their countries of origin as well as ongoing exposures in products such as traditional foods, medications, and cosmetics imported from their original home countries. Because diseases of toxic environmental origin seldom have unique physical signatures, the environmental screening history, supplemented by laboratory testing, is the principal diagnostic tool. The goal of this technical report is to enhance pediatricians' ability to recognize, diagnose, and manage disease caused by hazardous environmental exposures, especially toxic chemical exposures, in all countries and especially in LMICs.