The role of the pediatrician since the September 11, 2001 terrorist attacks has changed in some respects. Prior to that the pediatrician was concerned about keeping a healthy child healthy, and diagnosing the cause of an illness and making the child healthy again. Most of the illness problems appeared to revolve around bacterial and viral infections, although some of the concerns were about chemicals and injuries. Now there has been a dramatic increase in concern from parents, the community, and society at large about the potential for acute and long-term problems related to environmental conditions in homes, schools, recreational areas, occupational areas, the outside environment, the indoor environment, and terrorism. In a special study, 86% of a group of pediatricians reported that their medical training had not prepared them sufficiently to deal with problems of the environment or terrorism.
Clinicians, through the use of self-administered environmental investigation forms and nurse evaluation forms, should consider the potential for environmental conditions causing the observed symptoms. For instance, seizures can be the result of lead poisoning or carbon monoxide intoxication, learning disabilities can be caused by intrauterine alcohol exposure or lead intoxication, eczema can be aggravated by solvents, etc. The clinician should determine if symptoms subside or worsen in a particular location, during weekdays or weekends, at a special time of the day or during certain activities, and are other children associating with the child having the same symptoms. The clinician should determine if there are clusters of cases of the symptoms and work with local public health authorities and the Centers for Disease Control and Prevention (CDC) to share knowledge and gain more information about the specific problem. Parental occupational exposure to environmental factors, which may cause the symptoms experienced by the children, should always be investigated and evaluated.
The American Academy of Pediatrics and local chapters are emphasizing the extreme importance of the community in pediatric practice. This perspective enlarges the pediatrician’s focus from one child to all children in the community and includes the many problems related to the environment. There is an understanding that many factors affect the health of children including the family and social, political, cultural, economic, and environmental forces. In order to truly help the child, the pediatrician needs to combine good clinical practice with public health principles and work with the family, school, and community. There are many resources that need to be accessed and utilized appropriately.
To better prepare the pediatrician for his/her new role, it has been recommended by the American Academy of Pediatrics and local chapters that these doctors receive training and utilize information in the following areas:
- 1. Utilize epidemiological, demographic, and economic data to better understand the effects of poor health and social risks on child outcomes.
- 2. Work with public health departments and colleagues in other professions to identify and decrease barriers to the health and well-being of children.
- 3. Interact with childcare facilities, schools, and youth programs to help them understand how they affect child health.
- 4. Help provide health care for all children in the community (unfortunately politics in certain state and local areas have interfered with the care for all children).
- 5. Utilize community resources to promote good health.
- 6. Educate residents and medical students in community settings.
- 7. Learn about environmental concerns and children’s health and implement a program of environmental history taking within the office.
- 8. Educate parents about environmental problems and how they affect the health of their children.