Pediatric Environmental Health Specialty Units

Pediatric Environmental Health Specialty Units

The Pediatric Environmental Health Specialty Unit (PEHSU) program is a leading national source of medical information and consultative advice on environmental conditions, with emphasis on exposure to hazardous substances in the environment, that influence human health throughout the vulnerable stages of reproduction and pediatric development.

Role of the PEHSUs

The PEHSUs form a network that responds to requests for information throughout the United States (one in each of the federal regions) and offers guidance on prevention, diagnosis, management, and treatment of environmentally-related health effects from preconception through young adulthood.

Environmental hazards effect the health of children and reproductive-age adults in a variety of ways. Therefore, the PEHSU network has experts in pediatrics, allergy/immunology, neurodevelopment, toxicology, occupational and environmental medicine, nursing, reproductive health and other specialized areas.

PEHSUs work with health care professionals, parents, schools, community groups, and others to provide information on protecting children and reproductive-age adults from environmental hazards. They also work with federal, state, and local agencies to address children’s environmental health issues where children live, learn, and play. The basic services of the PEHSU network are: 

  1. Build the capacity of primary care clinicians to recognize environmental exposure risks, provide risk reduction counseling, and deliver patient care to those at risk of acute or chronic exposures to hazardous substances in the environment; 

  2. Integrate environmental health content, placing emphasis on hazardous substances in the environment and related health effects, into pre-service clinical (i.e., medical, nursing, and allied health) course work; and primary care residency programs (i.e., clinicians in pediatrics, family medicine, and obstetrics and gynecology); 

  3. Increase patient and population awareness of environmental exposure risks and ways to reduce those risks; 

  4. Provide education and consultative services to community members, clinicians, state and local health departments, appropriate federal programs, and others involved in protecting children and adults of reproductive age from environmental threats; and

  5. Offer educational and consultative assistance in communities where ATSDR and/or EPA are addressing environmental contamination.   

Why is Reproductive and Children’s Environmental Health a Concern?

Environmental threats can include toxins, pollutants, and natural disasters. These hazards are known to cause adverse health outcomes throughout the human lifespan. Children are particularly vulnerable to the health effects of these hazards due to both their physiological and psychosocial characteristics, including their rapid development and reliance on adults for basic needs. Early environmental exposures are especially detrimental to health and can have lifelong implications. For instance, prenatal exposures to air pollution, pesticides, and other chemicals have been found to cause preterm birth, low birth weight and neurodevelopmental disorders. Environmental risks continue as children grow, including use of e-cigarettes (with exposures to a number of toxicants) in adolescents. Research has demonstrated connections between environmental hazards and health conditions including asthma and childhood obesity. Furthermore, natural disasters such as wildfires, hurricanes, flooding, and volcanic eruptions raise concerns about hazardous exposures related to poor air quality due to inhalation of smoke and toxic fumes, mold, poor water quality, and chemical contamination. Some of the topics that PEHSUs address include:

  • Lead poisoning
  • Pesticide exposures
  • Mercury
  • Water pollution
  • Air pollution
  • Job related exposures in adolescents
  • Volatile Organic Compounds
  • Perfluoroalkyl substances (PFAS)

  • Environmental disasters
  • Exposures to hazardous waste sites
  • Environmentally related asthma
  • Agricultural pollutants
  • Solvents
  • Carbon monoxide
  • Arsenic

PEHSU History

The PEHSU program was created in 1998 by the Agency for Toxic Substances and Disease Registry (ATSDR) and the Environmental Protection Agency (EPA) through Executive Order 13405, "Protection of Children from Environmental Health Risks and Safety Risks,” and the recognition by ATSDR that critical clinical diagnoses related to children and adults had been missed because of clinicians’ lack of familiarity with environmental exposures and how to gather information and make diagnoses and treatment decisions. 

What is AAP’s Role in PEHSU?

The AAP serves as the PEHSU National Program Office (NPO) to support the 10 regional PEHSUs in the US and lead programmatic outreach to increase awareness, utilization, and impact of the program with the goal of reducing environmental exposures and improving health across the lifespan. The NPO also collaborates with other national organizations and programs to partner on common initiatives related to reproductive and children’s environmental health topics. It also manages the national call center, website, National Classroom, and more. 

National Program Office Contacts

Debra Waldron, MD, MPH, FAAP
PEHSU Principal Investigator
AAP Senior Vice President, Healthy & Resilient Children, Youth, & Families

Carl Baum, MD, FAAP, FACMT
PEHSU Medical Director

Trisha M Calabrese, MPH
PEHSU Project Director
AAP Senior Director, Pediatric Population Health

Cassie Bernardi, MPH
PEHSU Program Manager

Isabel Montoya
PEHSU Program Coordinator

How Do I Learn More? 

Additional AAP Resources for Providers

AAP Council on Environmental Health

Pediatric Environmental Health, 4th Edition

Lead Exposure and Lead Poisoning

This material was supported by the American Academy of Pediatrics (AAP) and funded (in part) by the cooperative agreement award number 5 NU61TS000296-02-00 from the Agency for Toxic Substances and Disease Registry (ATSDR).

Acknowledgement: The U.S. Environmental Protection Agency (EPA) supports the PEHSU by providing partial funding to ATSDR under Inter-Agency Agreement number DW-75-95877701. Neither EPA nor ATSDR endorse the purchase of any commercial products or services mentioned in PEHSU publications