Pediatric Environmental Health Questionnaire

The Pediatric Environmental Health Questionnaire is a tool for practitioners and parents to aid in the assessment regarding which children may be at greatest risk from harm due to environmental toxicants. This simplified format is not meant to be all-inclusive, but a screening aid for those that care for children to not only identify at-risk kids, but to create awareness regarding a prominent and overlooked contributor to chronic health issues.

The Top Ten Toxics are a compilation of the most likely sources of childhood environmental toxicants.

The most important component in childhood toxicity is to reduce the toxic load. Children by nature of their size, communication style (i.e., hand-to-mouth) and detoxification abilities have increased susceptibility and toxicity from exposures far greater as compared to adults. How to translate these factors into clinical practice recommendations are addressed at the end of the caretaker survey.

There are 10 questions that caretakers should complete prior to any clinical evaluation. The most prescient questions are posed in order to simplify the process, yet glean the most relevant information.

The following are indicators of children that are at risk to health issues from toxicants:

The child has been exposed to a significant amount of chemicals throughout pregnancy.
The child is not able to get rid of chemicals because of nutritional deficiencies and/or genetic factors.
The child has an allergic-type reaction to something in their environment.

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1. Indicators of Poor Metabolizers

Does your child experience symptoms from environmental allergens: Cigarettes, dust, pollen, mold, etc.?

Yes

No

2. Allergens

Does your child develop any of the following symptoms when exposed to specific foods/food groups: Stuffy nose, cough, wheezing, rashes, tummy complaints, mood changes/difficulty concentrating?

Yes

No

3. Solvents

Does your child have exposures to the following types of chemicals: Dry cleaning, attached garage, wood stove, busy streets, hobbies with chemicals, home remodeling, standard cleaning products, etc.?

Yes

No

4. Pesticides

Does you child have exposures from any of the following: Conventional diet, US public school meals, golf courses, vineyards, farms, pets treated with chemicals, etc.?

Yes

No

5. Metals

Does you child have any of the following types of exposures: Broken mercury thermometer, fluorescent bulbs, silver amalgams, fish consumption, live in an old home built before 1978, etc.?

Yes

No

6. Mold

Has your child been exposed to any of the following: Visible mold at home or school, water damage at home or school, sick from central air or heat, etc.?

Yes

No

7. Plastics

Does your child have exposures to any of the following: Eat canned/plastic-wrapped food (microwaved), plastic orthodontic devices, use plastic water bottles/ pacifier, etc.?

Yes

No

7. Personal Care Products

Is your child exposed to any of the following personal care products: Fabric softener sheets, fluoridated toothpaste, scented products, hair products/dyes, make- up, sunblock, etc.?

Yes

No

9. Persistent Organic Pollutants (POPS)

Has your child been exposed to any of the following: Dump or Super Fund site, industrial plant, non-stick cookware (Teflon), flame retardants (pajamas), etc.?

Yes

No

10. Electromagnetic Frequencies (EMFs)

Has your child been exposed to any of the following at home or school: Power stations, Smart Meters, cell towers, dimmer switches, wifi/router, cell phone, Alexa-type voice assistant, smart watch, baby monitors, etc.

Yes

No

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Upon submitting, by email you will receive the top 10 health recommendations for optimizing your children’s health.

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