San Francisco Bay Area PSR teamed up with sister chapter Greater Boston PSR to develop an exciting, new clinical tool for pediatric and family care practices that provides comprehensive information about preventing exposures to toxic chemicals. The Pediatric Environmental Health Toolkit, which has been officially endorsed by the American Academy of Pediatrics (AAP), includes laminated desk and pocket reference guides for providers, patient handouts including “Prescription for Prevention” sheets and refrigerator magnets, and two colorful, bilingual Toolkit posters for clinics and exam rooms.

We are pleased to have a distinguished group of pediatricians involved in the planning and development group. They include Guenter Hofstadler, MD, and Brian Linde, MD, who drafted the initial guidelines, and Mark Miller, MD, MPH, Lisa Asta, MD, Siobhan McNally, MD, and David Wallinga, MD, who participated in revising and editing and helped oversee the pilot testing of the materials. SF Bay Area PSR’s Program Associate Lucia Sayre, MA, is another key player, with Maria Valenti and Michelle Gottlieb, MEM, of GB PSR leading the East Coast team.

Parents, Providers Concerned About Kids Environmental Health

Pediatric Environmental Health is a relatively new field prompted by concerns about such things as pesticide residues on foods, mercury in fish, and arsenic in drinking water and on play structures. Yet, numerous providers have hardly heard of it.  Studies have shown few environmental histories are taken, and that less than one-in-five pediatricians reports having received training in environmental history-taking even though they strongly believe in the importance of environmental exposures in children’s health. The issue is a high priority with parents. In a recent paper written by Dr. Sophie Balk, outgoing chair of the American Academy of Pediatrics environment committee and editor of the AAP “Green Book” for pediatricians, “…environmental exposures are among parents’ top concerns for their children.” This interest in environment and health issues has also been demonstrated through GB PSR’s In Harm’s Way trainings for health professionals. Pediatricians have regularly comprised the largest fraction of physician attendees at conferences.

Using “Teachable Moments” During Well-Child Visits

Initial assessment of need for the Toolkit was conducted by surveying participants at In Harm’s Way Trainings. Follow-up discussions with practicing pediatricians, and the organization of a pediatric planning group, led us to begin considering the optimum framework for the type of succinct, easily accessible reference materials the physicians told us they wanted. Noted pediatrician T. Berry Brazelton’s Touchpoints concept was mentioned repeatedly as a model that could work for the materials, which we began to think of as a multi-part environmental health “toolkit” for both providers and patients.

The beauty of the Touchpoints program is that it makes it quite easy for the practitioner to impart environmental health information during “teachable moments” with patients.

Toolkit Materials

The following items are in the Toolkit and are available
to download:

For Providers:

    • A summary of children’s unique susceptibilities to toxic substances
    • Brief summaries of major toxicants and their potential health effects
  • A two-sided, laminated pocket reference card containing priority anticipatory guidance keyed to specific developmental stages to use during well-child visits.
  • A two-sided, laminated Environmental Health Reference Card:
    • Brief descriptions of environmental toxins
    • Health effects summaries of those toxins
    • Sources and routes of exposure information
    • Prevention strategies
  • Two colorful posters in English and Spanish for clinic and exam rooms that highlight environmental health issues in a child’s indoor and outdoor environments.

For Patients and Their Families:

Additional Resources for Families

Pediatric Environmental Health Toolkit Trainings:
A Clinical Resource for Practitioners

A series of trainings to introduce pediatric providers to the Toolkit are happening around the country in the next six months. Please visit Greater Boston PSR’s website for more information about upcoming trainings at

For more information about our Toolkit work in California, please contact SF Bay Area PSR’s Lucia Sayre at