Pediatric Environmental Health 4th Edition xiv background information for clinicians who are faced with providing practical advice to parents and communities. A chapter about environmental health considerations for children in low- and middle-income countries gives pedia- tricians in the United States a glimpse of the array of problems facing children growing up in less-privileged settings. The book is meant to be practical, containing information that is useful in office practice, but that could also be helpful to a clinician preparing a grand rounds presentation for colleagues or providing testimony before a group of state legislators. Throughout the book, we have taken the liberty of combining the contributions of multiple authors in each chapter. Although the fourth edition is 300% longer than the first, there are still many aspects of environmental health that could not be covered. The Council gave priority to those topics that appeared to have the greatest effect on child health or to be of concern to parents. I hope that the information presented in the book will foster an informed understanding of environmental health among those who care for children. For the purpose of this book, our definition of the environment is limited to those topics under the purview of the AAP Council on Environmental Health, which is to advise the AAP Board of Directors regarding protection of the health of the fetus, infant, and child from debilitating or hazardous environ- mental agents. We understand that the environment can be defined much more broadly to include injury prevention and prevention of gun violence. These and other high priority pediatric issues are beyond the scope of the Council on Environmental Health and are not addressed in this book. Parents and guardians of young children are intensely interested in the impact of the environment on their children’s health. They may look to their pediatrician for guidance about how to evaluate news reports about potential hazards in the air, water, and food. Yet the history of such well-established hazards as the exposure of children to secondhand smoke shows many years of epidemiologic and laboratory research before the weight of the evidence compels a consensus. While the evidence is accumulating, what should a worried parent do? Prudently avoid exposure after the first study suggest- ing problems is published? At what point should the pediatrician advocate a specific action? Obviously, there are no easy answers to these questions. Issues of value, scientific understanding, and cost are involved. Each hazardous exposure must be considered in the context of other problems facing the child and the financial, emotional, and intellectual resources available to surmount them. After fully understanding the facts and uncertainties, reasonable pedia- tricians may choose different ways to respond to the accumulating evidence. I have many people to thank for their contributions to this book. First, I am grateful to those who contributed the 33 chapters to the first edition, the 43 00_PEH_ch00_fm_i-xvi.indd 14 10/4/18 2:08 PM
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