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Key Concepts

Pediatricians and other child health care providers need the expertise necessary to

  • deliver anticipatory guidance to prevent childhood exposures,
  • take a relevant environmental history when necessary,
  • include environmental factors in differential diagnoses,
  • conduct appropriate risk-based laboratory tests for environmental illnesses, and
  • refer patients for workup of pediatric illnesses related to environmental factors.
About This and Other Case Studies in Environmental Medicine

This educational case study document is one in a series of self-instructional publications designed to increase the primary care provider’s knowledge of hazardous substances in the environment and to promote the adoption of medical practices that aid in the evaluation and care of potentially exposed patients. The complete series of Case Studies in Environmental Medicine is located on the ATSDR Web site at URL: In addition, the downloadable PDF [866 KB] version of this educational series and other environmental medicine materials provide content in an electronic, printable format. This may be useful for persons with slower Internet service.


We gratefully acknowledge the work of the medical writers, editors, and reviewers in producing this educational resource. Contributors to this version of the Case Study in Environmental Medicine are listed below.

Please Note: Each content expert for this case study has indicated that there is no conflict of interest that would bias the case study content.

CDC/ATSDR Developer(s): Pamela G. Tucker, M.D.

CDC/ATSDR Planners: Charlton Coles, Ph.D.; John Doyle, MPA; Kimberly Gehle, M.D.; Sharon L. Hall, Ph.D.; Michael Hatcher, DrPH; Ronald T. Jolly; Barbara M. Riley, RN; Delene Roberts, MSA; Brian Tencza, BS, MEd.

CDC/ATSDR Commenters: Mark Anderson, MD; Ketna Mistry, MD

Contributors: Sophie Balk, MD; Cynthia Bearer, MD

Peer Reviewers: Rose Goldman, MD; Alan Woolf, MD

Disclaimer and Disclosure


The state of knowledge regarding the treatment of patients potentially exposed to hazardous substances in the environment is constantly evolving and is often uncertain. In developing its educational products ATSDR has made a diligent effort to ensure the accuracy and the currency of the presented information. ATSDR, however, makes no claim that the environmental medicine and health education resources discussed in these products comprehensively address all possible situations related to various substances. The products are intended for educational use to build the knowledge of physicians and other health professionals in assessing the conditions and managing the treatment of patients potentially exposed to hazardous substances. The products are not a substitute for a health-care provider’s professional judgment. Please interpret the environmental medicine and the health education resources in light of specific information regarding the patient and in conjunction with other medical authorities. Use of trade names in ATSDR products is for identification purposes only and does not imply endorsement by the Agency for Toxic Substances and Disease Registry or the U.S. Department of Health and Human Services.

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U.S. Department of Health and Human Services
Agency for Toxic Substances and Disease Registry
Division of Toxicology and Human Health Sciences
Environmental Medicine Branch