Dr. Catherine Karr — Toxicologist — Pesticide Activist — "PAY-SUE" PEHSU — NCAMP —

Published: Wednesday, May 5, 2010

Where the Environment and Children’s Health Come Together at the UW

By Lisa Stiffler
Worried about chemicals leaching out of your toddler’s sippy cup? Troubled over reports that your child’s rubber ducky is laced with toxics? Dr. Catherine Karr is here to help.

Karr is the director of the Northwest Pediatric Environmental Health Specialty Unit, an organization of environmental health experts standing ready to advise doctors and parents concerned about children’s exposure to potentially toxic chemicals.

The University of Washington-based unit answers questions about things like the risks of lead exposure, the effects of pesticides on kids and ways to reduce asthma. The group includes seven doctors, scientists and healthcare providers focused on the intersection of the environment and children’s health.

“We recognize the special vulnerability of children,” Karr said. “Kids are not little adults.”

Children are uniquely at risk when it comes to toxics. Organs begin developing in the fetus, and the lungs, brain and immune system in particular continue their development for many years after birth. Children eat, drink and breathe more for their size relative to an adult. Their metabolism is faster, and their physiology is different. If a child consumes lead, for example, 50 percent of it will be absorbed, while an adult will absorb 10 percent. They simply interact differently with the environment, rolling around and putting their hands and countless other items straight into their mouths.

Part of a National Focus

The UW’s Pediatric Environmental Health Specialty Unit (or PEHSU) was one of the first two units opened in 1998 as part of the national Association of Occupational and Environmental Clinics. Previously, the organization had worked on adult exposures at heavily polluted Superfund sites. In the 1990s, people began to recognize the need for pediatric specialists and the PEHSU (pronounced “pay-sue”) program was born.

Some doctors were hesitant to embrace the new green-tinged specialty.

“They were asking, ‘What was this environmental thing?’” said Katherine Kirkland, executive director of the Association of Occupational and Environmental Clinics in Washington, D.C. “It was understandable. There’s some bad science out there. It’s taken a while to get accepted.”
There are now 10 U.S. PEHSUs, one in Canada and one in Mexico. They’re funded through the federal government, with added support from the universities and institutions that partner with the units. The Northwest PEHSU serves Washington, Oregon, Idaho and Alaska.

Environmental pediatrics, while still not an officially sanctioned medical specialty, now is widely accepted in the medical community. Even the august American Academy of Pediatrics has partnered with PEHSU in outreach efforts.

“They’re definitely on board with us now,” Kirkland said.

Green Advice Backed by Science

The PEHSU program earned its quick acceptance thanks to its rigorous adherence to scientifically-sound advice. In fact, Karr and many of the other doctors in the Northwest unit do their own research.

Karr is an expert in pollution-caused respiratory disease and pesticide-related health issues. She recently published a study that found that babies exposed to higher levels of car and truck exhaust, wood smoke and industrial air pollutants had an increased rate of bronchiolitis, a form of respiratory disease seen in young children.

A study published in February that was co-authored by Karr found higher rates of asthma in children who were exposed to air pollution while still in their mother’s womb and during the first year after their birth.

Dr. Sheela Sathyanarayana, another doctor with the Northwest PEHSU, captured news headlines two years ago with her reports on phthalates and babies. Phthalates are a family of man-made chemicals that are added to countless consumer products to make plastics softer and fragrances longer lasting. Sathyanarayana, who holds positions at the UW and Seattle Children’s, found phthalates in the urine of babies after using baby shampoos, powders and lotions. The chemical is known to disrupt development and reproduction in animal studies.

In her current research, Sathyanarayana is studying the use of phthalate-containing IV tubes and bags in hospitals, and how their use can alter infants’ reproductive hormones and other health indicators.

Begin With the Basics

Sathyanarayana’s expertise is in endocrine-disrupting chemicals – phthalates, bisphenol A (or BPA) and chemical flame retardants. This motley crew can target processes in the body responsible for behavior, fertility and cancer, and the chemicals are found everywhere. But when she’s working with patients concerned about environmental health, Sathyanarayana begins with the basics.

Keeping a home clean and well ventilated is “what truly makes a safe environmental home,” she said. “There are really easy steps that people can take that they don’t know about.”

That includes reducing mold exposure by using a bathroom fan with every shower and by eliminating sources of moisture. She instructs people to vacuum carpets thoroughly and limit exposure to dust, which carries allergy-triggering dust mites and can also be an exposure route for flame retardants and other pollutants.

The PEHSU educates the public via fact sheets on the main Web site and hosts trainings for healthcare professionals.

The Northwest PEHSU also regularly takes calls from pediatricians and parents seeking advice. And the demand is rising. The number of consultations has approximately tripled locally over the past five years, Karr said. Funding for the program, however, hasn’t kept pace and there’s a shortage of support for environmental health research that’s specific to children, the experts said.

Karr and Sathyanarayana also hope that government regulations will start to catch up with the research showing that many of these chemicals are being measured in the blood and tissues of children and adults. New rules are being passed to ban certain uses of endocrine disruptors; Washington lawmakers this year passed a rule prohibiting the use of BPA in baby bottles and sippy cups, food and drink containers used by children under three, and sports bottles.
At the same time, both doctors warn that parents shouldn’t become frantic trying to eliminate their children’s chemical exposure.

“There is no such thing as zero exposure in our industrialized society,” Sathyanarayana said.

Additionally, just because someone is exposed to a toxic chemical, it doesn’t guarantee that they’ll be harmed. Genetics and the combination of exposures both play a role, as does the general environment in which a baby or child is living. A happy home can be the best antidote.

“Being a thoughtful parent, you can do a lot to ensure your kid’s health,” Karr said. “It’s not just the chemicals.”

Lisa Stiffler is a Seattle-based environmental writer and mother.


Seattle’s Child Magazine: Where the Environment and Children’s Health Come Together at the UW.