Çevre ve çocuk sağlığı

Çocuklar küçük yetişkinler olarak düşünülmemelidirler. Doku ve organ sistemleri hızlı büyüme, gelişme ve farklılaşma göstermektedir. Çocukların alışılmadık tüketme ve çevresel kaynaklı kimyasal maddelere maruz kalma özellikleri olmakla birlikte, yetişkinlerden oldukça farklı konularda duyarlılıkları vardır. Çevresel etkenlerle karşılaşma yollarında, bu etkenlerin vücuda emilim şekillerinde, sonrasında dokulara dağılımlarında, kimyasal maddeleri vücuttan elimine etme yeteneklerinde, kimyasal ve radyoaktif maddelere verdikleri yanıtlarda farklılıklar mevcuttur. Bu farklılıklar çocuğun gelişim evresindeki yerine göre de değişkenlik gösterir. Çevrenin çocuk üzerindeki etkileri konusundaki bilgilerimiz hızla artmakla birlikte halen yetersizdir. Çocuklar, evler, okullar, diğer binalar, bahçeler, gıda maddeleri ve kontamine sular, tarımsal uygulamalar, iş ortamlarında toksinlerle temas eden ebeveynlerin kıyafetleri aracılığıyla potansiyel karsinojenik etkisi olan çeşitli kimyasal maddelere maruz kalmaktadırlar. Kurşun, metil civa, arsenik gibi kimyasal maddeler, elektromanyetik alanlar, iyonize radyasyon, televizyon, gürültü ve oyuncaklarla etkileşim sonrası oluşabilecek bedensel ve zihinsel birçok sağlık problemi de bu makalede tartışılmıştır. Çocukların çevresel etkenlere karşı korunması modern toplumun önde gelen sorunlarından bir tanesidir. Çocuk sağlığını koruma amaçlı yapılacak çevresel düzenlemelerde çocuk hekimlerinin katkısı gerekmektedir. Bu makalede önemli bazı çevresel faktörlerin sağlık üzerine etkilerinden söz edilmiş ve bu faktörlere etkili tıbbi önlemler oluşturabilmek için yapılması gerekenlere kısaca değinilmiştir. Çocukların bu çevresel etkenlerle temasının azaltılabilmesi için çaba gösterilmeye devam edilmelidir.

Anahtar Kelimeler:

Çocuk sıhhati, Çevre sağlığı, Süt çocuğu

Environment and child health

Children cannot be considered "little adults". Their tissues and organs are rapidly growing, developing and differentiating. Children have unusual patterns of consumption and exposure to environmental chemicals, and they have vulnerabilities that are quite distinct from those of adults. There are differences in exposures, pathways of absorption, tissue distribution, ability to eliminate chemicals from the body, and responses to chemicals and radiation. The differences vary with the developmental stages of the child. Knowledge, although rapidly increasing, is still incomplete regarding the impact of the environment on children. Children are exposed to potentially carcinogenic toxins in houses, schools, other buildings, lawns and gardens, through food and contaminated drinking water, from agricultural application drift and from carry-home exposure of parents occupationally exposed to toxins. Many mental and physical health risks for children exposed to environmental chemicals such as lead, methyl mercury and arsenic, to electromagnetic fields, ionized radiation, television, noise and toys are also discussed in this article. The protection of children against environmental hazards is a major challenge to modern society. Altering the environment to protect the health of children requires pediatrician intervention. This article presents the health effects of some of the more important environmental factors and outlines requirements for effective medical response to these events. We conclude that efforts should continue to reduce childhood exposure.

Keywords:

Child Welfare, Environmental Health, Infant,

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1. Landrigan PJ, Schecter CB, Lipton JM, Fahs MC, Schwartz J. Environmental pollutants and disease in American children. Environ Health Perspect 2002; 110:721-8.
2. Lanphear BP, Bearar CF. Biomarkers in pediatric research and practice. Arch Dis Child 2005; 90:594-600.
3. Ursitti F, Vanderlinden L, Watson R, Campbell M. Assessing and managing exposure from arsenic in CCA-treated wood play structures. Can J Public Health 2004; 95:429-33.
4. Kwon E, Zhang H, Wang Z, Jhangri GS, Lu X, Fok N, et al. Arsenic on the hands of children after playing in playgrounds. Environ Health Perspect 2004; 112:1375-80.
5. Lagerkvist BJ, Bernard A, Blomberg A, Bergstrom E, Forsberg B, Holmstrom K, et al. Pulmonary epithelial integrity in children: relationship to ambient ozone exposure and swimming pool attendance. Environ Health Perspect 2004; 112:1768-71.
6. Schuz J, Kaatsch P, Kaletsch U, Meinert R, Michaelis J. Association of childhood cancer with factors related to pregnancy and birth. Int J Epidemiol 1999; 28(4):631-639.
7. Jensen CD, Block G, Buffler P, Ma X, Selvin S, Month S. Maternal dietary risk factors in childhood acute lymphoblastic leukemia (United States). Cancer Causes Control 2004; 15:559-70.
8. Shu XO, Perentesis JP, Wen W, Buckley JD, Boyle E, Ross JA, et al. Children's oncology group. Parental exposure to medications and hydrocarbons and ras mutations in children with acute lymphoblastic leukemia: a report from the Children's Oncology Group. Cancer Epidemiol Biomarkers Prev 2004; 13:1230-5.
9. Possible Health Effects of Exposure to Residential Electric and Magnetic Fields. Washington, DC: National Academy Press; 1997.
10. Linet MS, Hatch EE, Kleinerman RA, et al. Residential exposure to magnetic fields and acute lymphoblastıc leukemia in children. N Engl J Med 1997; 337:1-7.
11. Campion EW. Power lines, cancer, and fear. N Engl J Med 1997; 337:44-6.
12. Draper G, Vincent T, Kroll ME, Swanson J. Childhood cancer in relation to distance from high voltage power lines in England and Wales: a case-control study. BMJ 2005; 4:1290.
13. Schmidt CW, Childhood cancer: A growing problem. Environ Health Perspect 1998; 106:18-23.
14. Harvey EB, Boice JD Jr, Honeyman M, Flannery JT. Prenatal x-ray exposure and childhood cancer in twins. N Engl J Med 1985; 312:541-5.
15. Zahm SH, Ward MH. Pesticides and childhood cancer. Environ Health Perspect 1998; 106:893-908.
16. Reynolds P, Von Behren J, Gunier RB, Goldberg DE, Harnly M, Hertz A. Agricultural pesticide use and childhood cancer in California. Epidemiology 2005; 16:93-100.
17. Van Wijngaarden E, Stewart PA, Olshan AF, Savitz DA, Bunin GR. Parental occupational exposure to pesticides and childhood brain cancer. Am J Epidemiol 2003; 157:989-97.
18. Bunin GR, Kuijten RR, Boesel CP, Buckley JD, Meadows AT. Maternal diet and risk of astrocytic glioma in children: a report from the Childrens Cancer Group (United States and Canada). Cancer Causes Control 1994; 5:177-87.
19. Mueller BA, Nielsen SS, Preston-Martin S, Holly EA, Cordier S, Filippini G, et al. Household water source and the risk of childhood brain tumours: results of the SEARCH International Brain Tumor Study. Int J Epidemiol 2004; 33:1209-16.
20. Van Duijn CM, van Steensel-Moll HA, Coebergh JW, van Zanen GE. Risk factors for childhood acute non-lymphocytic leukemia: an association with maternal alcohol consumption during pregnancy? Cancer Epidemiol Biomarkers Prev 1994; 3:457-60.
21. Colley JR, Holland WW, Corkhill RT. Influence of passive smoking and parental phlegm on pneumonia and bronchitis in early childhood. Lancet 1974; 2:1031-4.
22. Fergusson DM, Horwood LJ, Shannon FT. Parental smoking and respiratory illness in infancy. Arch Dis Child 1980; 55:358-61.
23. Sandler DP, Everson RB, Wilcox AJ, Browder JP. Cancer risk in adulthood from early life exposure to parents' smoking. Am J Public Health 1985; 75:487-92.
24. Hofhuis W, et al. Adverse health effects of prenatal and postnatal tobacco smoke exposure on children. Archives of Disease in Childhood 2003; 88:1086-91.
25. Brody DJ, Pirkle JL, Kramer RA, Flegal KM, Matte TD, Gunter EW, et al. Blood lead levels in the US population. Phase 1 of the Third National Health and Nutrition Examination Survey (NHANES III, 1988 to 1991) JAMA 1994; 272:277-83.
26. Bjerre B, Berglund M, Harsbo K, Hellman B. Blood lead concentrations of Swedish preschool children in a community with high lead levels from mine waste in soil and dust. Scand J Work Environ Health 1993; 19:154-61.
27. Gaga EO, Tuncel PE, Tuncel SG. Exposure of school children to Pb and Zn in an industrialized city of Turkey. Fresenius Environ Bull 2002; 11:249-53.
28. Soldin OP, Hanak B, Soldin SJ. Blood lead concentrations in children: New ranges. Clin Chim Acta 2003; 327:109-13.
29. Özden TA, Kılıç A, Vehid HE, Toparlak D, Gökçay G, Saner G. Blood Lead Levels in School Children. Indoor Built Environ 2004; 13:149-54.
30. Özden TA, İşsever H, Gökçay G, Saner G. Longitudinal analyses of blood lead levels and risk factors for lead poisoning in healthy children under two years of age. Indoor Built Environ 2004; 13:303-8.
31. Wilhelm M, Lombeck I, Hafner D, Ohnesorge FK. Hair lead levels in young children from the F.R.G. J Trace Elem Electrolytes Health Dis 1989; 3:165-70.
32. Lekouch N, Sedki A, Bouhouch S, Nejmeddine A, Pineau A, Pihan JC. Trace elements in children's hair, as related exposure in wastewater spreading field of Marrakesh (Morocco). Sci Total Environ 1999; 243:323-28.
33. Winneke G, Lilienthal H, Kramer U. The neurobehavioural toxicology and teratology of lead. Arch Toxicol Suppl 1996; 18:57-70.
34. Markowitz M. Lead poisoning. Pediatr Rev 2000; 21:327-35.
35. Schaffer SJ, Szilagyi PG, Weitzman M. Lead poisoning risk determination in an urban population through the use of a standardized questionnaire. Pediatrics 1994; 93:159-63.
36. Davidson PW et al. Mercury exposure and child development outcomes. Pediatrics 2004; 113:1023-9.
37. American Academy of Pediatrics, Committee on Environmental Health. Noise: A hazard for the fetus and newborn. Pediatrics 1997; 100:724-7.
38. Als H, Lawhon G, Brown E, Gibes R, Duffy FH, McAnulty G, et al. Individualized behavioral and environmental care for the very low birth weight preterm infant at high risk for bronchopulmonary dysplasia; neonatal intensive care unit and developmental outcome. Pediatrics 1986; 78:1123-32.
39. Buehler DM, Als H, Duffy FH, McAnulty GB, Liederman J. Effectiveness of individualized developmental care for low-risk preterm infants: behavioral and electrophysiologic evidence. Pediatrics 1995; 96:923-32.
40. Henkin RI, Knigge KM. Effect of sound on the hypothalamic-pituitary-adrenal axis. Am J Physiol 1963; 204:701-4.
41. Frankenshaeuser M, Lundberg U. Immediate and delayed effects of noise on performance and arousal. Biol Psychol 1974; 2:127-33.
42. Thiessen GJ. Disturbance of sleep by noise. J Acoustic Soc Am 1978; 64:216-22.
43. Rosenberg J. Jets over labrador and quebec: noise effects on human health. CMAJ 1991; 144:869-75.
44. Salford LG, Brun AE, Eberhardt JL, Malmgren L, Persson BR. Nerve cell damage in mammalian brain after exposure to microwaves from GSM mobile phones. Environ Health Perspect 2003; 111:881-3.
45. Brenner DJ, Elliston CD, Hall EJ, Berdon W. Estimated risks of radiation-induced fatal cancer from pediatric CT. Am J Roentgenol 2001; 28:2387-8.
46. Dalrymple GV, Goulden ME, Kollmorgen GM, Vogel H. Medical Radiation Biology. Philadelphia: WB Saunders; 1973: 235.
47. Martin A, Harbison S. An Introduction to Radiation Protection. London: Science Paperbacks; 1972: 41.
48. Ohno H, Suzuki M, Aoyama T, Mitani K. [Determination of organotin compounds in polyvinyl chloride toys] Shokuhin Eiseigaku Zasshi 2003; 44:208-12.
49. Marin ML, Lopez J, Sanchez A, Vilaplana J, Jimenez A. Analysis of potentially toxic phthalate plasticizers used in toy manufacturing. Bull Environ Contam Toxicol 1998; 60:68-73.
50. Dhanya CR, Gayathri NS, Mithra K, Nair KV, Kurup PA. Vitamin E prevents deleterious effects of di (2-ethyl hexyl) phthalate, a plasticizer used in PVC blood storage bags. Indian J Exp Biol 2004; 42:871-5.
51. Kluwe WM, Haseman JK, Douglas JF, Huff JE. The carcinogenicity of dietary di(2- ethylhexyl) phthalate (DEHP) in Fischer 344 rats and B6C3F1 mice. J Toxicol Environ Health 1982; 10:797-815.
52. Tickner JA, Schettler T, Guidotti T, McCally M, Rossi M. Health risks posed by use of Di-2-ethylhexyl phthalate (DEHP) in PVC medical devices: A critical review. Am J Ind Med 2001; 39:100-1.
53. Owens J, Maxim R, McGuinn M, Nobile C, Msall M, Alario A. Television-viewing habits and sleep disturbance in school children. Pediatrics 1999; 104:27.
54. Bernard-Bonnin AC, Gilbert S, Rousseau E, Masson P, Maheux B. Television and the 3- to 10-year-old child. Pediatrics 1991; 88:48-54.
55. Lowry DT, Nio JTC, Leitner DW. Setting the public fear agenda: longitudinal analysis of network TV crime reporting, public perceptions of crime, and FBI crime statistics. J Commun 2003; 53:61-73.
56. Singer MI, Miller DB, Guo Shenyang, Flannery DJ, FriersonT, Slovak K. Contributors to violent behavior among elementary and middle school children. Pediatrics 1999; 104:878-84.
57. Redlener I, Grant R. The 9/11 terror attacks: Emotional consequences persist for children. Contemp Pediatr 2002; 4:1-26.
58. Walma van der Molen JH, Valkenburg PM, Peeters AL. Television news and fear: A child survey. Commun Eur J Commun Res 2002; 27:303-17.
59. Cantor J, Nathanson AI. Children's fright reactions to television news. J Commun 1996; 46:139-52.
60. Boynton-Jarrett R, Thomas TN, Peterson KE, Wiecha J, Sobol AM, Gortmaker SL. Impact of television viewing patterns on fruit and vegetable consumption among adolescents. Pediatrics 2003; 112:1321-6.
61. Maynard M, Gunnell D, Emmett P, Frankel S, Davey Smith G. Fruit, vegetables, and antioxidants in childhood and risk of adult cancer: the Boyd Orr cohort. J Epidemiol Community Health 2003; 57:218-25.