Pediatric Environmental Home Assessment - Background on Indoor Pollutants

Between damp indoor environments and upper respiratory (nasal and throat) tract symptoms, coughing, wheezing and asthma symptoms in sensitized persons.

Between presence of mold or other agents in damp indoor environments and upper respiratory (nasal and throat) tract symptoms, coughing, wheezing, and hypersensitivity pneumonitis in susceptible persons.

Therefore, it is important to identify mold, moisture and damp indoor spaces in the resident's home, especially if the resident has respiratory problems. Things to look for:

Use of dehumidifier. A dehumidifier is an excellent way to remove moisture from the air. However, it does not fix the source of the moisture. The source of moisture may be creating mold, attracting pests, allowing dust mites to grow and damaging the home. Use it as a clue that there is a moisture problem. Ask the resident.
Use of vaporizer or humidifier. Many people find that dry air, especially in the winter, is uncomfortable and may irritate their respiratory system. Some doctors recommend it when in a young child's bedroom to reduce coughing. If the humidifier measures the humidity in the air and only adds enough to keep the humidity less than 60%, they are helpful. However, if the humidifier - like some low-cost vaporizers - simply sprays water in the air until the water is gone, it poses a serious threat especially to a child. The high humidity will allow dust mites to grow, attract insects and mice, and deteriorate paint. It must go. In addition, the humidifier water or the sponge in it can be a source of mold.
Musty odor. Usually a musty odor is a sign of a mold problem. But the mold may be hidden in a crawlspace, basement, attic, or behind the walls. If it smells like sewage, check the floor drains. The water trap may be dry. Just add water to block the sewer gas smell.
Visible water / mold damage. This is a serious problem that must be cleaned. The key is to stop the source of the moisture and remove the physically mold with detergent.

A moisture meter is a simple to use and valuable tool to identify moisture problems.

Key Resources: EPA - www.epa.gov/mold/index.html and CDC - www.cdc.gov/mold/dampness_facts.htm.

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Pets - Keep It Clean Module

According to a 2000 Institute of Medicine Report, there is sufficient evidence of a casual relationship between cats and exacerbation of asthma in sensitive individuals. A person is likely to be sensitized if the person was exposed either none or high levels of cat dander when young. For dogs, there is sufficient evidence of an association but not a casual relationship with exacerbation of asthma in sensitive individuals.

Controlling pet dander is not easy. Getting rid of the pet is unpopular. If the resident must have a cat or a dog, the best approach is keep the pet outside. If the pet needs to be inside, keep the pet outside of the child's bedroom and clean up the pet dander in all rooms regularly with a vacuum with a High-Efficiency Particulate Air (HEPA) filter. Carpeting is especially hard to clean.

Key Resource: CDC - www.cdc.gov/healthypets/petweek.htm.

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Pests - Keep It Pest-Free Module

According to a 2000 Institute of Medicine Report, there is sufficient evidence of a casual relationship between:

House dust mites and both the development of asthma and the exacerbation of asthma.
Cockroaches and exacerbation of asthma.

Key Resources: CDC - www.cdc.gov/nceh/publications/books/housing/cha04.htm and EPA - www.epa.gov/pesticides/controlling/

Cockroaches: The 2005 American Housing Survey does not report on the presence of cockroaches and insects. The U.S. Census Bureau will add that in the future because of the health threat posed by cockroaches. Cockroaches exacerbate asthma, especially in urban children. Urban children are more likely than most to be sensitized to cockroaches. There is increasing evidence that cockroaches may lead to development of asthma. The problem does not disappear when the roaches are gone. Their shells, feces, and urine contain the proteins that cause the problems. Their residue needs to be cleanup up.

Cockroaches do not like the light. So if you or a resident see them, they are either overpopulated or their nest was just disturbed. In this case, there are thousands more unseen in the walls. You will usually only see the brown specs - called frass - they leave behind. Integrated pest management that includes housekeeping, maintenance and the use of baits and boric acid are effective controls. Click here for more information.

When you talk to residents, you may want to ask about water beetles. Some people call them water beetles and the term may be seen as less judgmental.

Mice: According to the 2005 American Housing Survey, 5.6% of all homes had signs of mice in the last three months.. Evidence since the 2000 Institute of Medicine report indicates that mice dander may contribute to exacerbation of asthma. Mice also carry disease. Go to www.cdc.gov/rodents/ for more information.

Rats: According to the 2005 American Housing Survey, 0.8% of homes had signs of rats in the last three months. Rats also carry various diseases and are difficult to control. Go to www.cdc.gov/rodents/ for more information.

Bedbugs: Bedbugs bite people, consume their blood and leave. While they prefer beds but are small and flat enough to hide in small crevices in the floor or furniture. The bite swells and can be locally painful. They are difficult to kill once an infestation starts. A professional is needed to get rid of them.

House Dust Mites: House dust mites are invisible to the eye. They are the only pest known to cause the development of asthma. It also exacerbates asthma. Young children are particularly susceptible. The keys to controlling house dust mites to reduce humidity levels, eliminate carpeting in bedrooms and using allergen impermeable encasings on beds and pillows.

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Lead-Paint Hazards - Keep It Contaminant-Free - Slide 6

According to the Centers for Disease Control, there is no known safe blood lead level. Health effects associated with exposure to lead and lead compounds include, but are not limited to, neurotoxicity, developmental delays, hypertension, impaired hearing acuity, impaired hemoglobin synthesis, and male reproductive impairment. Lead bioaccumulates, and it is difficult to remove from blood and bones. Lead exposure in young children is of particular concern because children absorb lead more readily than adults. Children have a higher risk of exposure because of their more frequent hand-to-mouth behavior. Low levels of lead in a child’s bloodstream can interfere with growth and cause cognitive impairment, permanent hearing and visual impairment, and other damage to the brain and nervous system. The effects of long-term lead exposure or poisoning in children are well documented: Higher school failure rates and reductions in lifetime earnings due to permanent loss of intelligence and increased social pathologies.

Through the 1940’s, paint manufacturers frequently used lead as a primary ingredient in many oil-based interior and exterior house paints. Usage gradually decreased through the 1950’s and 1960’s as titanium dioxide replaced lead and as latex paints became more widely available.

Paint that contains lead can pose a health threat through various routes of exposure. House dust is the most common exposure pathway through which children are exposed to lead paint hazards. Dust created during normal lead-based paint wear (especially around windows and doors) can create an invisible film over surfaces in a house. Children, particularly younger children, may also ingest lead-based paint chips from flaking walls, windows, and doors. Lead from exterior house paint can flake off or leach into the soil around the outside of a home, contaminating children’s play areas. Cleaning and renovation activities may actually increase the threat of lead-based paint exposure by dispersing lead dust particles in the air and over accessible household surfaces. In turn, both adults and children can receive hazardous exposures by inhaling the dust or by ingesting paint-dust during hand-to-mouth activities.

There are extensive regulations regarding lead-based paint in the homes built before 1978. They include:

Defining lead-based paint hazards
Special HUD standards in federally subsidized homes
Disclosure of lead-hazards in property sales and leases
Contractor notice when disturbing more then two square feet of paint
Licensing and training for abatement and other lead-based paint activities.
State and local regulations that go beyond the federal regulations.
Proposed rules affecting most renovation, repair and painting.

If the home is built before 1978 and you see loose, chipping, flaking, cracking, chalking paint on the floor or windows, the home probably has lead-based paint hazards. Work with your state or local childhood lead poisoning prevention program to find out to get the home evaluated by a lead risk assessor. If the resident says that the home was evaluated and either passed or failed, ask for a copy of the paperwork. While repairs may have addressed lead-based paint hazards present at the time, the hazards may have reemerged if the paint was disturbed or the underlying cause of paint deterioration such as moisture damage or friction surfaces remain.

Click here for background information. Check out the following resources

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Asbestos - Keep It Contaminant-Free - Slide 16

Asbestos is the name given to a number of naturally occurring, fibrous silicate minerals mined for their useful properties such as thermal insulation, chemical and thermal stability, and high tensile strength. Asbestos is commonly used as an acoustic insulator, thermal insulation, fire proofing and in other building materials. Many products are in use today that contain asbestos.

Asbestos is made up of microscopic bundles of fibers that may become airborne when asbestos-containing materials are damaged or disturbed. When these fibers get into the air they may be inhaled into the lungs, where they can cause asbestosis, lung cancer and mesothelioma.

It is best to leave anything that looks like asbestos alone. If there are fibers present, advise the resident to have the home tested for asbestos by an asbestos inspector.

Key Resources: CDC - www.cdc.gov/niosh/topics/asbestos/ and EPA - www.epa.gov/asbestos.

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Radon - Keep It Contaminant-Free - Slide 38

Radon is the second leading cause of lung cancer. In non-smokers, it is the leading cause. Radon comes from the natural (radioactive) breakdown of uranium in soil, rock and water and gets into the air you breathe. Radon can be found all over the U.S. It can get into any type of building - homes, offices, and schools - and result in a high indoor radon level. Residents are most likely to get their greatest exposure at home, where they spend most of your time.

Testing is the only way to know if resident is at risk from radon. EPA and the Surgeon General recommend testing all homes below the third floor for radon. Testing is inexpensive and easy. Below is a photo of typical radon sampling kit.

Residents should test their home for radon. If levels are over 4.0 microcuries per liter, they should mitigate the hazards.

Key Resources: EPA - www.epa.gov/radon/ and CDC - www.atsdr.cdc.gov/HEC/CSEM/radon/

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Health and Safety Alarms - Keep It Ventilated

Smoke and Fire: Every home should have a smoke alarm. Virtually all states require it. A smoke alarm alerts residents to a fire. It does not warn residents of carbon monoxide.

Key Resources on Smoke Alarms: Underwriter Labs - www.ul.com/consumers/smoke.html

Carbon Monoxide: You can’t see or smell carbon monoxide, but at high levels it can kill a person in minutes. Carbon monoxide (CO) is produced whenever any fuel such as gas, oil, kerosene, wood, or charcoal is burned. If appliances that burn fuel are maintained and used properly, the amount of CO produced is usually not hazardous. However, if appliances are not working properly or are used incorrectly, dangerous levels of CO can result. Hundreds of people die accidentally every year from CO poisoning caused by malfunctioning or improperly used fuel-burning appliances. Even more die from CO produced by idling cars. Fetuses, infants, elderly people, and people with anemia or with a history of heart or respiratory disease can be especially susceptible.

CO detectors/alarms always have been and still are designed to alarm before potentially life-threatening levels of CO are reached. CO alarms should be installed according to the manufacturer's instructions. CPSC recommends that one CO alarm be installed in the hallway outside the bedrooms in each separate sleeping area of the home. CO alarms may be installed into a plug-in receptacle or high on the wall because CO from any source will be well-mixed with the air in the house. Make sure furniture or draperies cannot cover up the alarm.

NCHH recommends that residents purchase a CO alarm that does more than the minimum needs to alarm in life-threatening conditions. Residents need a CO alarm that records the peak level of CO in the home. You can come back later to see if there were CO levels that may threaten the residents health but not life. These alarms also display CO levels over 30 ppm. NCHH also recommends a CO alarm that has battery backup. Some CO injuries occurred when the power went out and the resident used a dangerous means - such as an unventilated space heater or charcoal grill - to heat the home. These meters cost around $45 at retail. Below is a photo of the alarm with digital display, peak level recorder, and battery backup.

Key Resources on CO Alarms: CDC - CDC - www.cdc.gov/co/default.htm, EPA - www.epa.gov/iaq/co.html, CPSC - www.cpsc.gov/cpscpub/pubs/466.html and Home Safety Council - www.homesafetycouncil.org/safety_guide/sg_co_w001.aspx

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Tobacco Smoke Exposure - Keep It Contaminant-Free - Slide 19

Environmental Tobacco Smoke contains at least 250 chemicals known to be toxic or cause cancer. It is a mixture of the smoke given off by the burning ends of a cigarette, pipe, cigar, and the smoke emitted at the mouthpiece and exhaled from the lungs of smokers (mainstream smoke).^1,2The widespread practice of smoking in buildings exposes nonsmoking occupants to combustion by-products under conditions where airborne contaminant removal is slow and uncertain. Over the past two decades, medical science has shown that nonsmokers suffer many of the diseases of active smoking when they breathe secondhand smoke.

On Tuesday, June 27th, 2006, the Surgeon General released a major new report on involuntary exposure to secondhand smoke, concluding that secondhand smoke causes disease and death in children and nonsmoking adults. The report finds a causal relationship between secondhand smoke exposure and Sudden Infant Death Syndrome (SIDS), and declares that the home is becoming the predominant location for exposure of children and adults to secondhand smoke.

No smoking should be allowed in a home, especially a home with children. If someone must smoke, they should do it outside.

Key Resources: CDC - www.cdc.gov/tobacco/ETS_Toolkit/ and EPA - www.epa.gov/smokefree/.

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Other Irritants - Keep It Contaminant-Free - Slide 27

Residents should try to reduce exposure to volatile organic compounds that may irritate the respiratory system or impact the central nervous system. While it depends on personal preferences, recent research has raised questions about air fresheners as well as scented candles, incense and potpourri. If the resident has respiratory problems, suggest that the resident stop using these potential irritants. In addition, sometimes these products are used to mask a problem such as mold.

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Type of Cleaning - Keep It Clean

Sweeping with a broom or using a dry mop does not clean the fine particles that may pose environmental hazards. Lead dust and may asthma allergen require vacuum with a High Efficiency Particulate (HEPA) filter. A HEPA filter is at least 99.97% efficient in removing monodisperse particles of 0.3 micrometers in diameter. A damp mop or damp dusting also also helpful to clean. Without a HEPA filter, a regular vacuum may spread the lead dust and allergens around the home. Below is a photo of a typical HEPA filter.