Pediatric Environmental Home Assessment

It is a warm summer day and you are going out on a home visit to see a family. The family has a six-year old child who has, and is being treated for, asthma. The mom has concerns about recent exacerbations in her child's asthma and the need for more frequent use of “rescue” inhalers.

You note that the family lives in a multi-family building in an urban neighborhood. The building appears to have been built in the late 1950s. That is consistent with other buildings in the neighborhood. Given its urban location, you know that the home is connected to a public water system.

As you go along, you make notes and check off any relevant information on the PEHA Survey form. Let's get started!

Welcome and Introductions

As you talk further, the mom reports that she is a Section 8 tenant. When she moved in, she says the landlord told her that the house was built in 1958 and that lead hazard control work was completed before she moved in 18 months ago. She could not remember getting any booklet or warnings about lead when she signed her lease.

You ask the mom about other general housing characteristics. She knows there is a basement but has not been in there. She says she has seen the oil truck connect up to the fittings on the side of the house. She shows you the unlocked door to the basement in the common area. You check out the basement.

The mom says that the oil heat can be hard to control in the winter. Some rooms are too hot and others are too cold. She sometimes has to open windows to make the rooms comfortable.

You observe, and the mom reports, that there are no pets in the home.

The mom is focused on the construction dust and mice. She says she has not seen any mold. You follow along the PEHA Survey Form and ask about other pests. The mom reports no trouble with cockroaches, rats, or bedbugs.

You ask about asbestos and radon. The mom reports that she has no knowledge about whether the building has been tested or treated.

You do not observe any air fresheners or scented candles present, but you ask about their use. The mom confirms that she does not use those items because they aggravate her child’s asthma.

Next you do a kitchen walkthrough with the mom.

Kitchen

You review the PEHA Survey Form and ask to move on to the bedroom and bathroom.

Living Room Walkthrough and Neighborhood Review

You note the active construction outside and the dust that is accumulating in the window sill even though the window is closed. You also note that there are no window guards on the windows and that the blinds have looped cords.

You ask the mom when was the last time the young children were tested for lead. Mom notes that it was within the last year and the results were less than 10.

You sit down again with the mom to review home safety questions. You provide her with a poison control hotline sticker to place on the phone. You ask about fire safety issues. She notes that there is no smoking allowed in the house and matches are stored in a high, safety-locked cabinet. The family does not have a formal fire escape plan.

The mom reports that the hallway lighting is good. She has no safety concerns about lighting. In the kitchen you note the coffee maker and tea kettle. You ask about the child’s access to hot liquids. The mom notes that her son is older and is aware that he should not touch hot things. You ask the mom if she knows what the hot water temperature is set at. She does not know.

Bedroom and Bathroom

You ask the mom about the use of humidifiers in the bedroom. She notes that she sometimes uses them in the winter because the air gets too dry from the hard to control heat.

As you talk further, the mom confirms that the bathroom fan does function although it is a bit noisy. You observe a hair dryer on the edge of the sink. You ask the mom about adult supervision when her child is bathing. She notes that she is right there most of the time but may sometimes leave the room to grab a towel or item of clothing for the child.

Medication Review and Wrap-up

View “Medication Review and Wrap-up” video clip (7.0 MB).

Conclusion

Review the information on your completed PEHA Survey Form and enter it using the on-line version.

What to do When You are Done With the PEHA Survey

Review the information on your completed PEHA Survey Form;
Highlight any bolded responses;
Highlight any notes you made;
Match up your information to the appropriate items on the Nursing Care Plan (form or on-line)
Complete a PEHA Nursing Care Plan Form for this family (Part 1, Part 2, and Part 3) noting any action that you do not think should be done in this situation.

10320 Little Patuxent Parkway, Suite 500 • Columbia, MD 21044
Phone: 410.992.0712 • Fax: 443.539.4150