Community

Industrial zones, polluted lakes or streams, dump sites - Water source: bottled, city, well - School exposures: esp. if symptoms less nights or weekends; arts & crafts, "portables"

Household 

Type of dwelling: asbestos, radon (especially basement units); formaldehyde in mobile homes - Age and condition: lead (especially if pre-1950) - Heating sources: CO, NO2 - Environmental tobacco smoke (ETS) - Pesticides: indoor or outdoor

Hobbies

Model-building: toluene, other solvents - Increased risk in visually impaired - Lead risks: automotive work; indoor firing ranges

Occupational 

Parents' occupation (factories, landscaping) - Known occupational exposures - Change or shower at work or home - Risks: lead, asbestos, pesticides - Remember adolescent employment

Key Questions

1. Do symptoms subside or worsen in a particular location (e.g. home, child care, school, room) 
2. Do symptoms subside or worsen on weekdays or weekends? At a particular time of day 
3. Do symptoms worsen during hobby activities, such as working with arts & crafts? 
4. Are children your child spends time with experiencing similar symptoms?

Anticipatory Guidance

• Prenatal - Home environment, smoking, Environmental tobacco smoke, mold, occupational exposure, breast or bottle-feeding issues 
• 2 months - Environmental tobacco smoke, sun exposure, mold 
• 6 months - Poison exposures, incl. pesticides; lead Preschool - Arts & crafts exposures 
• Teenage - Occupational exposures, hobbies, smoking 
• Spring - Lawn & garden products, sun exposure 
• Fall or Winter - Wood stoves, fireplaces, gas stoves

Reference: Etzel, RA, Ed. Handbook of Pediatric Environment Health. Chicago: AAP, 1999.