American Academy of Pediatrics Council on Environmental Health

View all recommendations from this society

Released May 17, 2021

With the exception of certain heavy metals (eg, lead), do not routinely use measurements of environmental chemicals in a person’s blood or urine to make clinical decisions.

It is virtually impossible for people not to come into contact with hundreds of chemicals each day—whether those chemicals are in our food, air, water, soil, dust, or the products we use. And it is even more difficult for people to know whether those chemicals are harmful to their health or not. Presence does not mean toxicity.

The measurement of an environmental chemical in a person’s blood or urine does not by itself mean that the chemical causes disease. Advances in analytical methods allow us to measure low levels of environmental chemicals in people, but separate studies of varying exposure levels and health effects are needed to determine whether such blood or urine levels result in disease. These studies must also consider other factors such as duration of exposure. For some environmental chemicals, such as lead, research studies have given us a good understanding of the health risks associated with different blood lead levels. For many environmental chemicals (eg, phthalates, polychlorobiphenyls) more research is needed to assess health risks from different blood or urine levels. Thus, just because a chemical is found to be in the body does not mean that harm will occur. Moreover, these measurements are not helpful to guide clinical intervention or treatment. Pediatric Environmental Health Specialty Units ( can provide additional information about indications, measurement, and interpretation of environmental chemicals in blood or urine, including lead and other heavy metals.

These items are provided solely for informational purposes and are not intended as a substitute for consultation with a medical professional. Patients with any specific
questions about the items on this list or their individual situation should consult their physician.

How The List Was Created

The American Academy of Pediatrics is an organization of 67,000 primary care pediatricians, pediatric medical subspecialists and pediatric surgical specialists
dedicated to the health, safety and well-being of infants, children, adolescents and young adults.

The American Academy of Pediatrics’ Council on Environmental Health (COEH) consists of pediatricians who have a special interest in children’s exposures to
environmental contaminants and the care of the environment in which we live. COEH strives to inform pediatricians, parents, communities, and policy makers on
environmental issues that can result in harm to children. As a result, the members of the Executive Committee of COEH were queried to provide their scientifically
informed opinions as nationally recognized experts in pediatric environmental health to identify diagnostic and management decisions that have resulted in
patient harm either from a misdiagnosis or inappropriate therapy. These 5 clinical issues are the result. Various expert committees, councils, and sections of the
AAP reviewed and approved the list. The list was approved by the AAP Board of Directors and Executive Committee.

Note: Pediatricians should consult with specialists who are trained in toxicology or environmental health when questions such as these arise. The American
Academy of Pediatrics has partnered with the American College of Medical Toxicology (ACMT) to co-administer the Pediatric Environmental Health Specialty
Units (PEHSU), a network of pediatricians and medical toxicologists serving individual federal regions to help with education and consultation of children with
environmental exposures. PEHSUs are funded by the US Department of Health and Human Services Agency for Toxic Substances and Disease Registry and the
US Environmental Protection Agency with a cooperative agreement with AAP and ACMT. Visit:


Centers for Disease Control and Prevention. Fourth National Report on Human Exposure to Environmental Chemicals. Atlanta, GA: Centers for Disease Control and Prevention, US Department of Health and Human Services; 2009. Available at:

Centers for Disease Control and Prevention. National Biomonitoring Program. Biomonitoring: Making a Difference [presentation]. Available at: biomonitoring_presentation.html