American Academy of Pediatrics Council on Environmental Health

View all recommendations from this society

Released May 17, 2021

Do not routinely test urine for metals and minerals in children with autistic behaviors. Toxicologic exposures have not been conclusively associated with the development of autistic behaviors in children. Testing for metals and minerals may be harmful if treatment is guided on the basis of these results.

Thimerosol or ethylmercury has been used as a preservative in multidose vaccine vials and have been blamed for the increase in autism rates over the past 2 decades. However, studies have failed to show a causative link between environmental exposures and the development of these symptoms. As symptoms of autism occur early in childhood and, possibly, months to years after any potential exposure may have resulted in neurotoxicity, the likelihood of continued presence of such toxicant is low. Parents, however, may be desperate for answers and seek out alternative sources for information and receive advice to obtain laboratory analysis for minerals and metals as causative agents without insurance reimbursement. Finding an abnormal result has led to ill-advised treatments and death in some patients.


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: www.pehsu.net

Sources

Modabbernia A, Velthorst E, Reichenberg A. Environmental risk factors for autism, an evidence-based review of systematic reviews and meta-analyses. Mol Autism. 2017;8:13

Baxter AJ, Krenzelok EP. Pediatric fatality secondary to EDTA chelation. Clin Toxicol. 2008;46(10):1083-1084

James S, Stevenson SW, Silove N, Williams K. Chelation for autism spectrum disorder (ASD). Cochrane Database Syst Rev. 2015;(11):CD010766