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Children’s Environmental Health: The Biological Remembrance of Things Past to Inform the Future

October 2, 2023

Commentary From the Council on Environmental Health and Climate Change

The origins of the Council on Environmental Health and Climate Change (COEHCC) can be traced to 1957, when the American Academy of Pediatrics (AAP), in response to growing concerns related to children’s exposure to radiation fallout in the wake of nuclear weapons testing on Bikini Island, formed the Committee on Radiation Hazards and Congenital Malformations. Following a series of transformations, the current “council” format was adopted in 2008. “Climate change” was added to the council’s name in 2021 to reflect a commitment to addressing this critically important children’s health issue.

The mission of COEHCC is to advise the AAP Board of Directors on issues pertaining to environmental health, toxic exposures, climate change, and environmental justice; to support legislative initiatives designed to protect the health of the fetus, infant, child, and adolescent from environmental hazards and climate change; to advance health equity by addressing environmental disparities; and to develop information, educational resources, and initiatives related to children’s environmental health, climate change, and environmental justice. Additionally, the COEHCC develops the AAP landmark Pediatric Environmental Health policy manual (aka “The Green Book”), a groundbreaking resource on the prevention, identification, and treatment of a wide range of environmental hazards.

The articles highlighted herein, and the invitation to author Rebecca Dzubow, MPH, MEM, with the US Environmental Protection Agency (EPA) Office of Children’s Health Protection, were discussed and agreed upon among the members of the COEHCC executive committee.

Children’s Environmental Health: The Biological Remembrance of Things Past to Inform the Future

Rebecca Dzubow, MPH, MEM

Affiliation: US Environmental Protection Agency, Office of Children’s Health Protection

Highlighted Articles From Pediatrics

History shows that children’s health has been a driving force for judicious environmental protection. Our understanding that lead in the blood of children impedes brain development and that ambient air pollution results in premature deaths propelled the phase out of leaded gasoline and the establishment of national ambient air quality standards for lead.1,2 We know that exposure to mercury in the womb harms the developing nervous system resulting in adverse effects on fine motor skills and cognitive thinking, which is why environmental protections have been put in place to reduce mercury exposure.3 The voice of pediatricians and public health practitioners has long been vital to secure these important public health advances. As we celebrate the 75th anniversary of Pediatrics, we recognize a few of the seminal articles that were foundational to the introduction of ideas that gave rise to further inquiry, informed the public discourse, and ultimately helped the EPA and other authoritative bodies to take action to protect the health of our children and our future, regardless of zip code.

While we once thought the fetus to be protected from external hazards through the placental and blood-brain barriers, we now know this to be an overstatement. A vast overstatement, given what we know now about movement of environmental contaminants across these barriers. As early as 1960, Knobloch and Pasamanick4 stated “Prenatal experience, birth weight and later physical status are the most important, and in essence, the only significant factors we have been able to discover at this point that result in group differences in developmental quotients.” Many attribute the birth of the field called developmental origins of health and disease (DOHaD), also known as the Barker Hypothesis, to David Barker’s seminal 1986 publication.5 We also know, however, that great thinkers stand on the shoulders of giants, and we can see statements on DOHaD concepts in earlier articles published in Pediatrics. In 1966, Dubos et al6 poetically stated: “From all points of view, the child is truly the father of the man. […] Socially and individually the response of human beings to the conditions of the present is always conditioned by the biological remembrance of things past.” Almost 50 years later, in 2009, Braveman and Barclay7 would write, “We need more research on the early-life origins of adult chronic disease. Understanding birth outcome disparities should receive special priority, given how powerfully low birth weight and preterm birth predict development and health across the life course.” Regrettably, a 2021 policy statement by the AAP Council on Environmental Health reminds us again that we still need additional research focused in this area to understand “the early life-course vulnerabilities and potential effects into adulthood.”8

At the EPA, we embrace this charge and—for the 25th anniversary of the children’s environmental health Executive Order9 in 2021—we were proud to have updated the EPA’s Policy on Children’s Health.10 We now recognize formally the prenatal period as critical and affirm that exposure to contaminants during early life is a key consideration in the assessment of how environmental impacts shape human health over the course of a lifetime. In the EPA’s day-to-day decision-making we now also recognize that children’s health is influenced by social determinants, and that those living in highly exposed or underserved communities may have reduced biological resilience and ability to recover from exposure to environmental hazards.

Articles in Pediatrics have noted these and many other statements that we now consider truths. Contributors to this journal have forged future paths by encouraging public health practitioners to recognize the breadth of the problems and multiplicity of social forces that affect our children.4,5,11-13 As we herald together the next generation in Pediatrics, we must consider our common obligation to evaluate the cumulative impacts of the myriad of chemical and non-chemical stressors that affect health in overburdened communities and result in disproportionate impacts. We thank the many people who contribute to this journal and celebrate working collaboratively across academia, medical and health care professions, advocacy organizations, tribal nations, state and local governments, and the federal family to protect our children and our future. Cheers to another 75 years of good health!


  1. Bellinger D, Sloman J, Leviton A, Rabinowitz M, Needleman HL, Waternaux C. Low-level lead exposure and children's cognitive function in the preschool years. Pediatrics. 1991;87(2):219-227
  2. Bellinger DC, Stiles KM, Needleman HL. Low-level lead exposure, intelligence and academic achievement: a long-term follow-up study. Pediatrics. 1992;90(6):855-861
  3. L Amin-Zaki L, Elhassani S, Majeed MA, Clarkson TW, Doherty RA, Greenwood M. Intra-uterine methylmercury poisoning in Iraq. Pediatrics. 1974;54(5):587-595
  4. Knobloch H, Pasamanick B. Environmental factors affecting human development, before and after birth. Pediatrics. 1960;26(2):210-218
  5. Barker DJP, Osmond C. Infant mortality, childhood nutrition and ischaemic heart disease in England and Wales. Lancet. 1986;1:1077-1081
  6. Dubos R, Savage D, Schaedler R. Biological freudianism: lasting effects of early environmental influences. Pediatrics. 1966;38(5):789-800
  7. Braveman P, Barclay C. Health disparities beginning in childhood: a life-course perspective. Pediatrics. 2009;124(Suppl 3):S163-S175
  8. Brumberg HL, Karr CJ, Council on Environmental Health. Ambient air pollution: health hazards to children. Pediatrics. 2021;147(6):e2021051484
  9. Executive Order 13045: Protection of children from environmental health risks and safety risks. Government Printing Office. 62 FR 19885; April 23, 1997
  10. US Environmental Protection Agency. Children’s Health Policy and Plan. 2021
  11. Fraser FC, Walker BE, Trasler DG. Experimental production of congenital cleft palate: genetic and environmental factors. 1957;19(4):782-787
  12. Sameroff AJ, Seifer R, Barocas R, Zax M, Greenspan S. Intelligence quotient scores of 4-year-old children: social-environmental risk factors. Pediatrics. 1987;79(3):343-350
  13. Shea KM, Committee on Environmental Health. Global climate change and children’s health. Pediatrics. 2007;120(5):1149-1152

Other Seminal Pediatrics Articles Identified by COEHCC

1948 - October 1973

November 1973 - October 1998 

November 1998 - Present

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