Visits for illness of undetermined cause may warrant investigation of potential environmental determinants.

Therapeutic Visits

Visits for illness of undetermined cause may warrant investigation of potential environmental determinants. This presents a significant challenge to physicians, as many environmental health problems have non-specific symptoms that mimic those of more common etiology. Common complaints, such as respiratory problems and headache, may have a complex etiology that involves some environmental factors.

The CH2OP list of questions is still highly relevant to taking the exposure history, but there are other obvious questions that may help pinpoint specific behaviours, activities or events that may be related to a discrete episode of illness.

Questions to Ask:

Is/was there any pattern to the timing of symptoms?

For example:

Did they occur at a particular time of day, week or season?

What was the relationship between the onset and severity of symptoms and the child’s recent activities?

For example:

Was the child active in outdoor sports? (I.e., possible exposure to outdoor air pollutants.)

Has the child spent a lot of time mouthing any particular toys or other items lately? (I.e., possible exposure to toxic chemicals, lead or cadmium-tainted dust?)

Was there a relationship between location and the onset and severity of symptoms? Do symptoms resolve with a change in location?

Are there other sorts of concerns with the child’s health and well being? For example, poor performance in school or learning, attention or behavioural problems may all be signs of chronic exposure to lead.

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