Developmental Stage	Developmental Characteristics	Vulnerabilities	Anticipatory Guidance
Preconception	-	Male and female parental reproductive systems Occupational, environmental, and vocational exposures Pharmaceuticals Substance abuse	Dietary advisories (mercury and PCBs)
Fetal	Rapid cell division Organogenesis Mother's internal environment	Dividing cells sensitive to transplacental carcinogens Developing reproductive system can lead to transgenerational effects Critical periods of organ development Immature blood-brain barrier Placenta as semipermeable membrane	Dietary advisories (mercury and PCBs) Occupational, environmental, and avocational exposures Take-home occupational exposures Pharmaceuticals and herbal and alternative remedies Substance abuse Topical insect repellents Baseline household environmental survey Maternal exposures during preparation of nursery and other remodeling (lead and volatile organic compounds)

The information in this table is adapted from Bearer (1995).
Anticipatory guidance is the education provided to parents or caretakers during a routine prenatal or pediatric visit to prevent or reduce the risk that their fetuses or children will develop a particular health problem (CDC 1997).

Table 2. Special Susceptibilities and Anticipatory Guidance About Opportunities for Hazardous Exposure by Developmental Stage (Continued)

Developmental Stage	Developmental Characteristics	Vulnerabilities	Anticipatory Guidance
Newborn (birth to 2 months)	Nonambulatory Restricted environment High calorie and water intake High air intake Highly permeable skin Alkaline gastric secretions (low gastric acidity)	Brain development Immature blood-brain barrier Synapse formation Lungs alveolar development lung fluid cleared by pulmonary lymphatic system High respiratory rate Skin very permeable with large surface-to-volume ratio Gastrointestinal tract: highly permeable, increased pH Immature detoxification capacity of liver, kidney, and digestive system Skin Contaminants used or deposited on floor, especially household products, pesticides, and take-home occupational agents	Consider day care and home, indoor, and outdoor environments Ingestion Breast milk Infant formula (tap or well-water contaminants) Respiratory Indoor air contaminants, especially those layering near the floor (e.g., mercury, pesticides, allergens, radon, asbestos, and take-home occupational agents). Outdoor air pollutants, especially ozone and particulates

Table 2. Special Susceptibilities and Anticipatory Guidance About Opportunities for Hazardous Exposure by Developmental Stage (Continued)

Developmental Stage	Developmental Characteristics	Vulnerabilities	Anticipatory Guidance
Infant/Toddler (2 months to 2 years)	Crawling and early walking Oral exploration Limited diet High intake of fruits and vegetables	Brain development Immature blood-brain barrier Synapse formation Lungs: alveolar development High respiratory rate Skin very permeable with large surface-to-volume ratio Small intestine avidly absorbs lead if diet deficient in iron and calcium Immature detoxification capacity of liver, kidney, and digestive system	Consider day care and home, indoor, and outdoor environments Ingestion Pesticides on fruit and vegetables Tap water contaminants Contaminants on floor and within easy reach, especially medicines, household products, pesticides, lead, and take-home occupational agents Pica Respiratory Indoor air contaminants, especially those layering near the floor (e.g., mercury, pesticides, allergens, radon, asbestos, and take-home occupational agents) Outdoor air pollutants, especially ozone and particulates Skin Contaminants on floor and within reach, especially household products, pesticides, and take-home occupational agents Topical insect repellents

Table 2. Special Susceptibilities and Anticipatory Guidance About Opportunities for Hazardous Exposure by Developmental Stage (Continued)

Developmental Stage	Developmental Characteristics	Vulnerabilities	Anticipatory Guidance
Young child (2 to 6 years of age)	Expanded environment, still includes significant time on floor Increased independence High intake of fruits and vegetables	Brain developing Lungs: alveolar development and increasing volume Small intestine avidly absorbs lead if diet deficient in iron or calcium Immature detoxification capacity of liver, kidney, and gastrointestinal system	Consider home, day care, preschool, and playmates' indoor and outdoor environments Ingestion Pesticides on fruit and vegetables Tap water contaminants Contaminants on floor and within easy reach, specially medicines, household products, pesticides, lead, and take-home occupational agents Pica Respiratory Indoor air contaminants, especially those layering near the floor (e.g., mercury, pesticides, allergens, radon, asbestos, and take-home occupational agents) Outdoor air pollutants, especially ozone and particulates Skin Contaminants on floor and within reach, especially household products, pesticides, and take-home occupational agents Topical insect repellents

Table 2. Special Susceptibilities and Anticipatory Guidance About Opportunities for Hazardous Exposure by Developmental Stage (Continued)

Developmental Stage	Developmental Characteristics	Vulnerabilities	Anticipatory Guidance
School-aged child (6 to 12 years)	Increased number of environments and less supervised play: school, playground, friends' houses	Brain developing Lungs: increasing volume	Consider home, school, friends, and afterschool programs' indoor and outdoor environments Ingestion Tap water Food Respiratory Indoor and outdoor air quality Hazards associated with hobbies and school crafts Take-home occupational hazards Skin Hazards associated with hobbies and school crafts Take-home occupational hazards Topical insect repellents

Table 2. Special Susceptibilities and Anticipatory Guidance About Opportunities for Hazardous Exposure by Developmental Stage (Continued)

Developmental Stage	Developmental Characteristics	Vulnerabilities	Anticipatory Guidance
Adolescent (12 to 18 years)	Puberty Accelerated growth Experimentation with controlled substances Independence and exposure to multiple environments Possible employment, work in family business, or training in hazardous trades	Brain and lungs continue to develop Muscles and bones grow rapidly Gonad maturation Breast development Ova and sperm maturation	Consider home, school, friends, occupational, and trade school environments Ingestion Tap water Food Occupational hazards ingested because of poor poor hygiene Substance abuse Respiratory Indoor and outdoor air quality Occupational and trade school hazards Take-home occupational exposures Hazards associated with hobbies and school crafts Substance abuse Skin Occupational and trade school hazards Take-home occupational exposures Hazards associated with hobbies and school crafts Topical insect repellents

Previous Section

Next Section

Revised 2002-07-30.

Agency for Toxic Substances and Disease RegistryCase Studies in Environmental Medicine Pediatric Environmental Health Special Susceptibilities and Anticipatory Guidance about Opportunities for Hazardous Exposure by Developmental Stage

Table 2. Special Susceptibilities and Anticipatory Guidance About Opportunities for Hazardous Exposure by Developmental Stage

Table 2. Special Susceptibilities and Anticipatory Guidance About Opportunities for Hazardous Exposure by Developmental Stage (Continued)

Table 2. Special Susceptibilities and Anticipatory Guidance About Opportunities for Hazardous Exposure by Developmental Stage (Continued)

Table 2. Special Susceptibilities and Anticipatory Guidance About Opportunities for Hazardous Exposure by Developmental Stage (Continued)

Table 2. Special Susceptibilities and Anticipatory Guidance About Opportunities for Hazardous Exposure by Developmental Stage (Continued)

Table 2. Special Susceptibilities and Anticipatory Guidance About Opportunities for Hazardous Exposure by Developmental Stage (Continued)

Agency for Toxic Substances and Disease Registry
Case Studies in Environmental Medicine

Pediatric Environmental Health
Special Susceptibilities and Anticipatory Guidance about Opportunities for Hazardous Exposure by Developmental Stage