Table 2.

Basic Components of an Environmental History

Home Environment		Occupation and Hobbies
• Age and condition of home (lead paint) • Carbon monoxide and fire alarms • Tobacco smoke • Water damage / Mold	• Pests / Pesticides • Heat and cooking source • Strong odors, solvents, cleaning products • Heat and cooking sources • Radon	• Caregiver jobs (contaminant transfer from clothing, shoes) • Adolescent jobs (safety) • Hobby activities in the home (paints, chemicals, safety) • School exposures
Food and Water		Other
• Water source (well water vs. public system) • Fish (large predatory fish have mercury) • Rice products (arsenic)		• UV radiation and sun protection • Noise (loud toys, headphone volume) • Sources of neighborhood pollution (highways, industries)
Patient characteristics can help focus the environmental history.
• Asthma: assess for common environmental asthma triggers such as mold, pests, dust mites, tobacco smoke, furry pets, cleaning chemicals, strong odors • Neurodevelopmental disorders: in addition to a general environmental history, assess for pica behavior and other risk factors that may increase the likelihood of exposures (e.g., lead); assess for use of alternative medications • Headaches/flu-like symptoms in family members: assess for sources of carbon monoxide • Patient age can help direct screening questions and anticipatory guidance (refer to the Pediatric Environmental Health Toolkit: https://peht.ucsf.edu/ for age-specific information)

Environmental History forms are available (in English and Spanish) for an general environmental history and an asthma-focused environmental history: www.neefusa.org/resource/pediatric-environmental-history