’ Housing and Child Health Michael Weitzman, MD, a,b Ahmareen Baten, MD, c David G. Rosenthal, MD, c Risa Hoshino, c Ellen Tohn, d and David E. Jacobs, PhD e,f The connection between housing and health is well estab- lished. Physical, chemical, and biological aspects of the child’s home, such as cleanliness, moisture, pests, noise, accessibility, injury risks, and other forms of housing environmental quality, all have the potential to influence multiple aspects of the health and development of children. Basic sanitation, reduced house- hold crowding, other improvements in housing and expanded, and improved housing regulations have led to advances in children’s health. For example, lead poisoning prevention policies have profoundly reduced childhood lead exposure in the United States. This and many other successes highlight the health benefits for families, particularly children, by targeting interventions that reduce or eliminate harmful exposures in the home. Additionally, parental mental health problems, food insecurity, domestic violence, and the presence of guns in children’s homes all are largely experienced by children in their homes, which are not as yet considered part of the Healthy Homes agenda. There is a large movement and now a regulatory structure being put in place for healthy housing, which is becoming closely wedded with environmental health, public health, and the practice of pediatrics. The importance of homes in children’s lives, history of healthy homes, asthma, and exposures to lead, carbon monoxide, secondhand/third- hand smoke, radon, allergy triggers is discussed, as well as how changes in ambient temperature, increased humidity, poor ventilation, water quality, infectious diseases, housing structure, guns, electronic media, family structure, and domes- tic violence all affect children’s health. Curr Probl Pediatr Adolesc Health Care 2013;43:187-224 Introduction Importance of Homes in Children’s Lives F or most children, the home and its immediate surroundings are the first and major environ- ments they experience throughout their early years. Young children spend the majority of their time in the home. On average, children spend  15 h a day indoors at home. Infants average nearly 20 h/day indoors. 1,2 The connection between housing and health, meanwhile, is well established. 3 Physical, chemical, and biological aspects of the home, such as cleanliness, water quality, lead-based paint hazards, secondhand and thirdhand smoke (SHS and THS), ventilation, mold and moisture, pests, noise, accessi- bility, injury risks, and other forms of housing environmental quality, all have the potential to influ- ence multiple aspects of the health and development of children. 4 Children are particularly vulnerable to housing- related pollutants because they spend proportionally more time indoors than adults. They also have increased exposure due to physiological and behavioral factors, such as hand-to-mouth activity. Air and settled dust levels of pesticides and lead, for example, also have been found to be higher closer to the floor, increasing exposure. Children have increased surface area to total body mass and higher respiratory rates, pound for pound drink more water and consume more food, thereby contributing to increased exposure espe- cially during “critical windows of exposure.” 5 In the case of air pollutants, infants and young children constitute a special risk group due to the fact that their respiratory system is not yet completely developed until the age of 6. 6 Children and infants have a higher resting metabolic rate and rate of oxygen consumption per unit of body mass. Therefore, their intake of any air pollutant is likely to be greater. In addition to an increased need for oxygen relative to their size, children have narrower airways than do adults. 6 Thus, irritation caused by air pollution that would produce only a slight response in an adult can Curr Probl Pediatr Adolesc Health Care 2013;43:187-224 1538-5442/$ - see front matter & 2013 Mosby, Inc. All rights reserved. http://dx.doi.org/10.1016/j.cppeds.2013.06.001 From the a New York University School of Medicine, Department of Pediatrics, New York, NY; b New York University School of Medicine, Department of Environmental Medicine, New York, NY; c New York University School of Medicine, Department of Pediatrics, New York, NY; d Tohn Environmental Strategies, LLC, Wayland, MA; e National Center for Healthy Housing, Columbia, MD; and f University of Illinois at Chicago, Environmental and Occupational Health Sciences Division, Chicago, IL. Curr Probl PediatrAdolesc Health Care, September 2013 187