Vulnerability, of children

For the sake of clarity, this chapter will divide between first considering the merits and importance of acknowledging philosophically and practically that drugs are not just the problem of the presenting individual, but of their families too. It will then focus on the particular problems encountered by children of parents who are drug dependent. Inevitably the greater potential vulnerability of children of parents with drug problems imposes a necessary hierarchy of need and response. The important point however, is that the protection and welfare of such children is not just about the parent and the child but about the extended family too. 

Weiss (2000) Vulnerability of children and the developing brain to neurotoxic hazards. Environ Health Perspect, 108(Suppl 3) 375-381. 

The special vulnerability of children should form the basis for development of child-protective policies and risk assessment approaches. A lack of lull proof for causal associations should not prevent efforts to reduce exposures or implement intervention and prevention strategies. 

The increased awareness about the special vulnerability of children has led to a number of new research programmes, international agreements, and international alliances that specifically address and promote healthy environments for children (UNICEF, 1990, 2001a WHO, 1997, 2002a Suk, 2002 Suk et al 2003). A few key international activities are cited below ... 

In 1997, the Declaration of the Environment Leaders of the Eight on Children s Environmental Health acknowledged the special vulnerability of children and committed their countries to take action on several specific environmental health issues, such as chronic lead poisoning, microbiologically contaminated drinking-water, endocrine disrupting chemicals, environmental tobacco smoke (ETS), and poor air quality. 

Decontamination after a chemical terrorist attack needs to be well planned, efficient, and cognizant of the special needs of children. It is well recognized that the unique vulnerabilities of children may lead to a disproportionate number of pediatric victims after a chemical attack. Without proper planning and consideration as to how children will be decontaminated, the potential for preventable pediatric casualties is increased due to time loss and confusion. It is highly recommended for pediatricians to be involved in the development of each hospital s plans for decontamination. Over the last several years, many advances have been made in the management of the critically injured child. In fact, studies have shown that children managed in a pediatric intensive care imit (PICU) have better outcomes than children managed in an adult intensive care unit (Wheeler and Poss, 2003). Not all hospitals have the resources to have their own PICU, but they need to be able to provide the... 

Slow response to the growing information on the impacts of chemicals on ecosystems and health and emerging concerns such as endocrine disruption and the unique vulnerability of children ... 

My particular responsibility on the academy s radiation committee was to maintain current records on the status of the research on Hiroshima, Nagasaki, and the Marshall Islands. Those facts and figures told us one thing We must not delay in sounding a global alarm about the hazards of radiation in all its forms, and the particular vulnerability of children. 

Clearly, the incidence of cancer resulting from exposure to bomb radiation is not large in total numbers. There had been hints of that while I was in Nagasaki for the first time, and it was confirmed by later studies. But small as the total numbers are, they nevertheless demonstrate a remarkable increase and, above all, serve as yet another measure of the vulnerability of children. 

This book is my way of remembering. It flows from my conviction that every decision maker, every citizen, needs to know the human cost of nuclear warfare. I want no mistakes. I want no decisions that ignore the very particular vulnerability of children, and through the children, the vulnerability of the future of all of us. 

The Protocol drafting occurred within a context of intense preoccupations with immigration, prostitution, and the vulnerabilities of children. Given these very different preoccupations, one of its achievements is oflen held to be agreement reached on the first internationally recognized definition of trafficking ... 

With disruption of this barrier, molecules such as albumin freely enter the brain and ions and water follow. Because the brain lacks a well-developed lymphatic system, clearance of plasma constituents is slow, edema occurs, and intracranial pressure rises. At lower levels of exposure, subtle dysfunction of the blood-brain barrier may contribute to neurobehavioral deficits in children (Bressler and Goldstein 1991 Goldstein 1993). The particular vulnerability of the fetus and infant to the neurotoxicity of lead may be due in part to immaturity of the blood-brain barrier and to the lack of the high-affinity leadbinding protein in astroglia, which is discussed later in this section. Results of measurements of transendothelial electrical resistance across the blood-brain barrier from mice of various ages showed that lead potentiates cytokines-induced increase in ion permeability of the blood-brain barrier (Dyatlov et al. 

In recognition of the increased vulnerability of the developing organism, both the U.S. EPA Food Quality Protection Act [77] and the U.S. EPA Safe Drinking Water Act [78] mandate that infants and children warrant special consideration in the risk assessment process. Immune system ontogeny and the sensitivity of the developing immune system to xenobiotics are discussed in detail in chapter 20 of this volume. 

Children s exposure pattern differs from that of adults and children may be more heavily exposed than adults to certain chemicals in the environment as they, on a body weight basis, breathe more air, drink more water, and eat more food than adults additionally, their behavior patterns, such as play close to the ground and hand-to-mouth activities, can increase their exposure. The differences in exposure patterns between children and adults are often used as an argument for increased susceptibility of children to chemicals however, it should be recognized that such differences are not related to increased vulnerability to chemicals but are purely related to an increased internal exposure (Nielsen et al. 2001). 

The reasons that relatives gave for taking on the care of children were always framed in terms of the children s wellbeing and protection but more importantly it was because these children were part of their family and vulnerable. They loved them and felt a responsibility towards them, and perhaps particularly because of their circumstances, were very protective ... 

This chapter considers practitioner responses to parenting and child welfare in the context of drug problems. The increased vulnerabilities of these children and the statutory framework around child protection merits a closer consideration of the ways in which practitioners think about such cases. The key question that informs this discussion is why had so few of the children described in this study been the subject of investigation The interviews with parents, with their children and with grandparents, all indicated... 

About 50% of children and adolescents with schizophrenia show characteristic symptomatology in their premorbid personality (Stutte, 1969) they have been described as withdrawn, shy, introverted, sensitive, and anxious. It is not clear whether these personality characteristics directly predispose them to schizophrenia, or whether they enhance the constitutional vulnerability of those children. Again, there is a large body of evidence for neurobiological and neurodevelopmental deficits in schizophrenic children and adolescents prior to the full manifestation of their disorder (Remschmidt 1993 2002). 

The 1996 Food Quality Protection Act (FQPA) now requires that an additional safety factor of 10 be used in the risk assessment of pesticides to ensure the safety of infants and children, unless the EPA can show that an adequate margin of safety is assured with out it (Scheuplein, 2000). The rational behind this additional safety factor is that infants and children have different dietary consumption patterns than adults and infants, and children are more susceptible to toxicants than adults. We do know from pharmacokinetics studies with various human pharmaceuticals that drug elimination is slower in infants up to 6 months of age than in adults, and therefore the potential exists for greater tissue concentrations and vulnerability for neonatal and postnatal effects. Based on these observations, the US EPA supports a default safety factor greater or less than 10, which may be used on the basis of reliable data. However, there are few scientific data from humans or animals that permit comparisons of sensitivities of children and adults, but there are some examples, such as lead, where children are the more sensitive population. It some cases qualitative differences in age-related susceptibility are small beyond 6 months of age, and quantitative differences in toxicity between children and adults can sometimes be less than a factor of 2 or 3. 

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