A 4-Year-Old Girl with Manifestations of Multiple Chemical Sensitivities

Environmental Health Perspectives, Dec, 2000 by Alan Woolf

Table 2. Pediatric considerations in multiple chemical sensitivities.

Diagnosis             There is no agreed upon case definition
                       of MCS in adults and little that is
                       evidence-based in the diagnosis or
                       treatment of adults.
                       There is even less known about
                       children so diagnosed.
                      It has been proposed that children's
                       learning disorders or attentional
                       deficit hyperactivity disorder (ADHD)
                       might be explained by
                       MCS, but without any convincing
                       scientific evidence.
                      Adults with MCS have often been
                       diagnosed with psychiatric conditions
                       such as anxiety neurosis, somatoform
                       syndromes, or depression.
                       It is unknown whether affected
                       children or their parents or
                       caretakers have specific psychiatric
                       diagnoses. However, it seems
                       evident that they are living with
                       considerable psychosocial stress
                       and pain.

Management            Parents will frequently shop for a doctor
                       and seek alternative practitioners because
                       of their frustrations and dissatisfaction
                       with the response of physicians to their
                       child's MCS.
                      It may be difficult for health care providers
                       to communicate with parents who hold such a
                       system of fixed beliefs about their child's
                       ill health and perceived environmental toxins.
                      Therapies recommended by clinical ecologists
                       may engender additional risks if used for
                       children. For example, severely restricted
                       diets can interfere with the basic nutritional
                       requirements needed for normal growth and
                       development.
                      Other therapies recommended, such as
                       desensitization, herbs, or vitamins, may be
                       especially harmful to children, whose
                       developing body systems (e.g. central
                       nervous and immune systems) are particularly
                       vulnerable to injury.
                      Young children may have a limited capacity to
                       detoxify certain herbs, hormones, and remedies
                       through the liver and kidneys, with a
                       consequent higher risk of toxic reactions.
                      Infants and young children are particularly
                       vulnerable to fluid and electrolyte imbalances
                       provoked by laxatives or purging; they may not
                       have the capacity to detoxify and eliminate
                       herbs, minerals, and dietary supplements used
                       by clinical ecologists and other practitioners
                       as remedies in adults.

Public health and     Many adult MCS patients implicate an incident
psychosocial issues    in the workplace that involved a chemical
                       exposure the inciting agent. For children,
                       school or home would logically be the
                       commonly implicated site of the triggering
                       exposure to a food, drug, or chemical.
                      The social isolation that accompanies chemical
                       avoidance strategies is particularly disabling
                       for children. Such isolation impairs a
                       child's ability to make friends and otherwise
                       interferes with normal psychosocial
                       development. Avoidance of school may impair
                       their intellectual development.
                      Children as well as adults are entitled to the
                       same protections afforded by federal laws
                       under the Americans with Disabilities Act
                       (34). This federal law has been applied to
                       include patients with MCS. For children,
                       the law could be interpreted to include
                       prior notification of parents if pesticide
                       spraying or other chemical applications were
                       planned at a school or day care center. The
                       law might mandate other accommodation of the
                       special needs of a child with MCS.
                      Children depend on adults to make responsible
                       choices concerning their health that are in
                       their best interests. The diagnosis of MCS
                       can lead to lifestyle choices that may add
                       stress to family relationships, especially if
                       parents disagree between themselves or with
                       health care professionals on the diagnosis and
                       management options open to them.