Converging findings from genetics and molecular biology demonstrate that a host of internal and external signals can stimulate or inhibit gene expression, including subtle factors such as the light-dark cycle and tactile stimulation . The department’s commitment to helping patients maintain good health and improve function extends through outpatient clinics, inpatient rehabilitation hospitals and consultation in skilled nursing facilities.

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Health effects from these diverse indoor air pollutants include respiratory irritation with cough and wheezing, exacerbation of asthma, allergic responses, cancer, and central nervous system effects . Exposure to asbestos, leading to lung cancer, is also a concern due to the prevalence of asbestos in schools and some homes (U.S. Environmental Protection Agency, 1987; American Academy of Pediatrics, 1987). Fetal undernutrition is believed to induce persistent changes in several metabolic pathways, but the exact mechanisms are only now being pieced together through a range of animal experiments and human measurement studies (Seckl, 1998; Barker, 1998). Because it is likely that events occurring at other times modify prior influences, there is a growing interest in understanding the predisease pathways and biological changes that occur prior to the recognition of a vast array of clinical outcomes.

Thus, for adolescents, like their younger counterparts, peer relations continue to play a role in both adolescence and beyond. Although these basic approaches to parenting appear to apply throughout a child’s life course, the tasks facing parents change as the child develops, and thus parenting must change. For example, beyond tending to the infant’s biological needs, the task for the parent of infants and young toddlers is the establishment of secure attachments . A child in the suburbs may sustain ozone exposure that is as high as, or even higher than, the exposures of an inner-city child. In contrast, particulate matter less than 2.5 microns diameter (Pm2.5), which can affect respiratory function, may vary from block to block.

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• The built environment plays a major role in promoting or hampering physical activity in children.
• Schools, parks, and even sidewalks that are integrated into the design of a community can encourage physical activity.
• Factors influencing playground injury prevention include supervision, age-appropriateness of equipment, suitable fall surfaces, and equipment maintenance.
• For example, physical activity among youth increases when schools offer such facilities as basketball courts and sports fields .

Newborn screening identifies infants with phenylketonuria, enabling dietary modification that avoids adverse manifestations of the disorder. Electronic media have become an integral part of everyday life for many children in the United States and thus warrant explicit discussion. Children spend more time watching television than in any other single activity except sleep .

A child living near a busy intersection or near a heavily traveled website truck route may sustain considerably more particulate exposure than a child living in a quieter neighborhood several blocks away. Automobile crashes are the leading cause of death among children over a year old. In 2000, 2,343 children under age 15 were killed in traffic crashes, including 1,668 who were passengers, 469 who were pedestrians, and 175 who were on bicycles. That same year, 291,000 children under 15 years of age were injured in traffic crashes, including 248,000 who were passengers and 22,000 who were pedestrians. On an average day, 6 children are killed and 797 are injured in motor vehicle crashes.

Children between the ages of 2 and 17 spend an average of 4.5 hours a day in front of screens, watching television, playing video games, and using the computer . The potentially adverse consequences of television viewing led the American Academy of Pediatrics to recommend that children under 2 years old should not watch television, and older children should not have television sets in their bedrooms .