AAP Says Communities Must Be Ready to Care for Children During Potential Chemical and Biological Attacks

With children among the victims of chemical attacks and biological outbreaks in recent years, the American Academy of Pediatrics (AAP) calls on health care providers to be ready to recognize and respond when young patients are exposed to these events.

The AAP’s newly updated policy statement and technical report in the February 2020 Pediatrics (published online Jan. 27), both titled “Chemical-Biological Terrorism and its Impact on Children,” says attacks such as the 2017-18 chemical attacks by the Assad regime against civilians in Syria highlight the need for pediatricians, emergency responders, hospitals and public health officials to prepare for similar events that may affect U.S. children. Those attacks sickened and killed dozens of people, including many children.

A broad range of public health initiatives have been developed since the terrorist attacks of Sept. 11, 2001. The AAP raises concerns, however, that these initiatives many times have not ensured the protection of children. Some medical countermeasures for particular chemical and biological agents, for example, have not been adequately studied or approved for use in children.

“We’ve seen a growing number of disasters involving chemical attacks and infectious disease outbreaks in the world, and we realize these events could possibly happen in our communities. We want to be prepared to respond to the needs of children, who would be at greatest risk of exposure and harm,” said Dr. Sarita Chung, MD, FAAP, a lead author of the report and a member of the AAP Council on Disaster Preparedness and Recovery executive committee.

In chemical attacks, for example, children may be disproportionately affected because they would take in more contaminated air, food and fluids relative to their body weight than adults, said co-author Carl Baum, MD, FACMT, FAAP, a former AAP Council on Environmental Health executive committee member who now serves on the Council on Disaster Preparedness and Recovery executive committee.

“Children also spend more time closer to the ground, where toxic substances can settle. And they have a relatively larger body-surface area, which makes chemicals that touch the skin more dangerous for them,” Dr. Baum said. He said that children also face greater long-term medical and mental health needs after exposure to these agents and terrorist events.

In addition to advocating for greater federal, state and local pediatric readiness for chemical and biological attacks, the policy statement and technical report offer resources to help pediatricians and others who care for children recognize and respond to symptoms of possible exposures. Pediatricians likely would be among the first to see children exposed to biological agents, which may have an incubation period and often mimic symptoms of common infectious illnesses.

“Pediatricians seeing a sudden surge of respiratory illness in children during a time of year when flu is not common, for example, should be prepared to quickly report these patterns to public health officials,” said Ann-Christine Nyquist, MD, MSPH, FAAP, a co-author and member of AAP’s Committee on Infectious Diseases.

Other recommendations include collaboration between pediatricians, emergency responders, hospitals and municipal and government agencies to develop plans for triage and treatment protocols. These might include child-appropriate decontamination procedures, use of personal protective equipment, and ready access to properly dosed medications and vaccinations, among other important countermeasures.

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