The NYSCHECK Centers are committed to supporting healthcare professionals as they address pediatric patients and their families’ environmental concerns. An environmental history helps healthcare professionals better understand their patients’ environments, identify and mitigate environmental hazards, diagnose and treat health conditions, and promote healthy environments. 

This page is intended to guide clinicians on taking an environmental health history and tailoring the history to fit a variety of clinical settings.  

For additional levels of information or support, see the Resources linked below or  contact your local NYSCHECK center or regional PEHSU.

What is an environmental history?

An environmental history is a set of questions designed to provide a clinician with a better understanding of potential hazards in a patient’s environment. The environment can be defined as where we live, work, play, learn, and sleep. We are learning more and more about how our environment impacts health. Healthy People 2030 identifies “Neighborhood and Built Environment” as one of the domains that makes up social determinants of health.1 Taking an environmental history can be an important part of understanding the full clinical picture for a patient. An environmental history can be very comprehensive and dive deep into every potential exposure in a patient’s environment, or it can be brief and focused on a specific aspect of their environment or a specific hazard. It can also be used in different ways:

  • Diagnose and treat: An environmental history may be used as a part of a typical history that is used to diagnose and treat patients. For example, a patient may present with worsening asthma. It may be helpful to understand if there are any home asthma triggers, such as pests or mold, that are contributing to this patient’s worsening asthma. 
  • Screen: An environmental history may be used to screen vulnerable patients for environmental exposures. This screening can then be used to educate patients around risk reduction strategies as well as provide patients with resources to better understand the health risks and ways to mitigate them. While here we focus on children, even in adults an environmental screen can be important. For example, for patients who just finished therapy for lung cancer, it may be beneficial to screen them for poor air quality in their community or home and provide them with resources around decreasing exposure to air pollution.

The environmental history, as with all histories that are obtained in medicine, is incredibly dynamic. It is flexible to meet the needs of different patient populations, different patient ages, different clinical settings, and different clinical time demands. Additionally, an environmental history can change over time. An example is lead screening. It is imperative to screen for lead exposures in babies given their hand-to-mouth behaviors that make them particularly vulnerable to lead poisoning. However, as the child ages out of the toddler years and those hand-to-mouth behaviors, it may not be as pertinent to ask a family about lead exposures. 

The Agency for Toxic Substances and Disease Registry (ATSDR) has more information on taking an environmental history: Environmental Medicine Education Resources. The American Academy of Pediatrics (AAP) also has information: Taking an Environmental History.

EVERYONE! An environmental history can be incorporated into many different aspects of a clinical visit. The goal and focus of the visit as well as clinical flow will help determine who is best positioned to take the environmental history .

Some people who may take an environmental history include:2

  • Health care professionals working with infants, children and adolescents including pediatricians, family medicine physicians, nurses, other primary care providers, and trainees
  • Social workers, public health professionals, home visitors, or community health workers, who visit the home, school, playground or other places where children spend time
  • Parents or caregivers, through self-administered questionnaires 

ANYTIME! An environmental history is dynamic and can be taken throughout the clinical course. It can be taken prior to symptom development and used as a screening tool to inform risk reduction counseling and resource allocation. It can also be used to diagnose health conditions in patients that are symptomatic. This includes diagnosing health conditions caused by environmental exposures, such as lead poisoning, and decreasing symptom burden or exacerbations caused by environmental exposures, such as decreasing asthma environmental triggers. The environmental history can also be taken to guide treatment.

It should be noted that the environmental history can change over time. It is of particular importance to understand a patient’s environmental exposures during specific ages where growth and development make individuals more susceptible to environmental exposures. This resource breaks down environmental health guidance by age: Pediatric Environmental Health: e-Toolkit for Prevention. These windows of vulnerability include childhood and the perinatal period.3 However, it is also important to take an environmental history anytime there are changes in a patient’s health conditions, development, or environment. This doesn’t need to be burdensome and should be driven by the goals and purposes of a clinical visit. 

An environmental history does not need to be time consuming and comprehensive. The questions may differ depending on if they are for screening versus diagnosing/treating. There are multiple environmental health screeners available; however, there is not currently a validated one. To diagnose/treat, the questions asked are very similar to working up other health-related conditions. Overall, the questions should be focused on meeting the needs of the patient, guiding clinical care, and reducing or preventing environmental exposures.

The environmental history can include questions related to:4 

The home: 

  • What is a family’s zip code? This can be helpful for understanding extreme weather risks, air pollution exposure, the age of the neighborhood/housing, and other environmental exposures.
  • Does the family own or rent their home? When was the home built?
  • What is the home environment like? Are there cracks, maintenance issues, mold growth, lead paint, gas appliances, renovations underway, or pests? 
  • Does the family have working smoke detectors and carbon monoxide detectors?
  • Does the family use or store pesticides in the home?
  • What type of water does the family use- well water vs municipal water supply?

Diet:

  • Ask about a family’s diet?
    • Do they have any increased risk for mercury exposure from eating fish?

Tobacco/Smoke:

  • Does anyone in the family smoke and/or use other nicotine products?
  • Does the family have working smoke detectors?

Sun:

  • What is the family’s plan for sun exposure?
  • What is the family’s plan for extreme heat days?

Water: 

  • Where does the family get their water from?
  • Has it been tested?

Work:

  • Are there any occupational exposures either take-home exposures from caregivers/parents or from the child?

It should be noted that environmental exposures can happen anywhere in which an individual spends time. Thus, the questions may also need to include the work environment and/or school environment.

A mnemonic that may be helpful in guiding the environmental history is below: 

Environment Example Questions
C Community Do you live in a community affected by wildfires?
H Home What year was your home built? Do you use pesticides in your home?
H Hobbies Do your hobbies include using chemicals, such as varnishes or lead-based paints?
O Occupation (School) Where do you work? What is the air quality like at school?
P Personal Habits What type of personal care products do you use?
D Diet What is your drinking water source? What type of fish do you eat?
D Drugs Are you taking any home remedies?
Adapted from: CMAJ 2002;166(8):1049-55

For a thorough list of anticipatory environmental guidance by child age, visit Pediatric Environmental Health: e-Toolkit for Prevention or consult the “Green Book,”  AAP’s policy manual on pediatric environmental health.

There are also resources that contain environmental histories that are specific to certain environmental exposures or that are specific to certain vulnerable groups:

For more information about environmental exposures for providers, visit Tips for Pediatric Clinicians: Talking to Patients about Environmental Health Concerns.

    1. 2030; HP. Neighborhood and Built Environment. US Department of Health and Human Services. Accessed January 27, 2026. https://odphp.health.gov/healthypeople/objectives-and-data/browse-objectives/neighborhood-and-built-environment
    2. Organization WH. Children’s environmental health: The paediatric environmental history. Accessed January 27, 2026. https://www.who.int/news-room/questions-and-answers/item/q-a-the-paediatric-environmental-history
    3. Wright RO. Environment, susceptibility windows, development, and child health. Curr Opin Pediatr. Apr 2017;29(2):211-217. doi:10.1097/MOP.0000000000000465.
    4. 4. Pediatrics AAo. Taking an Environmental History. Accessed January 27, 2026. https://www.aap.org/en/patient-care/environmental-health/promoting-healthy-environments-for-children/taking-an-environmental-history/

Updated: Sophia Milazzo, Lara Mattei-Dávila, Hannah Thompson, 1/27/2026