Pediatric Environmental Health Questionnaire (PEHQ)

2. Allergens: Does the child develop any of the following symptoms when exposed to specific foods/food groups: Stuffy nose, cough, wheezing, rashes, tummy complaints, mood changes/difficulty concentrating? *

3. Solvents/VOCs: Is the child exposed to the following types of chemicals: Dry cleaning, attached garage, wood stove, busy streets, hobbies with chemicals, home remodeling, standard cleaning products, etc.? *

4. Pesticides: Does the child have exposure to any of the following: Conventional diet, US public school meals, golf courses, vineyards, farms, pets treated with chemicals, etc.? *

5. Metals: Does the child have any of the following types of exposures: Broken mercury thermometer, fluorescent bulbs, silver amalgams, regular fish consumption, living in an old home built before 1978, etc.? *

6. Mold: Has the child been exposed to visible mold or water damage at home or school, or been symptomatic when exposed to central air or heat, etc.? *

7. Plastics: Does the child have exposure to any of the following: Canned/plastic-wrapped food (especially microwaved), plastic orthodontic devices, plastic water bottles, pacifiers, etc.? *

8. Personal Care Products: Is your child exposed to any of the following personal care products: Fabric softener sheets, fluoridated toothpaste, scented products, hair products/dyes, make-up, sunblock, etc.? *

9. Persistent Organic Pollutants (POPS): Has the child been exposed to any of the following personal care products: Dump or Super Fund sites, an industrial plant, non-stick cookware (Teflon), flame retardants (pajamas), etc.? *

10. Electromagnetic Frequencies (EMFs): Is the child exposed to any of the following at home or school: Power stations, Smart Meters, cell towers, dimmer switches, Wi-Fi/routers, cell phones, an Alexa-type voice assistant, smart watches, baby monitors, etc.? *