Are you having back pain with any of the following?

  • Severe pain, weakness or tingling in your leg(s).
  • Difficulty stopping urination or loss of control of bladder or bowels.
  • Unexplained fever, nausea or vomiting.
  • A history of cancer or unexplained weight loss.

We understand that you are experiencing one or more of the health issues that might be impacting your back pain.

We recommend that you discuss these health issues with your doctor before proceeding with this program.

Once you are cleared by your doctor to do this program, we hope it helps you find relief from your back pain.

Environmental Health and Your Child


Children are more vulnerable than adults to harmful substances in the environment. They breathe more air, drink more liquid, and eat more food per pound, thus exposing them to greater environmental toxins. Young children also are exposed to toxins when they crawl on the floor, touch things, and put their hands in their mouths.

Children may become sick or develop allergies or other respiratory problems, such as asthma, after being exposed to harmful environmental substances. Environmental toxins can also interfere with a child’s normal growth and learning (cognitive development). In severe cases, exposure to environmental toxins can be life-threatening.

It is important to learn how to reduce your child’s risk of exposure to harmful substances in the environment.

Types of Environmental Threats

You may be aware of certain environmental toxins that can harm your child, such as those in lead, household cleaning products, polluted water, tobacco smoke, and contaminated fish. However, a few lesser-known environmental health risks can also harm a child’s health.

Reduce your child’s exposure to these substances to prevent potential health problems:

Food pesticides

Food pesticides are poisons used to keep bugs out of our food supply. Pesticides are used on many foods regularly eaten by children, such as apples, apple sauce, orange juice, potatoes, berries, and eggs, and in meats from animals that graze or peck on grasses sprayed with pesticides, such as pork, chicken, and beef.

While the United States government monitors the amount of pesticides on food, we recommend that you thoroughly wash and peel the fruits and vegetables your child eats to remove pesticide residue.

Antibacterial agents

Antibacterial agents are often placed in products such as liquid soap, detergents, and toothpaste to stop the growth of bacteria. Many common household cleaning products also contain antibacterials. Some amount remains on a child’s hands after he or she uses an antibacterial or on a shared object, such as a toy. This can cause skin irritation or allergies in your child.

It is also possible that overuse of antibacterial products might create “superbugs,” or resistant bacteria that are not easily destroyed with antibacterial products.

Phthalate and BPA substances

Phthalates (THAL-ates) are oily, clear liquids used to make plastic softer and more flexible. Many toys are made with phthalates. Some personal care products, such as shampoo and perfume, contain phthalates. Phthalates are also found in children’s backpacks.

A child can be exposed to phthalates before birth from a mother who has a high level of phthalates while pregnant, usually as a result of exposure to cosmetics or perfumes that contain phthalates. The United States government has currently banned the use of a certain amount of phthalates in toys and children’s eating and sleeping products.

BPA (bisphenol-A) is a chemical used to harden plastic. It was commonly used to make baby bottles, sippy cups, baby formula cans, and other baby products. It was also used to make water bottles. Most companies no longer use BPA to make baby bottles and other baby products, although older products still contain BPA.

Fire retardants

Fire retardant chemicals (called polybrominated diphenyl ethers, or PBDEs) are commonly used to make household products, such as electronics, upholstery, carpets, and furniture, including the foam in couches. PBDEs may also be found in strollers, nursing pillows, car seats, and mattress pads.

Dust particles that contain PBDEs leak (leach) into the air from these products, and then your child inhales the contaminated dust. PBDEs are stored in fat cells where they continue to build up in your child’s body. Your child can also be exposed when you are pregnant and unknowingly inhale PBDEs.

PBDEs were added to household items in the 1970s to make products more fire-proof. California banned the use of these chemicals, but they still exist in household goods made before 2004. Most children (about 97 percent) have been exposed to PBDEs.

Related Health Problems

A child is at risk of developing the following health problems after exposure to the harmful environmental substances:

Food pesticides

Pesticides may block a child’s body from absorbing important nutrients needed for healthy growth and development. Children’s immature digestive systems may not fully eliminate food pesticides through their bowel movements. A high level of pesticides could permanently change the way your child’s body functions, especially if he or she absorbs pesticides during a critical stage in brain and nervous system development.

Acute exposure. If children suddenly absorb a large amount of pesticide, they might develop headaches, dizziness, muscle weakness, or twitching. They might feel nauseated or feel a tingling sensation in their muscles (similar to your foot or hand falling asleep).

Chronic exposure. If a child is exposed to food pesticides over a long period of time, he or she may develop learning disabilities, behavioral changes such as attention deficit hyperactivity disorder (ADHD), organ damage, asthma, and possibly serious diseases including leukemia and other forms of cancer.


Using antibacterial products to kill germs can cause skin and eye irritation. Your child may also develop food and other types of allergies. Although the reason is not clear, it is possible that your child’s immune system becomes weaker when antibacterials do the work instead. The result is that your child’s immune system cannot prevent or fight off normal childhood bacterial infections.

Most bacteria are harmless. Some bacteria are even healthy and are supposed to be in your child’s body to help the immune system function properly. Unfortunately, antibacterial agents kill both good and bad bacteria.

Phthalates and BPA substances

Children exposed to phthalates are more likely to have behavioral problems such as aggression and difficulty paying attention. It is possible that phthalates may interfere with a child’s brain development during crucial growth times. The higher the levels of phthalates a child has, the more severe the symptoms.

Children exposed to BPA may be at greater risk of developing certain health conditions such as obesity, abnormal hormone levels, brain and behavior problems, and ADHD. However, research is ongoing to confirm a connection.

Fire retardants

High levels of PBDE can cause problems with the way a child’s brain develops.

Children who are exposed to high levels of PBDEs from birth have problems with behavior, paying attention, and fine motor skills, and they have a lower IQ. For example, children may have trouble picking up objects between their fingers and thumb, such as using a pencil to write or holding a fork to eat. Children usually master fine motor skills between the ages of 6 and 12 years.

Other possible health problems from high PBDE exposure include thyroid disorders, learning disabilities, problems with memory, and hearing loss.


If you think your child has been exposed to environmental toxins, call us to schedule an appointment. It is important to diagnose high levels of harmful environmental substances early so your child does not suffer delays in normal development.

It is important that we see your child for regular checkups to monitor his or her development and growth. We are then able to identify any potential problems early on.

We typically order blood tests to measure the levels of environmental substances in your child.

Call us to schedule an appointment if your child:

  • Gains or loses a lot of weight.
  • Develops a skin rash.
  • Has difficulty breathing.
  • Complains of frequent sore throats.
  • Has problems sleeping.
  • Develops behavioral problems at school or home.
  • Shows signs of infection, such as fever over 102°F, reddish or warm skin, or a draining sore.

Risk Factors

Children are at risk of having problems from exposure to harmful environmental substances because they:

  • Eat more food, inhale more air, and drink more liquids per pound than adults.
  • Play and crawl on floors, carpets, and lawns where more toxins are present.
  • Put their hands in their mouths regularly.
  • Eat foods that contain higher levels of pesticides, such as apples, orange and apple juices, and eggs.
  • Are still developing their brains and nervous systems, making them more vulnerable to health problems.

Most babies are exposed to PBDEs when breastfeeding because nearly all mothers have a measurable amount of PBDE that concentrates in breast milk. However, the benefits of breastfeeding still outweigh the risks. If you are concerned, let us know so we can talk about it.

People who do not replace older furniture and electronics are also at greater risk of harmful environmental toxin exposure. As these products break down or tear, harmful PBDEs escape as dust, where they are inhaled.

Reduce Your Child’s Exposure to Food Pesticides

While the United States federal government monitors the amount of pesticides in the food supply, we recommend that you follow these general guidelines to reduce the amount of pesticides in your child’s diet:

  • Wash and peel all fruits and vegetables using a large amount of tap water.
  • Vigorously scrub fruit and vegetables that cannot be peeled with a brush under running water.
  • Peel and throw away outer leaves of lettuce, cabbage, and other leafy vegetables.
  • Trim all visible fat from meat (pesticides build up in fatty tissue).
  • Remove skin and fat from chicken and other poultry after cooking.

If possible, buy organic, pesticide-free vegetables, fruits, and meats. Because organic food is more expensive, you may want to focus on the foods that contain the highest amounts of pesticides, called the “dirty dozen.” These foods are:

  • Apples
  • Celery
  • Cherry tomatoes
  • Hot peppers and sweet bell peppers
  • Nectarines (imported)
  • Peaches
  • Strawberries
  • Grapes
  • Leafy greens such as spinach, kale, and collards
  • Cucumbers
  • Summer squash
  • Potatoes

If you are not able to buy organic foods, be sure to thoroughly wash and peel the fruits and vegetables your child eats.

The following produce has low pesticide levels. You do not need to buy organic:

  • Onions
  • Sweet corn
  • Pineapple
  • Avocado
  • Cabbage
  • Sweet peas
  • Asparagus
  • Mangoes
  • Eggplant
  • Kiwi
  • Locally grown cantaloupe
  • Sweet potatoes
  • Grapefruit
  • Watermelon
  • Mushrooms

Many commercial baby foods might also contain measurable amounts of pesticides (especially green beans and pears). If you are able, prepare your baby’s food at home using organic fruits and vegetables for the “dirty dozen” items. If you are unable to make your own baby food, try to buy organic baby food when you can.

Reduce Your Child’s Exposure to Antibacterials

Antibacterial soaps are not better at washing away germs than regular soap and warm water. Your child should avoid using products that contain antibacterials, such as liquid soap, toothpaste, and mouthwash.

Unless we recommend an antibacterial soap or other product, have children frequently wash their hands with regular soap and warm water to remove germs. Children should wash for about 15 seconds, so have them sing a song that lasts about 15 seconds, such as “Happy Birthday” or “Twinkle, Twinkle, Little Star,” and repeat it once while washing.

When water is not available, you can occasionally use antibacterial hand gel but be sure children rinse their hands as soon as water is available and before eating.

Reduce Your Child’s Exposure Phthalates and BPA

Try to reduce or eliminate your child’s exposure to phthalates and BPA by doing the following:

  • Buy products that are marked “phthalate-free” and “BPA-free.”
  • Buy BPA-free infant formula. 
  • Don’t reheat food in plastic containers or covered in plastic wrap in the microwave.
  • Avoid plastics with the numbers 3, 6, or 7 on the bottom of the product.
  • Store leftover food in glass or stainless steel rather than plastic.
  • Discard baby bottles, sippy cups, glasses, toys, and other plastic products that are cracked or chipped.
  • Buy fresh or frozen foods instead of canned foods (cans are often made with BPA).
  • Don’t place plastic containers in the dishwasher.
  • Avoid putting hot liquid in baby bottles, sippy cups, or water bottles that may contain BPA.
  • Use a safe plastic that has the number 1 on the bottom or use glass containers to store and reheat food.

Reduce Your Child’s Exposure to Fire Retardants

Most homes contain many products made with fire retardants, but you can reduce the amount of exposure for your child by:

  • Taping or sealing all tears in furniture
  • Keeping dust levels down by regularly cleaning with a damp mop and HEPA-filtered vacuum
  • Buying new furniture, bedding, and pillows that do not contain fire retardants, such as those made with cotton, wool, and polyester
  • Buying products that are marked as “flame-retardant-free”
  • Avoiding furniture that contains foam labeled “TB 117”
  • Buying wooden furniture instead of upholstered furniture
  • Using fewer carpets and drapes in your home (many are treated with fire retardants)

If you have small children who crawl on carpet, wash their hands frequently to reduce hand-to-mouth contact with fire retardant chemicals.

Cell phones, remote controls, and other electronics contain fire retardants. Do not let young children touch or put their mouths on these items.

Your Child's Care with Me

If you are concerned about your child’s symptoms, and your concerns are urgent, please contact our Appointment and Advice line, which is available 24 hours a day, 7 days a week. 

Our advice nurses can give you immediate advice, and our telephone staff can send me a message or schedule an appointment for your child. 

Depending on your child’s symptoms and medical history and your preferences, the nurse may:

  • Provide advice about how to care for your child at home.
  • Send me a message so I can follow up with you directly.
  • Offer you a telephone appointment with me or a trusted colleague.
  • Make an appointment for your child to be seen in person.

Whether by phone or in person, we will discuss your child’s symptoms and medical history, and address your concerns. Together we will create a treatment plan to help your child feel better.

You can connect with me in a variety of ways, depending on the situation and what is most convenient for you at the time. I am available online, by telephone, or in person.

  • For nonurgent questions or concerns, you can e-mail me using this site, once you have registered to use the Act for a Family Member feature. You can also schedule an appointment online to see me in person.
  • If your concerns are immediate, or you simply prefer to use the telephone, please call our Appointment and Advice line, which is available 24 hours a day, 7 days a week. Our advice nurses can give you immediate advice, and our telephone staff can send me a message or schedule an appointment for your child.
  • Depending on your child’s symptoms, you may also have the option to schedule a telephone appointment – with me or another pediatrician, if I am unavailable. Please let the telephone staff know what you prefer and what is convenient for you.

Coordinating Your Child's Care

Having all of our Kaiser Permanente departments located together or nearby, including pharmacy, laboratory, radiology, and health education, makes getting care for your child easier.

Another major benefit is our comprehensive electronic medical record system, which allows all of the doctors and clinicians involved in your child’s care to stay current on your child’s health status and to collaborate with each other as appropriate.

When every member of the health care team is aware of all aspects of your child’s condition, care is safer and more effective.

If you come to an office visit
  • At the beginning of your child’s visit, you will receive information about when he or she is next due for a well child visit (checkup) and immunizations. We can discuss and schedule any preventive tests that may be needed. 
  • At the end of your child’s visit, you may receive a document called the “After Visit Summary” that will summarize the issues we talked about during the visit. You can refer to it if you forget what we discussed, or if you just want to recheck your child’s height, weight, or vital signs. (If your child is under age 12, you can also view these summaries online, under Past Visits.)
If you schedule a telephone appointment
  • In addition to in-person visits, we now offer the option of telephone appointments for certain common pediatric concerns. Depending on your child’s symptoms, you may have the option to schedule a telephone appointment with me or another pediatrician, if I am unavailable. We will call you at an agreed-upon time, at whichever phone number is most convenient for you.
  • Many parents like this new option, but if you prefer to be seen in person, it’s always your choice. Just let the telephone staff know what type of visit you prefer.
  • Telephone appointments are not appropriate for all health concerns. The advice nurse can help you decide what type of care is best for you and your child.
If I prescribe medications

We will work together to monitor and assess how your child’s medications are working and make adjustments as needed. 

Prescriptions can be filled at any Kaiser Permanente pharmacy. Just let me know which pharmacy works best for you, and I will send the prescription electronically, in advance.

If refills are needed in the future, you can:
  • Order them online or by phone. Order future refills from my home page or by phone using the pharmacy refill number on your prescription label.
  • Have them delivered to you by mail at no extra cost. Or you can pick up your child’s medications at the pharmacy.
  • If no refills remain when you place your order, the pharmacy will contact me regarding your prescription.
If lab testing or imaging is needed

For lab tests, I will use our electronic medical record system to send the requisition to the Kaiser Permanente laboratory of your choice. For imaging procedures, such as X-rays, we will schedule an appointment with the Radiology Department. 

When the results are ready, I will contact you with the results by letter, secure e-mail message, or phone. In addition, you can view most of your child’s laboratory results online, along with any comments that I have attached to explain them.

If I refer your child to a specialist

My specialty colleagues are readily available to assist me if I need additional advice about your child’s condition. In some cases, I may contact them during your visit, so we can discuss your child’s care together. If we decide your child needs a specialty appointment after that discussion, we can often schedule it the same day or soon thereafter.

Convenient Resources for You

My goal is to provide high-quality care and to offer you choices that make your child’s health care convenient. I recommend that you become familiar with the many resources we offer so that you can choose the services that work best for you.

My Doctor Online is available to help you manage your child’s care at any time that is most convenient for you. From my home page you can:

Manage your child’s care securely

You can begin to manage your child’s care online by requesting access through our Act for a Family Member feature. Once you have added your child to your account, you can:

  • View and compose secure e-mail messages.
  • Manage your child’s prescriptions and refills.
  • Schedule well visit and nonurgent appointments.
  • View your child’s Preventive Services to see whether your child is due for any immunizations or well visits.
  • If your child is under 12, you can also view most lab test results and review information about past visits.
Learn more about your child’s condition
  • Read about causes, symptoms, treatments, and procedures.
  • Find interactive health tools, videos, and podcasts to help you manage your child’s condition.
  • View programs to help you decide on or prepare for a surgery or procedure.
Help your child stay healthy
  • Sign up for our online newsletters for parents, customized to your child’s age.
  • Locate health education classes and support groups offered at our medical center.
  • Explore interactive programs, videos, and podcasts that focus on helping you keep your child healthy.
  • Check to see when your child is next due for immunizations and a well visit (checkup).

Related Health Tools:


If you have an emergency medical condition, call 911 or go to the nearest hospital. An emergency medical condition is any of the following: (1) a medical condition that manifests itself by acute symptoms of sufficient severity (including severe pain) such that you could reasonably expect the absence of immediate medical attention to result in serious jeopardy to your health or body functions or organs; (2) active labor when there isn't enough time for safe transfer to a Plan hospital (or designated hospital) before delivery, or if transfer poses a threat to your (or your unborn child's) health and safety, or (3) a mental disorder that manifests itself by acute symptoms of sufficient severity such that either you are an immediate danger to yourself or others, or you are not immediately able to provide for, or use, food, shelter, or clothing, due to the mental disorder.

This information is not intended to diagnose health problems or to take the place of specific medical advice or care you receive from your physician or other health care professional. If you have persistent health problems, or if you have additional questions, please consult with your doctor. If you have questions or need more information about your medication, please speak to your pharmacist. Kaiser Permanente does not endorse the medications or products mentioned. Any trade names listed are for easy identification only.