AMERICAN ACADEMY OF PEDIATRICS POLICY STATEMENT Organizational Principles to Guide and Define the Child Health Care System and/or Improve the Health of All Children Committee on Environmental Health Radiation Disasters and Children ABSTRACT. The special medical needs of children ism involving chemical and biological weapons have make it essential that pediatricians be prepared for radi- recently occurred, raising fears about the intentional ation disasters, including 1) the detonation of a nuclear use of a radioactive device against a civilian popula- weapon; 2) a nuclear power plant event that unleashes a tion that includes children. Because of these threats, radioactive cloud; and 3) the dispersal of radionuclides there is a need for pediatricians to become more by conventional explosive or the crash of a transport informed about the issues that would occur in the vehicle. Any of these events could occur unintentionally or as an act of terrorism. Nuclear facilities (eg, power case of a significant radiologic event. plants, fuel processing centers, and food irradiation fa- cilities) are often located in highly populated areas, and HISTORY as they age, the risk of mechanical failure increases. The short- and long-term consequences of a radiation disaster Several historical events have shaped our under- are significantly greater in children for several reasons. standing of the consequences of radiation disasters. First, children have a disproportionately higher minute The atomic bomb blasts in Hiroshima and Nagasaki ventilation, leading to greater internal exposure to radio- in 1945 during World War II remain the most defin- active gases. Children have a significantly greater risk of ing moments in the consequences of a nuclear expo- developing cancer even when they are exposed to radia- sure. The Avalon Project at Yale Law School1 esti- tion in utero. Finally, children and the parents of young mated that in Hiroshima, the bomb released power children are more likely than are adults to develop en- equal to 15 kilotons of trinitrotoluene (TNT), killing during psychologic injury after a radiation disaster. The pediatrician has a critical role in planning for radiation an estimated 66 000 and injuring 69 000 of the 255 000 disasters. For example, potassium iodide is of proven exposed. The Nagasaki release, containing a 22-kilo- value for thyroid protection but must be given before or ton force, killed an estimated 39 000 among the soon after exposure to radioiodines, requiring its place- 195 000 exposed. In 1954, fallout from nuclear weap- ment in homes, schools, and child care centers. Pediatri- ons tests on Bikini Island fell on neighboring islands, cians should work with public health authorities to en- producing significant health effects in children; of 32 sure that children receive full consideration in local Marshallese exposed to fallout before 20 years of age, planning for a radiation disaster. 4 developed thyroid cancer and 1 developed leuke- mia.2 This event led the American Academy of Pe- ABBREVIATIONS. TMI, Three Mile Island; KI, potassium iodide; diatrics to establish the Committee on Radiation SI, International System of Units; CT, computed tomography Hazards and Congenital Malformations, the prede- (scan); NRC, Nuclear Regulatory Commission; FDA, Food and cessor to the Committee on Environmental Health.2 Drug Administration. On March 28, 1979, a nuclear power plant, Three Mile Island (TMI), had a near “meltdown” (overheat- INTRODUCTION ing of the fuel rods and a release of radiation) that everal large-scale radiation disasters have be- produced negligible doses among people living near- fallen children in the past, including the deto- by: a maximum of 0.001 Sv (100 mrem) and an aver- Snation of nuclear bombs in Hiroshima and Na- age dose to the community of 0.00001 Sv (1 mrem).3 gasaki, Japan; the nuclear power plant disaster in The TMI accident brought into question the safety of Chernobyl; and exposure to a cesium-127 source nuclear power plants and the potential consequences scavenged from an abandoned hospital in Brazil. In of a power plant mishap.4,5 Immediate administra- each case, postevent medical surveillance proved tion of potassium iodide (KI) was recommended for that children were disproportionately affected after those living near TMI, but it was not available. There radiation exposure. were no biological effects of the exposure but signif- In recent years, accidents at several nuclear power icant psychologic sequelae occurred.4,5 plants have proven such events can lead to the wide- In April 1986, a power plant in Chernobyl (also spread discharge of radioactive materials into the known as Chornobyl), Ukraine, had a mishap that environment. Additionally, acts of domestic terror- produced a meltdown. The area around the reactor was heavily contaminated with plutonium, cesium, PEDIATRICS (ISSN 0031 4005). Copyright © 2003 by the American Acad- and radioactive iodine. An estimated 120 million Ci emy of Pediatrics. of radioactive material were released, contaminating Downloaded from www.aappublications.org/news by guestPEDIATRICS on September 26, Vol. 2021 111 No. 6 June 2003 1455 more than 21 000 km2 of land, with the greatest areas they would not produce significant damage to of fallout occurring in Ukraine, Belarus, and the Rus- nearby structures, these devices could render an area sian Federation.6,7 Approximately 135 000 people uninhabitable; as little as 1 Ci of radioactive material were permanently evacuated.8 A total of almost 17 can be dispersed several blocks, forcing evacuation million people, including 2.5 million younger than 5 and closure of that area. years of age, were exposed to excess radiation.7 The In the United States, there are 103 active nuclear first delayed effect, beginning 4 years after exposure, reactors in 66 power plants across 31 states.16 Nu- was the occurrence of a great excess of cases of clear power plants pose several distinct radiation thyroid cancers in children and adolescents, espe- risks. The most important of these risks is the poten- cially among those younger than 4 years of age at the tial for release of radioiodines into the environment. time of the accident.9 Seventeen years later, the area Additionally, spent reactor fuel rods, which are typ- remains uninhabited because of persistent concerns ically retained by the nuclear power plant for many about environmental contamination. years, present a radiation hazard that is distinct from On September 13, 1987, in Goiania, Brazil, a lead an incident that releases a radioactive cloud. canister containing 1400 Ci of radioactive cesium was Since the 1990s, the possibility of a terrorist group left in a building when it was abandoned by radio- creating a nuclear weapon has become more possi- therapists. The canister was taken and opened by ble.17 A low-yield detonation device (Ͻ10 kilotons) looters. Children played with the material inside, would require only a small amount of plutonium or rubbing it on their bodies so they glowed in the highly enriched uranium, both of which are thought dark.10 An estimated 250 people were exposed, with to be obtainable in the current era.10 some receiving radiation doses as high as 10 Sv (1000 rem); 4 died of acute radiation sickness.11 Victims developed radiation-associated illnesses that ranged RADIATION CHARACTERISTICS AND from significant skin injury (radiation burns) to acute TERMINOLOGY radiation sickness to long-term health problems. Unstable atoms, in an effort to achieve stability, Thousands of people rushed to emergency depart- emit energy in the form of ionizing radiation. Ioniz- ments because of fear of contamination.10 Mitigation ing radiation is a type of high-frequency energy that efforts required the removal of 6000 tons of clothing, has adverse biologic effects, including damage to furniture, dirt, and other materials.12 DNA, production of free radicals, disruption of chemical bonds, and production of new macromole- SOURCES OF POTENTIAL RADIATION EXPOSURE cules.17,18 Ionizing radiation can be particulate and Humans are exposed to an estimated average of electromagnetic. Radionuclides, elements that emit 0.0036 Sv (360 mrem) of radiation annually. This ionizing radiation, exist naturally (eg, uranium) or radiation exposure comes from a number of natural can be manmade (plutonium). and manmade sources, including cosmic radiation There are 5 types of ionizing radiation: ␣-particles, and radon, cigarette smoke, medical devices, home ␤-particles, ␥-rays, x-rays, and neutrons.14 Each has appliances, and pharmaceutical agents. Air flight is different characteristics and behaviors. ␣-Particles associated with cosmic radiation exposure; a flight consist of 2 protons and 2 neutrons; they are ex- from New York to London results in an estimated tremely heavy with a limited ability to penetrate 0.00005 to 0.0001 Sv (5–10 mrem) of radiation expo- clothing or skin. However, when inhaled or ingested, sure. Radiation exposure from medical radiography they can penetrate epithelial tissue layers to a 50-␮m can range from 0.00005 to 0.0001 Sv (5–10 mrem) for depth, sufficient to produce cellular injury (explain- a chest radiograph to as much as 0.05 Sv (5000 mrem) ing the association between the ␣-emissions of in- for computed tomography (CT).13 haled radon and development of lung cancer). ␤-Par- Radiologic threats can be unintentional or inten- ticles, consisting of electrons only, have greater tional. Unintentional threats include power plant di- penetrance than do ␣-particles.