The Health Department released clinical guidelines for health care providers on how to treat children and adolescents exposed to the WTC disaster. The guidelines were written and reviewed in collaboration with external medical experts and other clinical advisors.
The World Trade Center Environmental Health Center at Bellevue Hospital has a pediatric program dedicated to the assessment and treatment of WTC-related conditions in children and adolescents. Parents who wish to make an appointment for a child who was exposed to the World Trade Center disaster and whom they believe is suffering from a health problem related to this exposure should call 877-WTC-0107.
What We Know from the Research
Among 3,184 children and adolescents enrolled in the WTC Health Registry: 1
- 22% experienced an eye irritation or eye injury on September 11, 2001 as a result of the WTC attack.
- Nearly half (45%) were caught in the dust cloud.
- 50% witnessed a disturbing event.
Children and adolescents in the WTC Health Registry have excellent access to health care: in 2007-2008, parents reported that nearly 98% had had a routine check-up with a primary care provider within the last 2 years.10
Among child and adolescent enrollees 2 to 3 years after 9/11: 1
- More than half (53%) had at least 1 new or worsened respiratory symptom, such as shortness of breath, sinus problems or wheezing.
- Young children caught in the dust cloud were twice as likely to have newly diagnosed asthma as children not caught in the dust cloud. About 6% of children under 5 years of age were diagnosed with asthma after 9/11, a rate twice as high as the regional (northeastern) rate for the same age group.
A study of lung function among 200 elementary school children in lower Manhattan's Chinatown suggests that those exposed to the WTC disaster may be more likely to be diagnosed with a respiratory illness eight years after 9/11.7
Six to seven years after 9/11, 14.4% of children and adolescents enrolled in the WTC Health Registry reported respiratory symptoms during the previous 12 months; of these, 74% had previously been diagnosed with asthma. WTC dust cloud exposure was associated with twice the risk for respiratory symptoms, in line with previous Registry dust cloud findings that showed twice the risk for new-onset asthma.10
A study of 148 children and adolescents who, on average, first sought care at the World Trade Center Environmental Health Center 8 years after 9/11 found an association between dust cloud exposure in childhood and decreased lung function. Patients who were exposed to dust in their homes also were more likely to be at greater risk for heart disease than children in a national survey.11
A high proportion of NYC public school children exposed to 9/11-related trauma developed a probable mental disorder. The level of exposure and previous trauma increased the likelihood of a mental health problem. A family member’s exposure to 9/11 was more strongly associated with a probable mental disorder than direct exposure, indicating that a parent or caregiver's 9/11-related trauma may have affected the child’s mental health.2
A survey of more than 8,200 New York City schoolchildren in grades 4 to12 conducted 6 months after 9/11 indicates that 40% of their families experienced at least 1 of 5 disruptions: family relocation, job loss, restricted travel, school closure and school relocation. After adjusting for sociodemographic characteristics, WTC exposure and prior trauma, youth reporting that their parents allowed them to travel less freely around the city after 9/11 were 3 times as likely to have PTSD as youth whose parents allowed them to travel without restrictions. Youth reporting family job loss were twice as likely to have PTSD as those who didn’t.9
A study conducted six months after 9/11 found that 18% of nearly 7,000 New York City public school students in grade 6 through 12 said they used mental health services, including those available in school, to talk about the terrorist attack. Direct exposure to the attack or probable diagnoses of PTSD or depression were associated with referral to mental health services outside school. Talking to a teacher or a religious leader also was associated with student use of external services, which reinforces the importance of training gatekeepers identify symptoms of psychological distress.12
In a study of 116 preschool children, those with prior traumatic experiences exposed to WTC-related trauma were at increased risk for developing sleep problems and behavioral issues. When evaluating the impact of terrorism and disaster on very young children, clinicians should consider disaster-related exposure and prior traumatic experience.3
A study of 200 middle school children in lower Manhattan suggests that children exposed to additional trauma, before or after 9/11, had more severe PTSD symptoms than those exposed to 9/11-related trauma alone, regardless of how directly they were exposed.4
Among 1,040 adolescents attending schools closest to the WTC site, 10% reported an increase in alcohol or substance use 18 months after 9/11. While the study didn’t include a general population comparison group to adjust for time or age trends, substance use rose with reported 9/11 exposure, even after controlling for depression and PTSD. For example, substance use among adolescents with 3 or more exposure risk factors was nearly 20 times higher as those with no exposure risk factors. Increased substance use was associated with impaired schoolwork, school behavior and grades.5
A small study of 102 pairs of mothers and their pre-school children exposed to 9/11 found that 3 years after 9/11:
- Children, especially boys, whose mothers had depression and PTSD were at greater risk for aggressive behavior, emotionally reactive behavior and physical complaints with no medical basis.6
A study of cord blood specimens of 210 infants whose mothers were pregnant on 9/11 and delivered in lower Manhattan hospitals found that those with higher PBDE levels scored lower on physical and mental development tests at one, four and six years of age. The study did not find a significant relationship between the level of chemicals and how close the mothers lived to the WTC site. Therefore, the relationship between WTC exposure and PBDE levels remains unclear.8
- Thomas, P, Brackbill R, Thalji L, et al. Respiratory and Other Health Effects Reported in Children Exposed to the World Trade Center Disaster of September 11, 2001 . Environmental Health Perspectives. 2008 October;116(10):1383-1390.
- Hoven CW, Duarte CS, Lucas CP, et al. Psychopathology Among New York City Public School Children 6 Months After September 11. Archives of General Psychiatry. 2005;62:545-551.
- Chemtob CM, Nomura Y, Abramovitz RA. Impact of Conjoined Exposure to the World Trade Center Attacks and to Other Traumatic Events on the Behavioral Problems of Preschool Children. Archives of Pediatric & Adolescent Medicine. 2008;162(2):126-133.
- Mullett-Hume E, Anshel D, Guevara V et al. Cumulative Trauma and Posttraumatic Stress Disorder among Children Exposed to the 9/11 World Trade Center Attack. American Journal of Orthopsychiatry 2008; 78(1):103-108.
- Chemtob CM, Nomura Y, Josephson L, et al. Substance Use and Functional Impairment among Adolescents Directly Exposed to the 2001 WTC Attacks. Disasters 2009; 33(3): 337-352.
- Nomura Y & Chemtob CM. Effect of Maternal Psychopathology on Behavioral Problems in Preschool Children Exposed to Terrorism. Archives of Pediatric & Adolescent Medicine 2009; 163(6): 531-539.
- Szema AM, Savary KW, Ying BL, & Lai K. High Asthma Rates Among Children in Chinatown, New York. Allergy & Asthma Proceedings 2010; 30(6):605-611.
- Herbstman JB, Sjodin A, Kurzon M, et al. Prenatal Exposure to PBDEs and Neurodevelopment. Environmental Health Perspectives 2010; 18:712-719.
- Comer JS, Fan B, Duarte CS et al. Attack-related Life Disruption and Child Psychopathology in New York City Public Schoolchildren 6-months Post-9/11. Journal of Clinical Child and Adolescent Psychology. 2010;39(4):460-9.
- Stellman SD, Thomas PA, Osahan S et al. Respiratory Health of 985 Children Exposed to the World Trade Center Disaster: Report on World Trade Center Health Registry Wave 2 Follow-up, 2007-2008. Journal of Asthma. 2013 Feb 18. [Epub ahead of print]
- Trasande L, Fiorino EK, Attina T et al. Associations of World Trade Center Exposures with Pulmonary and Cardiometabolic Outcomes among Children Seeking Care for Health Concerns. The Science of the Total Environment. 2012 Dec 29;444C:320-326.
- Graeff-Martins AS, Hoven CW, Wu P et al. Use of Mental Health Services by Children and Adolescents Six Months after the World Trade Center Attack. Psychiatr Serv. 2014 Feb 1;65(2):263-5.