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Child labor or youth work is defined in the United States as employment of children less than 18 years of age. While adolescents under age 18 are usually thought of as students, by senior year of high school 75% of U.S. teens are also working in a formal setting as employees.1 More than five million U.S. children and adolescents are estimated to be legally employed after school, on weekends, and during the summer (U.S. Department of Labor). Several million more are believed to be employed under conditions that violate wage, hour, and safety regulations, and an uncounted additional segment work in areas that are not even covered by child labor laws.2 Even as freshmen at age 14, almost a quarter of students hold jobs, and work in informal arrangements such as yard work, babysitting, work in family, or community agriculture is common much earlier.3 Despite the existence of laws that are intended to protect them, the number of young U.S. workers under age 18 who die each year has remained relatively constant in the past few years at about 68 per year; rates of younger teen occupational death are actually rising,1 and more than 200,000 teens continue to be injured on the job every year.4 Child and adolescent work-related injuries and exposures and their resulting health effects are not just remnants of Dickensian history but remain an important public health issue in the twenty-first century, as the following cases illustrate. Each of the cases represents a sentinel health event, a single isolated event that serves as a marker for a whole group of youth at potential risk of exposure, injury, or death.

Case 1: A 16-year-old boy cleaning a grill in a Kentucky fast-food restaurant collapsed and died, despite rapid emergency medical response. He had no history of cardiac problems, huffing solvents, or other drug use. The cleaning solution was an unknown mixture of substances, but analysis was unfortunately impossible as it was thrown out during all the activity. Concern remains that the cleaning mixture, when heated, may have released fumes causing a fatal arrhythmia. Since fast food is one of the major industrial segments hiring youth, and most youth who work in food service end up also performing cleaning tasks of some type with cleaning chemicals at the end of their shift this unresolvable case continues to cause concern. (Kentucky Fatality Assessment and Control Evaluation program, personal communication 1994 and subsequent discussions with county Coroner.)

Case 2: A 17-year-old boy running a thriving T-shirt printing business out of his bedroom presented to adolescent clinic one cold Pittsburgh winter with fatigue and elevated liver enzymes. His symptoms and physical findings were felt to be a result of his solvent exposure. His family had inadequate resources to purchase a spray booth, but were also unwilling to see him give up his lucrative business. As a compromise, they agreed to ...

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