About the ECHO Program

Understanding the effects of environmental exposures on child health and development is a priority for the National Institutes of Health. To advance knowledge in this area, NIH has launched a seven-year initiative called the Environmental influences on Child Health Outcomes (ECHO) program. While the goals of ECHO are consistent with those of the former National Children’s Study, the approach is different. ECHO is designed to capitalize on existing participant populations, and support approaches that can evolve with the science and take advantage of the growing number of clinical research networks and technological advances.


To enhance the health of children for generations to come.

ECHO’s Five Health Outcomes

ECHO supports multiple, synergistic, longitudinal studies using existing study populations, called cohorts, to investigate environmental exposures — including physical, chemical, biological, social, behavioral, natural and built environments — on child health and development. The studies focus on five key pediatric outcomes that have a high public health impact:

  • Pre-, peri-, and postnatal outcomes
  • Upper and lower airway
  • Obesity
  • Neurodevelopment
  • Positive health

Standardized Core Data Elements

The studies share standardized core data elements managed by a central coordinating center and an associated data analysis center. The core elements to be addressed across all studies are:

  • Demographics
  • Typical early health and development
  • Genetic influences on early childhood health and development
  • Environmental factors
  • Patient/Person (parent and child) Reported Outcomes (PROs)

Pediatric Clinical Trials Network

ECHO also supports the Institutional Developmental Award (IDeA) States Pediatric Clinical Trials Network to test prevention and treatment strategies among children from rural and medically underserved backgrounds. This 17-state network leverages the existing IDeA infrastructure by embedding clinical trials experts at IDeA state locations and facilitating their partnership with other academic institutions. This national network for pediatric research could help address access gaps for rural children by leveraging the infrastructure at existing IDeA state centers.

To support ECHO and other pediatric environmental exposures research, NIH awarded $144 million in new grants in fiscal year 2015 for the development of new tools to enhance measurement of environmental exposures.


The governance of the ECHO program is comprised of a senior program director, who reports directly to the NIH Director and works in concert with the principal investigators of the Coordinating Center and Data Analysis Center to form the ECHO Steering Committee leadership team. An External Scientific Board that reports directly to the NIH Director provides an external perspective to the ECHO Steering Committee leadership. The program is reviewed annually to determine if goals and milestones are being met, and whether additional adjustments need to be made or integrated to reflect new advances.