Poisoning - Lead Exposure

Victoria Samonte
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Evaluation and Assessment
Lead screening typically starts at age 6 months to 12 months. Lead screening guidelines vary regionally, but the recommended minimum screening is at 1 and 2 years. The CDC and the American Academy of Pediatrics recommend that children under age 6 be tested for lead if they:
• Live in or regularly visit a house or day care center built before 1950
• Live in or regularly visit a house built before 1978 that has been remodeled in the last six months
• Have a brother, sister, house mate or playmate who is being treated for lead poisoning
• Live with a parent whose job or hobby involves exposure to lead
• Live near an active smelter, battery recycling plant or other industry likely to release lead into the air
• Have been seen eating paint chips or dirt
• Have low levels of iron in the blood (anemia)
• Have never been tested for lead

Table 2 discusses the guidelines for questions to ask regarding a child’s environmental history.

Table 2: Guidelines for questions to ask regarding a child’s environmental history
Table 2: Guidelines for questions to ask regarding a child’s environmental history
Paint and soil exposure
What is the age and general condition of the residence?
Is there evidence of chewed or peeling paint on woodwork, furniture, or toys? How long has the family lived at that residence?
Have there been recent renovations or repairs in the house?
Are there other sites where the child spends significant amounts of time? What is the character of indoor play areas?
Do outdoor play areas contain bare soil that may be contaminated? How does the family attempt to control dust/dirt?

Relevant behavioral characteristics of the child
To what degree does the child exhibit hand-to-mouth activity? Does the child exhibit pica?
Are the child’s hands washed before meals and snacks?

Exposures to and behaviors of household members
What are the occupations of adult household members?
What are the hobbies of household members? (Fishing, working with ceramics or stained glass, and hunting are examples of hobbies that involve risk for lead exposure.)
Are painted materials or unusual materials burned in household fireplaces?

Miscellaneous questions
Does the home contain vinyl mini-blinds made overseas and purchased before 1997?
Does the child receive or have access to imported food, cosmetics, or folk remedies?
Is food prepared or stored in imported pottery or metal vessels?

Reference: Managing Elevated Blood Lead Levels Among Young Children: Recommendations from the Advisory Committee on Childhood Lead Poisoning Prevention, March 2002.


Blood Lead Levels in Children
The recommended and most commonly used diagnostic test is the concentration of lead in whole (venous) blood.
Experts now use a reference level or “blood lead level of concern” of 5 micrograms per deciliter to identify children with blood lead levels that are much higher than most children’s levels. The recommendation was based on a growing number of scientific studies that show that even low blood lead levels can cause lifelong health effects. This reference value is based on the 97.5th percentile of the National Health and Nutrition Examination Survey (NHANES)’s blood lead distribution in children. The current reference value is based on NHANES data from 2007-2008 and 2009-2010. CDC will update the reference value every 4 years using the two most recent NHANES surveys.


References
Poisoning - Lead Exposure Poisoning - Lead Exposure 05/11/2016
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