Nearly a half million children in the US are believed to have an elevated blood level. Pediatric health-care provider can intervene in a variety of ways to prevent and reduce the risk of lead exposure and lower the body's lead burden. Includes a Guide for Parents.
Lead poisoning is one of the most important preventable pediatric health problems in the United States. (1) Despite the remarkable reduction in average blood lead levels in children that followed elimination of lead as a gasoline additive in the late 1970s, (2) lead poisoning persists, largely because of aging housing, especially in inner cities, older suburbs, and rural areas. Additional cases are sometimes the result of cultural customs, such as the use of certain folk remedies. (3,4) Although lead poisoning affects children of all socioeconomic levels, those at the low end of the spectrum are affected disproportionately. (5-7)
For children who live in deprived or chaotic circumstances, an elevated lead level, with its harmful effects on intelligence and behavior, (8-10) can only compound the many social, economic, educational, and environmental threats they already face. Although chelation therapy of lead poisoning has become a fairly standard medical practice, (11) primary prevention--that is, not placing lead into the child's environment--is the only certain way to avoid the toxic effects of lead. (12-14) Secondary prevention (removing or isolating lead already present in the environment) requires a high degree of persistence and attention to detail and a cooperative effort among the health-care provider, family, and local health department. (15)
Children at risk, notably those in areas known for old housing and a high incidence of lead poisoning, continue to have routine blood screening performed at an unacceptably low rate. (16,17) Both at-risk children and children not considered at risk need to be screened using a personal risk questionnaire (Table 1). If the answer to any of the questions is "yes," a screening lead level should be obtained.
Since its inception in 1991, the Pediatric Lead Clinic at MetroHealth Medical Center, an inner-city teaching hospital in Cleveland where we practice, has treated hundreds of children for lead poisoning. Our patients live in a high-risk environment, defined by the Centers for Disease Control and Prevention (CDC) as an area in which 27% or more of the housing was built before 1950.1 In Cleveland, 85% of the houses were built before 1950. A second criterion for high risk is a population in which 12% or more of the children have a blood lead level [greater than or equal to] 10 [micro]g/dL. In Cleveland in 2002, that figure was 20%. With the health care of approximately 75% of our pediatric clinic population covered by the state's Medicaid program, economic limitations are also routine.
In the course of our work, we have learned some hard lessons about the outpatient management of lead poisoning. Interventions are often complex and time-consuming and draw on unfamiliar skills. But we have also developed a keen appreciation of the numerous opportunities for health-care providers to make a difference...
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