Is This Child At Risk For Lead Exposure?
There are often no apparent symptoms when a child is exposed to lead.
Centers for Disease Control and Prevention, 2022
Lead exposure during early childhood can cause intellectual and physical disabilities and behavioral problems and is associated with elevated risk for attention deficit/hyperactivity disorder, adolescent delinquency, aggression and reduced growth (AAP, 2021). There is no safe level of lead in a child’s blood, and the effects of lead exposure can be permanent.
Screening for lead exposure is a required component of every Texas Health Steps preventive medical checkup from ages 6 months to 6 years, with blood lead level testing required if lead exposure risk factors exist. Blood lead testing is required at ages 12 months and 24 months, regardless of risk factors. The U.S. Centers for Disease Control and Prevention (CDC) has determined that 97.5 percent of children ages 1 through 5 years have a blood lead level <3.5 μg/dL. The CDC and the Texas Department of State Health Services identify >3.5 μg/dL as the blood lead reference level that requires additional diagnostic testing and possible follow-up.
Review the following case examples and determine your next step for each patient.
During Xavier’s 18-month Texas Health Steps preventive medical checkup, his mother reports her son is active, curious and likes to explore his environment. Even though he has most of his baby teeth, he continues to put objects in his mouth like he did as a younger child. She states that Xavier recently began attending a home-based day care in an older house. Upon questioning, she says she is not sure how old the house is.
Lola is in your office for her 3-year Texas Health Steps preventive medical checkup. Her mother says the family recently returned from visiting relatives in Mexico, and she mentions how much they enjoyed eating the traditional foods she grew up with. You ask whether food was cooked or served in glazed pottery, which might contain lead that could leach into the food. She says the cookware was the same she grew up with and has never caused any problems. She reports that Lola is a happy child with a healthy appetite who shows no signs of health problems.
New patient Elijah is in your office for his 5-year Texas Health Steps preventive medical checkup. The boy’s father says the family recently moved to Texas. While reviewing Elijah’s medical history, you note there is no record his blood lead level has ever been tested. The boy’s father completes the Lead Risk Questionnaire and answers “No” to all the questions about risk factors.
Why it matters
Your awareness of lead exposure and its effects on young children positions you to identify potential lead risks, determine a child’s blood lead level, provide treatment when necessary, and counsel parents about how to prevent their families from being exposed to lead.
Resources
Texas Childhood Lead Poisoning Prevention Program (TXCLPPP).
TXCLPPP Forms for Health-Care Providers, including the Lead Risk Questionnaire (Pb-110) in English, Spanish, French, Arabic and Burmese.
Texas Health Steps Periodicity Schedule.
References featured in Course
American Academy of Pediatrics. (Reaffirmed, 2021). Policy Statement: Prevention of Childhood Lead Toxicity. Pediatrics, 138 (1): e20161493.
Centers for Disease Control and Prevention (2022). CDC updates blood lead reference value to 3.5 µg/dL.
Centers for Disease Control and Prevention. (2022). Blood Lead Levels in Children.