The Committee on Environmental Health of the American Academy of Pediatrics (AAP) has released a policy statement on lead exposure in children. The statement, “Lead Exposure in Children: Prevention, Detection, and Management,” was published in the October 17, 2005, issue of Pediatrics and is available online at http://pediatrics.aappublications.org/cgi/content/full/116/4/1036.
The AAP Committee made the following recommendations for physicians with young patients:
Anticipatory guidance should be provided to parents of all infants and toddlers about prevention of lead poisoning in their children. In particular, parents of children six months to three years of age should be made aware of normal mouthing behavior and should ascertain whether their homes, workplaces, or hobbies pose a lead hazard to their children. Parents should be informed that lead can be present in dust and can be ingested by children when they put hands and toys in their mouths.
Physicians should ask about lead hazards in housing and child care settings, as is done for fire and safety hazards or for allergens. If a lead hazard is suspected, the child's home should be inspected; many health departments can do the inspection. Expert training is needed for safe repair of lead hazards, and physicians should discourage families from undertaking repairs on their own. Children should be kept away from remediation activities, and the house should be tested for lead content before the child returns.
Physicians should know state Medicaid regulations and measure blood lead concentrations in Medicaid-eligible children.
Physicians should find out if there is relevant guidance from the city or state health department about screening children not eligible for Medicaid. If there is none, physicians should consider screening all children. Children should be tested at least once, when they are two years of age; or, ideally, twice (at one and two years of age), unless lead exposure can be confidently excluded. Physicians should recognize that measuring blood lead concentrations only at two years of age, when blood lead concentration usually peaks, may be too late to prevent peak exposure. Earlier screening, usually at one year of age, should be considered where exposure is likely. A low blood lead concentration in a one-year-old child, however, does not preclude later elevation, so the test should be repeated at two years of age. Managed health care organizations and third-party payers should fully cover the costs of screening and follow-up.
Physicians should be aware of any special risk groups that are prevalent locally, such as immigrants, foreign-born adoptees, refugees, or children whose parents work with lead or lead dust in their occupation or hobbies and those who live in, visit, or work on old buildings.
Physicians should be aware of the work of the National Advisory Committee on Childhood Lead Poisoning Prevention and any relevant local committees. Although there is evidence that even lower blood lead concentrations may cause adverse effects in children, there is little experience in the management of excess lead exposure in these children. Most of the recommendations concerning case management of children with blood lead concentrations of 15 mcg per dL (0.72 μmol per L) should be appropriate for children with lower concentrations, although tactics that decrease blood lead concentrations might be expected to be less and less effective as they are applied to children with lower and lower blood lead concentrations.