From the Guidelines
Children between 12 to 24 months of age should undergo targeted screening for elevated blood lead concentrations if they live in communities or census block groups with ≥25% of housing built before 1960 or a prevalence of children’s blood lead concentrations ≥5 μg/dL (≥50 ppb) of ≥5%. This recommendation is based on the most recent and highest quality study available, which emphasizes the importance of targeted screening in high-risk areas 1. The screening process typically involves a simple blood draw or finger prick to measure the amount of lead in the bloodstream.
Key Considerations for Screening
- Children who live in older homes built before 1960 are at higher risk of lead exposure due to the presence of lead-based paint.
- Residing in areas with high lead exposure risk or having siblings or playmates with elevated lead levels also increases the risk.
- The test results are crucial for early detection and intervention to reduce further exposure and minimize potential health impacts.
Follow-Up and Intervention
- A level below 5 μg/dL is considered normal, while higher levels require follow-up testing and potential intervention, as outlined in the guidelines 1.
- For children with blood lead concentrations ≥5 μg/dL, the pediatrician should inform the local or state health department and request an inspection of the child’s house to identify and remediate any lead hazards.
- Screening children for iron deficiency and insufficient dietary calcium intake is also important, as these can exacerbate the effects of lead exposure.
Importance of Early Detection
Lead screening is crucial because even low levels of lead exposure can cause developmental delays, learning difficulties, and behavioral problems in children. Early detection through screening allows for prompt intervention to reduce further exposure and minimize potential health impacts. The American Academy of Pediatrics recognizes the importance of environmental investigations and remediation in reducing lead exposure, and pediatricians play a key role in providing clues to identify sources of lead exposure 1.
From the Research
Recommendations for Checking Screen Lead Levels in Children's Blood
- The Centers for Disease Control and Prevention (CDC) recommends that clinicians obtain an environmental history on all children they examine and provide families with lead-prevention counseling 2.
- The CDC also recommends following blood lead screening recommendations established for their areas, and considering referral to developmental programs for children at high risk for exposure to lead 2.
- The American Academy of Pediatrics supports the CDC's guidelines for universal screening in areas with > or = 27% of housing built before 1950 and in populations in which the percentage of 1- and 2-year-olds with elevated BLLs is > or = 12% 3.
- For children living in other areas, the CDC recommends targeted screening based on risk-assessment during specified pediatric visits 3.
- The CDC recommends screening all Medicaid-eligible children at 12 months and again at 24 months, or at least once between 36 and 72 months if not previously screened 4.
- Universal screening is also recommended in areas where more than 27% of the housing was built before 1950, or where at least 12% of children 12 to 36 months of age have blood lead levels greater than 10 µg per dL 4.
Key Considerations for Blood Lead Screening
- Blood lead levels of less than 5 µg per dL are associated with impairments in neurocognitive and behavioral development that are irreversible 4.
- Risk factors for lead poisoning include age younger than five years, low socioeconomic status, living in housing built before 1978, and use of imported food, medicines, and pottery 4.
- Life-threatening lead levels are treated with chelation therapy, and lower levels should prompt case management and environmental investigations to identify and remove the source of exposure 4.
- Primary prevention strategies are essential to eliminate the harmful effects of lead on child development 4, 2.