Childhood Lead Poisoning Prevention

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Childhood lead poisoning is a major, preventable environmental health problem. Blood lead levels as low as 10ug/dL are associated with harmful effects on children's learning and behavior. Very high blood lead levels >70ug/dL cause devastating health consequences, including seizures, coma, and death. In 1991, the U.S. Public Health Service called for a society-wide effort to eliminate childhood lead poisoning.

Many Texas homes built before 1978 were painted with lead-based paint. Chipping paint or remodeling a house covered in lead paint will create dust, fumes and flakes that can cause poisoning.

Most children are poisoned by lead dust that settles on floors, toys and other surfaces where it can easily get on children's hands and then into their mouth.

Food stored in some glazed pottery and ceramic ware or stored in open cans can absorb lead contaminates.

Old water pipes or bare soil can also contain lead contaminates.

 

 

Pay-loo-ah Indochina's remedy (red powder) for high fever; prevalent in the Hmong community
Azarcon Mexican treatment (bright orange) for empacho (intestinal illness) which is 90% lead (aka- Rueda, Coral, Maria Lusia, Liga, Alarcon, Alarzon
Greta Mexican treatment (yellow powder) for empacho which is 90% lead
Ghassard Asian Indian folk remedy (brown powder) given to aid digention
Kandu

Asian Indian folk remedy (red powder) used to treat stomach ache

Bali Goli Asian Indian folk remedy (red powder) used to treat stomach ache
Home and folk remedies:

Absorbing too much lead can hurt a child’s brain and nervous system, blood, kidneys, digestive system and reproductive system.

Headaches, memory problems, nervousness, poor hearing, cranky, reduced hand-eye coordination, tired/sleepy, learning problems, anemia, effects child’s maximum learning potential, stomach pain, poor appetite, nausea, weight loss, complications with pregnancy, miscarriages and sterilization.

THSteps Lead Contact Role

Refer lead cases to appropriate programs within the Texas Department of Health for follow up.

Coordinate environmental assessments in areas where there is no local health department with this capability.

Notify interested parties of educational opportunities within Region 2/3.

Follow up with local providers to provide guidance on reporting elevated lead cases.

Reporting Requirements

Texas legislation requires providers report blood lead levels of 10ug/dL or greater in children 14 years old or younger.

If a provider chooses to use a lab other than the state lab, they are responsible for reporting elevated blood lead levels to the Texas Department of Health Bureau of Epidemiology.

Role of Health Care Providers

Give anticipatory guidance.

Administer blood lead test or Risk Assessment Questionnaire.

Provide family with lead education.

Provide follow up testing.

Anticipatory Guidance

Anticipatory guidance should be provided during prenatal care and during preventative care visits when children are 3-6 months old and again when they are 12 months of age. Parental guidance at these times might prevent some lead exposure and the resulting increase in blood levels that often occurs during a child’s second year of life.

Administer Blood Test of Risk Assessment Questionnaire

Administer blood test to Medicaid patients at 12 and 24 months

Administer a risk assessment questionnaire at 6 months, 18 months and 3,4,5, and 6 years of age. If the answer to any question is "yes" or “I don’t know”, administer a blood test.

If the patient is older than 24 months and younger than 6 years, and has never had a blood test, administer a blood test.

Provide Family with Lead Education

At a minimum education should cover:

The child’s blood lead level and what it means.

Potential adverse health effects of elevated blood lead levels.

Sources of lead exposure and suggestion on hot to reduce exposure.

Importance of good nutrition, adequate intake of calcium and iron in reducing the absorption and effects of lead.

Importance of wet cleaning to remove lead dust on floors, windowsills, toys and other surfaces.

Blood Lead 10-14ug/dL

Schedule child for follow up in 3-4 months.

Provide parents with educational materials concerning lead poisoning.

Test child every 3-4 months until two consecutive tests are <10ug/dL or three consecutive tests are <15ug/dL.

Blood Lead 15-19ug/dL.

Confirm test results with venous blood draw within one month.

Conduct an environmental assessment interview using TDH form M-100.

Provide parents with educational materials concerning lead poisoning prevention.

Test child every 3-4 months until two consecutive tests are <10ug/dL or three consecutive tests are <15ug/dL.

If two consecutive tests are still in the 15-19ug/dL range and an environmental assessment interview complete, a home visit may be necessary to assess the environment for lead contaminants.

An environmental investigation is needed only when the environmental assessment interview and home visit fail to identify the source of lead.

Blood Lead 20-44ug/dL

Confirm test results with venous blood draw within one week.

Upon confirmation, conduct a complete medical evaluation within 10 days.

Conduct an environmental assessment interview using TDH form M-100.

Provide parents with educational materials concerning lead poisoning prevention.

Test child every 3-4 months until two consecutive test are <10ug/dL or three consecutive test are <15ug/dL.

If two consecutive tests are still in the 20-44ug/dL range and an environmental assessment interview complete, a home visit may be necessary to assess the environment for lead contaminants.

An environmental investigation is needed only when the environmental assessment interview and home visit fail to identify the source of lead.

Blood Lead 45-69ug/dL

Confirm test results with venous blood draw within 48 hours.

Begin medical treatment under the guidance of a physician experienced in the treatment of lead poisoning within 48 hours.

Conduct environmental assessment (M-100, home visit, and/or environmental investigation as needed) within 48 hours.

Provide parents with educational materials concerning lead poisoning prevention.

Test child every 3-4 months until two consecutive test are <10ug/dL or three consecutive test are <15ug/dL.

Blood Lead >69ug/dL

Considered a medical emergency.

Medical treatment must begin immediately.

Environmental assessment (M-100, home visit and/or environmental investigation as needed) must begin immediately.

TDH Assistance

If providers need assistance conducting follow up interview, home visits or environmental investigations; they can contact their local health department or regional TDH office.

If providers are unable to locate clients for follow up; they can contact their regional TDH office for assistance.

References and Resources

Texas Medicaid Service Delivery Guide at www.eds-nhic.com.

Texas Department of Health Warehouse at www.tdh.state.tx.us.

Prevention is the Key (Power Point Presentation)

Childhood Lead Poisoning Prevention Program

Region 2/3 Lead Contacts

Region 2 Abilene
Kerri Tashjian
(325) 795-5866

Last updated August 05, 2010