Lead poisoning screening

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Aksiniya Stevasarova, M.D.

Overview

According to the CDC, screening for [lead poisoning] by blood lead test is recommended every for children aged 6 up to 36 and 36 to 72 months."CDC - Childhood Lead Poisoning Prevention Program - PLPYC 91 Chapter 6".

Screening

According to the CDC, screening for [lead poisoning] by blood lead test is recommended for virtually all children. Screening children with high probability of exposure to high-dose sources is the highest priority. Children at greatest risk for high-dose lead exposure should be screened more frequently. "CDC - Childhood Lead Poisoning Prevention Program - PLPYC 91 Chapter 6".

According to the CDC, children ages 6 to 72 months who live in or are frequent visitors to deteriorated old buildings, including day care centers, make up the highest priority group. Because the highest concentrations of lead in paint were used in the early 1900s, homes built before about 1960 are of greatest concern. Children whose homes are being renovated are also at extremely high risk. Because almost all U.S. children are at risk for lead poisoning (although some children are at higher risk than others), our goal is that all children should be screened, unless it can be shown that the community in which these children live does not have a childhood lead poisoning problem. "CDC - Childhood Lead Poisoning Prevention Program - PLPYC 91 Chapter 6".

Screening Schedule

  • Children 6 up to 36 months of age:
    • A child at low risk for exposure to high-dose lead sources by questionnaire should have an initial blood lead test at 12 months of age.

If the 12-month blood lead result is < 10 µg/dL, the child should be retested at 24 months if possible, since that is when blood lead levels peak. If a blood lead test result is 10-14 µg/dL, the child should be retested every 3 to 4 months. After 2 consecutive measurements are < 10 µg/dL or three are < 15 µg/dL, the child should be retested in a year."CDC - Childhood Lead Poisoning Prevention Program - PLPYC 91 Chapter 6". If any blood lead test result is > or = to 15 µg/dL, the child needs individual case management, which includes retesting the child at least every 3 to 4 months.

    • A child at high risk for exposure to high-dose lead sources by questionnaire should have an initial blood lead test at 6 months of age.

If the initial blood lead result is < 10 µg/dL, the child should be rescreened every 6 months. After 2 subsequent consecutive measurements are < 10 µg/dL or three are < 15 µg/dL, testing frequency can be decreased to once a year."CDC - Childhood Lead Poisoning Prevention Program - PLPYC 91 Chapter 6". If a blood lead test result is 10-14 µg/dL, the child should be screened every 3 to 4 months. Once 2 subsequent consecutive measurements are < 10 µg/dL or three are < 15 µg/dL, testing frequency can be decreased to once a year. If any blood lead test result is > or = to 15 µg/dL, the child needs individual case management, which includes retesting the child at least every 3 to 4 months."CDC - Childhood Lead Poisoning Prevention Program - PLPYC 91 Chapter 6".


  • Children > or = to 36 months and less than 72 months age:
    • All children who have had venous blood lead tests > or = to 15 µg/dL or who are at high risk by questionnaire should be screened at least once a year until their sixth birthday (age 72 months) or later, if indicated (for example, a developmentally delayed child with pica). "CDC - Childhood Lead Poisoning Prevention Program - PLPYC 91 Chapter 6".
    • If the blood lead level is 15-19 µg/dL, the child should be screened every 3-4 months, the family should be given education and nutritional counseling as described in Chapter 4, and a detailed environmental history should be taken to identify any obvious sources or pathways of lead exposure. When the venous blood lead level is in this range in two consecutive tests 3-4 months apart, environmental investigation and abatement should be conducted, if resources permit."CDC - Childhood Lead Poisoning Prevention Program - PLPYC 91 Chapter 6".
    • If the blood lead level is > or = to 20 µg/dL, the child should be given a repeat test for confirmation. If the venous blood lead level is confirmed to be > or = to 20 µg/dL, the child should be referred for medical evaluation and followup. Such children should continue to receive blood lead tests every 3-4 months or more often if indicated. Children with blood lead levels > or = to 45 µg/dL must receive urgent medical and environmental followup, preferably at a clinic with a staff experienced in dealing with this disease. Symptomatic lead poisoning or a venous blood lead concentration > or = to 70 µg/dL is a medical emergency, requiring immediate inpatient chelation therapy."CDC - Childhood Lead Poisoning Prevention Program - PLPYC 91 Chapter 6".

References


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