Get the lead out

Posted in the suggestions thread: “I have heard some friends talk about their babies being tested for lead at a year. Is this a common procedure? Does your practice do this? (My daughter is a patient who is 11 months old). What if the lead comes back at a high reading? Thank you, Bella.”

The American Academy of Pediatrics recommends targeted screening blood levels for children at risk for lead exposure. This includes children living in localities with high environmental lead levels, typically older cities and industrial areas.

In my practice, we utilize a “screening questionnaire”, asking parents about lead sources in a child’s environment. The questions include:

• Does your child live in a home build before 1978?
• Does your child live with anyone who has a job that involves lead?
• Does your child chew on or eat non-food items like paint chips or dirt?

If a child is determined to be “at risk” based on these questions, a blood lead level is drawn.

Most screening blood lead tests are done on fingerprick specimens. Though these are convenient to draw, they can be contaminated with surface debris that can lead to a false elevation. An elevated lead fingerprick result should be followed by a confirmatory test using a venous blood draw.

If a blood lead test is elevated, steps are taken to discover the source, protect others who might be exposed, and reduce the child’s blood lead burden with medicines that bind and remove lead from the body. The exact steps depend on how elevated the lead level turns out to be. The county health department would also get involved by visiting the home to help determine the source of the lead exposure.

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