Exposure to environmental dangers like lead is a critical factor in preventing harms like low birth weight, damage to intellectual facilities, and developmental delays. While exposure to lead rate vary by state, no amount of lead exposure is considered safe. Tracking lead exposure in your practice as well as participating in state and national prevention programs can keep kids safe and reduce lead exposure year over year. Here’s how to check the health of your practice’s lead prevention program.
Lead Exposure According to the AAP & CDC
The American Academy of Pediatrics (AAP) and Centers for Disease Control & Prevention (CDC) agree that no amount of lead exposure is safe, but that certain childhood populations are at increased risk.
In April 2022, the Food and Drug Administration (FDA) was accepting comments to a proposed change to reduce lead levels in fruit juices. The guidance called for “action levels of 10 parts per billion (ppb) for lead in apple juice and 20 ppb for lead in all other juices.” The FDA stipulates that lead cannot be removed from the food manufacturing system completely, but this guidance is a good step towards lower lead exposure levels for young children.
According to the CDC, the highest risk families include those in low-income households, including those on Medicaid, and those who live in houses constructed before 1978, when lead paint was banned in the U.S. Lead plumbing and lead dust are also high risk factors. Pregnant people can pass on exposure to lead to the fetus, and young children are very susceptible, both because they are more likely to place contaminated hands or objects in their mouths and because their brains are rapidly developing, leaving them vulnerable to exposure.
Pediatricians have a front-line role in preventing, diagnosing, and treating lead exposure in children. Luckily, there are many tools and data sources available to help your practice lead the way to less lead exposure.
Data & Preventing Lead Exposure
Collecting data for your community and state is a great way to understand the risks of lead exposure to children in your practice. You can find state and national data on the CDC’s website. Fortunately, many states have recorded lower rates of dangerous lead exposure over time, which suggests that lead prevention programs and recording data are helpful to reducing risk.
Reminder: in May 2021, the CDC lowered the acceptable Blood Lead Reference Value (BLRV) from 5.0 micrograms to 3.5 micrograms per deciliter.
Identify high risk populations in your community: these include Medicaid families and families in older housing. Another important population to consider is refugee and immigrant families, whose country of origin may not be as stringent to lead exposure as parents in the U.S. Education and compassionate conversations are great tools to helping families of other cultures understand the risks of lead exposure. Check out our previous post for more information on pediatrics in multicultural communities.
Share common exposure and safety precautions with families regularly to help ensure the community’s knowledge of exposure risk is present. This includes removing lead risks prior to moving or having children, and identifying cost-effective methods of lead removal, such as encapsulation of lead paint, i.e., painting over lead paint with safer paint. Cleaning up dust and keeping kids’ hands clean are other safety measures to recommend, along with many more from the Environmental Protection Agency (EPA).
Pediatric Blood Tests & Treatment for Lead
While prevention is key, children do not exhibit visible symptoms of lead exposure, which can lead to more harm as exposure and blood lead levels build over time. Blood testing is the only way to know for sure if a patient has been exposed to lead. Medicaid patients are required to be tested for lead exposure at 12 and 24 months; you may also test later when caregivers express concerns or if a child hasn’t received a previous test.
HealthyChildren.org has great resources for parents and caregivers on lead exposure, with helpful information on lead testing in young children.
Lead Testing Kit Options
Many pediatricians send lead testing kits to the lab for official testing. PCC recommends that mailing test kits to the lab is more cost-effective than testing in the office, however many pediatricians enjoy the convenience and time saved from the ability to test in the office.
Common lead testing kits include LeadCare, Tamarac, and MedTox. Certain LeadCare products were recalled in 2021. As of March 2022, LeadCare II products are again available.
Treatments for lead exposure include close monitoring and follow up with the patient, as well as adjustments to diet and even chelation therapy. Pediatricians may choose to refer or consult with a specialist or pediatrician well-versed in lead exposure. You can find experts at your state’s lead prevention programs or PEHSU, the Pediatric Environment Health Specialty Units.
Lead exposure is both dangerous and frightening for families: solid prevention efforts are a must. Patient engagement is a fantastic tool for practices seeking to understand their patients’ risk for exposure and to reduce exposure where it is found. From the lead testing you choose to how you engage with families about environmental risks, your practice can help protect kids against lead and other environmental factors that could harm them while maintaining the calm, reassuring presence needed for a tough, important conversation.
Protecting against lead is just one factor in why preventive care in pediatrics is so important. Not only does it protect children, preventive care also helps your pediatric practice stay financially stable and healthy. Learn more about why preventive care is the most important work pediatricians do in this webinar with PCC’s Chip Hart.