Childhood Lead Poisoning & Healthcare Providers

Childhood lead poisoning is 100% preventable. Yet, it is one of the most common pediatric health problems in the United States today. We know enough about its sources and the different pathways of lead exposure to prevent lead poisoning or to eliminate this disease altogether.

Lead poisoning is silent. Most poisoned children have no symptoms; thus, many case of lead poisoning go undiagnosed and untreated. Sadly, effects from lead poisoning are irreversible.

Lead poisoning is widespread throughout Iowa and Illinois. It is not solely a problem of inner city or minority children. Unfortunately, no socioeconomic group, geographic area, or racial or ethnic population is spared.

The Childhood Lead Poisoning Prevention Program (CLPPP) coordinates statewide efforts to identify and manage lead poisoning in those ages birth through six. This includes tracking cases of blood lead levels for children and providing outreach and education for families of children under the age of six years old with elevated blood lead levels above 5 micrograms per deciliter (mcg/dL). Children under the age of six with an elevated blood lead level greater than 10mcg/dL receive nurse case management services.

Contact [email protected] for more information about the Scott County Health Department Childhood Lead Poisoning Prevention Program.

Iowa Childhood Lead Screening & Management Guidelines
Iowa Administrative Code, Chapter 67, requires that any physician treating children ages 6 or younger must screen or test children for lead exposure on at least one occasion prior to kindergarten entry. However, IAC strongly encourages a parent or guardian of a child under two years of age to have the child tested for elevated blood lead levels by the time that the child reaches two years of age. Read more about testing requirements for schools and providers here: Blood Lead Testing for Schools/Providers.

Physicians and health care providers should evaluate all children ages 6 or younger using the Iowa HHS Childhood Lead Poisoning Risk Questionnaire.

Physicians and health care providers should conduct a blood lead test for any child who:

  • Answers “yes” or “I don’t know” to any question listed in the risk questionnaire
  • Resides in a home located within a designated high risk ZIP Code
  • Is Medicaid-eligible
  • Has had a change in address since his/her last office visit

The Iowa Department of Health and Human Services recommends children be tested at 12 and 24 months of age. Thereafter, all children should be evaluated annually until age 6 using the Iowa HHS Childhood Lead Poisoning Risk Questionnaire.

Physicians and health care providers should also review the Guidelines for Treatment and Follow Up on Childhood Blood Lead Levels.

How should the blood be drawn?

The most reliable measure of a child’s blood lead is a venous test. Capillary draws may be used for screening, with the understanding that a capillary specimen can be contaminated by lead dust from a child’s hands. CDC does not recommend using a filter paper test, as it also can be contaminated by environmental lead. All capillary and filter paper results of ≥5 μg/dL should be repeated using a venous test collected into a lead-free tube.

Click here to review Iowa Health and Human Services reporting requirements of blood lead level testing.

If a child has an elevated lead level, what should a health care provider do next?

The CDC recommends that providers conduct medical evaluation including the following:

  • Detailed history of symptoms, existence of pica, siblings with lead poisoning, potential sources of lead and previous blood lead results
  • Description of age and condition of all housing where the child spends time
  • Assess exposures to renovation in housing
  • Occupational histories of adults in the household to determine if the child is exposed to lead brought home from the workplace
  • Physical examination, with special attention to neurologic, psychosocial and language development.
  • Learning or developmental delays should prompt further assessment and referrals to appropriate programs
  • Evaluation of nutritional status, especially of calcium and iron
  • Children with higher BLLs may need chemical treatment. The U.S. Food and Drug Administration approves the use of succimer (Chemet®) for treating children with BLLs greater than 45 μg/dL. These children need to be monitored more closely for at least one year until the BLL decreases. They should be seen by a physician every other week for eight weeks and, then, once a month for six months.
    • Educate parents on the meaning of the BLL and potential health effects
    • Discuss proper nutrition
    • Refer patients to other agencies to provide additional service

For children with blood lead levels ≥20 μg/dL, a SCHD public health nurse will visit the home and teach parents housekeeping and hygiene to prevent further exposure, and SCHD lead risk assessor will evaluate the building to identify lead hazards. SCHD public health nurses will collaborate with primary care providers about medical issues and follow-up activities.

For children with blood lead levels between 10-20 μg/dL, a SCHD public health nurse will teach parents housekeeping and hygiene to prevent further exposure. Health department staff can provide visual home inspections to evaluate dwellings and identify potential lead hazards. SCHD public health nurses will collaborate with primary care providers about medical issues and follow-up activities.

When should a lead-poisoned child be retested?

Follow-up testing should take place according to the CDC recommendations on blood lead level testing.

What steps should a healthcare provider take?

  • Encourage parents and guardians to follow up with lead screening appointments
  • Communicating blood lead level test results and the possible health impact
  • Overseeing ongoing monitoring of children with blood lead levels above 3.5 mcg/dL
  • Confirmation of capillary blood lead levels above 3.5 mcg/dL with a venous sample
  • Emphasize healthy nutrition to reduce absorption of lead
  • Encourage parents and guardians to report housing issues to their city or town building officials

Mandatory reporting of blood lead test results:
Iowa Administrative Code 641 Chapter 1 requires all blood lead test results be reported to the Iowa Department of Public Health Bureau of Environmental Health Services (IDPH EHS) to monitor lead exposure in Iowa. This applies to all blood lead tests for any person living in Iowa, regardless of the person’s age or the test result. Patient address is essential to determine public health jurisdiction and must always be included in the report. Click here for information on how to report.