California Childhood Lead Poisoning Prevention Branch: Children at Risk
Note that the neurodevelopmental sequelae of lead poisoning may not be apparent for some years. The parents or other caregiver should remember to inform future health care providers and school guidance counselors that the child was lead-poisoned and may have special needs.
- Children with lead poisoning are usually asymptomatic. Symptoms that do occur are often subtle and mimic other childhood illnesses. The degree of symptoms varies from child to child.
- Mild lead poisoning can be associated with hyperactivity, irritability, sleeplessness, lack of concentration, behavioral problems, and learning disabilities.
- More severe lead poisoning may be accompanied by hearing problems, headaches, nausea, vomiting, abdominal pain, loss of appetite, constipation, muscle soreness, anemia, neurological impairments such as stumbling or loss of concentration, seizures, encephalopathy, and coma.
- Persistent neurological impairment can follow even mild episodes of lead poisoning.
- Stopping ongoing exposure is the best remedy for most children with elevated blood lead levels.
Screening for Childhood Lead Poisoning
While primary prevention of lead hazards remains the essential public health goal, the only way to identify individual lead-poisoned children is by screening for blood lead. Children are at the greatest risk from the time they begin to crawl until six years of age. Under California law and consistent with recommendations of the CDC, children with identified risk factors should be screened at age one and again at age two (See Centers for Disease Control and Prevention (CDC), Managing Elevated Blood Lead Levels Among Young, Children. Atlanta, GA: US Dept. of Health and Human Services, March 2002).
Title 17 of the California Code of Regulations, Section 37000 and following, requires health care providers to do the following:
- Give anticipatory guidance at each periodic health assessment visit from the age of six months until the child reaches 72 months of age.
- Screen children for blood lead at 12 and 24 months of age who are receiving services from publicly supported programs for low-income children, such as Medi-Cal, the Child Health and Disability Prevention Program (CHDP), the Special Supplemental Nutrition Program for Women, Infants and Children (WIC), and Healthy Families.
- Screen children for blood lead at 12 and 24 months of age who are not in such programs but found to be at risk because a parent or guardian answers "yes" or "don't know" to the risk assessment question: "Does your child live in, or spend a lot of time in, a place built before 1978 that has peeling or chipped paint or that has been recently renovated?"
- Perform these evaluations or screenings upon learning that the child is less than 24 months old and the evaluation or screening was not done at 12 months of age or the child is from 24 months up to 72 months old and the evaluation or screening was not done at the age of 24 months.
- Screen any child up to 72 months old if changed circumstances have put the child at risk.
- If the BLL is equal to or greater than 10 µg/dL, take steps to reduce it to less than 10 µg/dL; e.g., education, clinical evaluation, follow-up BLLs, referral to the local childhood lead poisoning prevention program, and chelation when appropriate.
Of course, a child may be tested for blood lead at any age if appropriate or at the request of the parent or guardian. The health care provider also may choose to question the caregiver about other lead hazards known to be common in his or her community, such as the use of lead amulets in some Southeast Asian communities.
Note that these regulations apply to all physicians, nurse practitioners, and physician assistants, not just Medi-Cal or CHDP providers.
Medical Management of Childhood Lead Poisoning
The health care provider should consult the state CLPPB at 510-620-5600 or the local childhood lead poisoning prevention program for detailed information. Note that chelation is not generally considered appropriate until BLLs are at or above the level of 45 µg/dL. It is also important to remember that screening may be by capillary draw, but all subsequent tests should be on venous specimens.