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Testing for Lead Exposure in 2022

April 1, 2022

Reducing the impact of lead exposure on young children’s health is, in my opinion, one of the great public health successes in the last 20 years. When I was a resident, we had a “lead clinic” for the hundreds of patients with lead toxicity, and I had a “cheat sheet” clipped to my clipboard with the treatment protocol for patients who were admitted for lead chelation treatment.

I suspect that the majority of practicing pediatricians have not had to treat a patient for lead toxicity. This happy state of affairs is the result of much advocacy by pediatricians and other child health and public health professionals, who were able to effect changes in laws regulating the lead content of gasoline, paint, and water pipes and implemented practice guidelines for children to routinely be screened for lead toxicity at ages 1 and 2 years. Of course, screening is not helpful unless you have a plan for evaluation and treatment. Public health department staff routinely follow up with families whose children have elevated lead levels to inspect the home and require lead abatement if needed.

Recent events have raised concern that the system of early detection, follow up, and abatement may be at risk. Alan Woolf, MD and Mary Jean Brown, ScD from Harvard University describe these events and their potential negative impact on child health in a Pediatrics Perspectives entitled, “Old Adversary, New Challenges: Childhood Lead Exposure and Testing,” which is being early released by Pediatrics this week (10.1542/peds.2021-055944).

In particular, the authors discuss the potential impact of:

  • Lowering of the blood lead level threshold at which public health follow-up is needed, from 5 ug/dl to 3.5 ug/dl, essentially doubling the number of children who require public health follow-up. There are just not enough public health resources to meet this demand.
  • The COVID-19 pandemic, during which many children did not receive well-child care and many adults embarked on do-it-yourself home improvement projects (which, in older homes with lead paint, may expose individuals to lead).
  • The national recall of the point-of-care blood lead testing instrument that is used in many pediatric practices, which has resulted in the need to send many families to commercial or hospital-based laboratories for blood lead testing.

The authors point out that many children who were born in the past 3 years have never had blood lead testing, and the children who are most likely to feel the negative impact of this are those who are from families who live in low-income housing which may be poorly maintained. These are also the families for whom an extra trip to a laboratory is a significant barrier.

This Pediatrics Perspectives provides a succinct summary of the challenges and advocacy opportunities for child health and public health professionals to work to mitigate some of these challenges.

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