Elevated Blood Lead Levels and Resettled Refugee Children: A Study That Will Lead You to Take Action :

A blood lead level (BLL) greater than or equal to 5 micrograms per deciliter is considered elevated and a potential contributor to neurodevelopmental and other health problems in children. In the United States, we typically screen for lead exposure at ages 1 and 2 and even earlier (age 6 months) if we feel a child is at increased risk. Although this strategy works for children born in this country, Pezzi et al. (10.1542/peds.2018-2591) point out in a new study being released this week, more intense screening may be needed for refugee children. Their study illustrates this need by noting the BLL prevalence based on results obtained upon arrival on 27,284 children less than 17 years of age in 12 resettlement cities and then 3 to 6 months after resettlement. The authors found that 19.3% had elevated levels on initial testing and, among a subset of children (n=1,121) who had a follow up screening result 3 to 6 months later, 10.4% experienced a BLL increase. Why might this happen?  We asked Drs. Andrea Green and Matthew Saia (10.1542/peds.2018-3567), experts in refugee health from the University of Vermont, to share with us their thoughts about these findings in an accompanying commentary.  Drs. Green and Saia provide several hypotheses as to why the BLL goes up after arrival such as the housing they are moved into and the lead-lined utensils and pottery they may be using for meals. Just as important they remind us of the prevention strategies we can do at the community level by making sure housing for refugee families is lead-free and at the individual child level, such as assuring overall good nutrition, which can reduce lead absorption. Reading this study and commentary will hopefully make you even more of an advocate for ensuring no child experiences unnecessary exposure to lead whether born in or immigrating to the United States.