July week 4: Lead Screening


Chandran L, et al.  Lead Poisoning: Basics and New Developments.  Peds in Review.  2010;31;399-406. 
AAP Policy Statement.  Lead Exposure in Children: Prevention, Detection, and Management.  Pediatrics.  Vol. 116 No. 4 October 2005  
CDC MWR: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5312a6.htm,   http://www.cdc.gov/nceh/lead/blood_levels.htm

Case 1:

You are seeing a 15 month old boy for a well visit and note that although screening lead level and hematocrit were ordered at the 12 month exam, you do not have results.  Mom reports she has been really busy and wants to know how important lead screening really is.


Who should be screened for lead? 

At what age are children routinely screened for lead?

In areas where the incidence of increased BLL is low, what questions do you ask to guide targeted screening?

What is considered a safe lead level?

What are common sources of lead exposure?

Why are children more at risk for lead poisoning than adults?

How can a parent reduce a child’s lead exposure?

What is the treatment for an elevated lead level?

Case 2:

A mother brings in her 2 month old daughter for a well visit.  She recently switched to formula so she could go back to work.  She tells you, “Don’t worry, I use BPA-free bottles and mix the formula only with Evian bottled water.”  You discuss with her the lack of fluoride in most bottled water and suggest she use filtered tap water instead.  She looks at you, horrified, and says, “but I’ve heard the water in DC is full of lead!”


How do you address mom’s concerns? 

PREP question:

A resident in continuity clinic approaches you to review the laboratory values obtained at a patient’s 12-month health supervision visit. The fingerstick hemoglobin measurement was 10.5 g/dL (105.0 g/L), and the lead concentration was 11.0 mcg/dL (0.53 mcmol/L).

Of the following, the next BEST step for this boy is to

A. admit him to the hospital for chelation therapy
B. call child protective services to move him to a shelter
C. call the health department to arrange for an environmental investigation
D. measure the venous lead concentration
E. refer him for formal developmental evaluation and neuropsychometric testing