Lead Poisons Children

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Lead Poisons Children

• Cuyahoga County Board of Health
• Romona Redding, R.N., B.S.N.

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How many children are lead poisoned?
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The Cuyahoga County Picture

• Approximately 10.5 or 2654 children living in
  Cuyahoga County tested in 2003 were lead
  poisoned.
• In the city of Cleveland approximately 13.5 of
  the children tested in 2003 were lead poisoned
  (2,249).
• In the city of East Cleveland approximately 20
  of the children tested in 2003 had elevated blood
  were lead poisoned (177).
• Source 2003 Annual ODH Data

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How is lead poisoning defined?
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Lead Poisoning Defined

• Lead is measured in micrograms/deciliter or ug/dl
  in blood.
• Centers for Disease Control and Prevention has
  changed definition level several times.
• Currently children are considered to be lead
  poisoned at 10 ug/dL of blood (CDC 1991).
• Research shows that damage may begin at levels as
  low as 5 ug/dl.

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Lead Poisons

• There is no safe level of lead in the human body.
• Lead accumulates in the brain, kidneys, blood,
  and bones.
• Lead poisoning causes learning disabilities,
  hearing problems, language delays, and behavioral
  problems.
• High levels of lead can cause seizures, coma, and
  death.

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Symptoms

• Headache
• Stomachache
• Vomiting
• Hyperactivity
• Sleep disturbances
• Irritability
• Clumsiness
• Lack of appetite
• Most children do not show symptoms!

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Testing Methods

• Venous Sampling (blood draw)
• Preferred testing method
• More accurate
• One test confirms all results
• Capillary Sampling (fingerstick)
• Can have false highs from surface contamination
  and concentration from milking the finger.
• One test confirms results lt10 ug/dL.
• Two tests needed to confirm result 10 ug/dL or
  greater.

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Poisoning Classifications

• 0-9 ug/dl below level of concern
• 10-14 ug/dl low toxicity
• 15-19 ug/dl mild toxicity
• 20-44 ug/dl moderate toxicity
• 45-69 ug/dl high toxicity
• gt70 ug/dl severe toxicity, medical emergency

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Lead Poisoning Treatment

• Children are not generally treated with
  medication until levels reach at least 45 ug/dl.
• Treated with chelation medication.
• Given orally outpatient or IV inpatient.
• Medication rapidly decreases lead levels.
• Levels rebound after decline, but usually not as
  high as initial level.
• Regular follow-up is pertinent in determining
  that lead levels continually decline.
• Medication can be nephrotoxic or damaging to
  kidneys.
• Once a child is lead poisoned, treatment has not
  been shown to reduce risks of long-term problems,
  prevention of lead poisoning is best.
• Unless a childs lead level is 45 or greater the
  best treatment is to reduce or eliminate lead
  exposure.

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Who is at risk?
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Child at risk of lead poisoningOAC 3701-30

• Any child under the age of six who meets one or
  more of the following
• Medicaid eligible.
• Lives in a high risk zip code.
• Lives in or regularly visits a residential unit,
  childcare facility, or school built before 1950.
• Lives in or regularly visits a residential unit
  built before 1978 with recent ongoing or planned
  renovation/remodeling.
• Has a sibling or playmate that has or did have
  lead poisoning
• Frequently comes in contact with an adult who has
  a lead-related hobby or occupation.

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Children up to 5 years old are at highest risk

• Peak exposure ages are 1 and 2.
• Why?
• Beginning to be mobile.
• Have normal hand-to-mouth behaviors.
• Rapid growth and development period and their
  bodies will absorb more lead than older children
  and adults.
• Children with nutritional deficits in iron,
  calcium, and/or zinc may be at higher risk for
  lead poisoning.

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Minority Children

• Minority children
• For example, 22 of black children and 13 of
  Mexican-American children living in housing built
  before 1946 have elevated blood lead levels
  compared with 6 of white children living in
  comparable types of housing (source CDC).

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Medicaid Children

• Estimates by NHANES (1991-1994) Medicaid
  enrollees accounted for
• -60 of children with lead levels 10 ug/dL or
  greater.
• -83 of children with lead levels 20 ug/dL or
  greater.

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Children in High-risk Zip Codes

• Children in certain geographic locations are at
  increased risk for lead exposure.
• Current high risk zip codes include
• Cleveland
• Cleveland Heights
• East Cleveland
• Garfield Heights (44105)
• Shaker Heights
• Lakewood
• Bedford, Bedford Heights, Oakwood

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Poisoning can happen before birth

• 95 of lead is absorbed into the bones.
• Lead can be mobilized by the nutritional demands
  of pregnancy.
• Lead can cross the placenta as early as the 12th
  week of gestation.
• Children who are poisoned inutero can have same
  long-term effects as other children.
• Supplementation of calcium, zinc, and iron is
  very important to prevent lead mobilization in
  women with a history of lead poisoning.

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When should children be tested?
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Medicaid Children

• Children on Medicaid, Healthy Families, or
  Healthy Start are federally mandated to be lead
  tested at ages 1 2.

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Children at risk of lead poisoning

• Mandated by state law that children are tested
  before age 6.
• Recommended that children are tested at ages 1
  2 and every year as medically indicated.

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Prevention

• Educate and raise awareness about lead poisoning,
  lead sources, testing, and local resources.

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Help End Childhood Lead Poisoning!