6/22/2020 CHILDHOOD LEAD POISONING IN MICHIGAN Lab Training PowerPoint slides courtesy of Healthy Homes Coalition of West Michigan WHY LEAD IS AN ISSUE Number one ENVIRONMENTAL HEALTH THREAT to children in the United States. According to the Center for Disease Control, half a million U.S. children ages 1 – 5 have unsafe lead levels. 1
6/22/2020 LEAD TESTING This Photo by Unknown Author is licensed under CC BY ‐ NC ‐ ND 2
6/22/2020 LEAD SCREENING REQUIREMENTS FOR MANAGEMENT EVALUATION Are all children assessed for lead screening? Circle what records are used to assess: MCIR Med. Record MI ‐ WIC If no lead test have been performed, is the client referred for lead testing? THE EFFECTS OF LEAD ON THE BRAIN • Most damage occurs in the brain • Disrupts growing brain connections • Results in decreased intelligence • Causes learning disabilities • Creates behavior problems • Effects every child differently 3
6/22/2020 RESEARCH 1999 ‐ 2013 Environmental lead exposure associated with an increased risk for numerous conditions and diseases: • reading problems • school failure • delinquent behavior • hearing loss • renal disease • cardiovascular disease HISTORY • Before 1970 lead exposure was defined by a blood lead level of 60 µg/dL (micrograms per deciliter) or higher • Blood lead concentration for defining lead exposure has steadily been reduced: • 4 0 µg/dL in 1971, 30 µg/dL in 1978, 25 µg/dL in 1985, 10 µg/dL in 1991 and 5 µg/dL in 2014. • Reductions occurred because blood lead levels as low as 10 were associated with adverse effects, such as lower intelligence. 4
6/22/2020 µg/dL ADULTS Elevated CHILDREN micrograms per deciliter Blood Levels 150 Death Coma/Seizures Coma/Seizures 100 Anemia Kidney Damage Anemia 50 Decreased lifespan Decreased ability to make red blood cells Decreased ability to make red blood cells 40 30 Nerve problems Nerve Problems 20 Hypertension Interference with Brain Development 10 (IQ/hearing/growth ) WHAT HAPPENS TO LEAD IN THE BODY? Stored for long periods in mineralizing tissue such as teeth and bones Can be released again into the bloodstream during times of bodily stress, such as: ~ pregnancy ~ breastfeeding ~ calcium deficiency ~ osteoporosis (thinning of the bones) 5
6/22/2020 WHY ARE KIDS AT HIGHER RISK? Lead becomes dust from peeling/chipping paint and is present in soil Children explore the environment using their hands and mouths They spend a lot of time on the floor where sources of lead are found Children absorb and retain 50% more of the lead they ingest than adults HOW DO I KNOW IF A CHILD HAS ELEVATED BLOOD LEAD LEVELS? Child may not look or act sick Symptoms are vague, mimic other illnesses Common symptoms: stomach upset, fatigue, hyperactivity, poor appetite, sleeping difficulties Testing is the ONLY way to know ‐ One Poke = Two Tests Blood tests should be done at 12 and 24 months 6
6/22/2020 LEAD AND PREGNANCY Lead passes from mom to her unborn baby Too much lead increases risk of brain, kidney, nervous system damage to baby as well as miscarriage, premature birth and low birth weight Remodeling, occupational exposure and pica are risk factors that warrant testing for lead in pregnancy Breastfeeding is encouraged even with elevated lead levels (< 40 ug/dL) CDC does not recommend universal testing of all pregnancy women WHO IS AT RISK? Anyone can have elevated lead levels Infants and children up to 6 years are most at risk Children living in a home built before 1978 Pregnant women Children adopted from a foreign country Refugee and immigrant children 7
6/22/2020 SOURCES OF LEAD Lead ‐ based paint usually in homes built before 1978 Chipping and peeling paint High friction areas Contaminated soil Contaminated drinking water from old plumbing SOURCES OF LEAD Old painted toys Imported spices and herbs Imported food cans with lead soldered seams Imported lead ‐ glazed pottery Home or Folk remedies including Greta, Azarcon, Liga and Paylooah Imported Cosmetics including Kohl, Surma and Kaj This Photo by Unknown Author is licensed under CC BY ‐ NC ‐ ND 8
6/22/2020 SOURCES OF LEAD Lead brought into the home on clothes by those working in lead related industries: manufacturing, construction, automotive repair, plumbing, electronics. Hobbies such as making fishing sinkers, stained glass, pottery, firearms. This Photo by Unknown Author is licensed under CC BY ‐ SA ‐ NC REMEMBER….EDUCATION IS THE KEY 9
6/22/2020 WHERE DO CHILDREN GET TESTED ? • Well Child Checks at primary care provider or Clinics • Medicaid pays • Commercial insurance pays • WIC • Check with Local Public Health Department This Photo by Unknown Author is licensed under CC BY ‐ NC ‐ ND DIAGNOSIS A simple blood test A capillary test of ≥ 5 µg/dL (micrograms per deciliter) needs to have a venous confirmatory test An elevated Venous Blood Lead Level ≥ 5 µg/dL (211+) Follow up with doctor and health department 10
6/22/2020 WHY WIC CHILDREN ARE AT RISK •Children in WIC share some of the same risk factors as children who become lead ‐ poisoned. •Risk factors include: •Infant and toddler behaviors (putting stuff in their mouths) •Low income •May live in older housing •Have nutritional needs (especially anemia). LEAD SCREENING Testing: First test at 1 year cert (coincide with Hgb test) Must be at least 12 months between tests 2 nd test ~30 month CEVAL (if 18 month Hgb was ok) If child enrolled at older age, should test at least once between 3 ‐ 5 years if never tested Results of lead screenings listed on MICR 11
6/22/2020 LEAD SCREENING If this is a WIC visit that will involve a capillary stick for hemoglobin for a child under 3, ask the parent if the child has had a blood lead test within the last year. If the child has not been tested, prepare the extra supplies that will be needed to obtain a blood lead sample at the same time as the hemoglobin. One Poke = TwoTests RISK CRITERIA 211+ Criteria (PG, BE, BP, NPP, IBE, IBP, IFF, C1 – C4) Elevated blood lead levels: Venous blood lead level at or above 5 micrograms per deciliter within the past 12 months 12
6/22/2020 ≥5 Record date of test, value >10 and venous Method to generate risk 25 Enter lead value when results received from State lab, if desired. 13
6/22/2020 WIC’S ROLE Assignment of risk code 211 + results in referral to RD; others can be referred as indicated Nutrition Education Referrals WELL FED MEANS LESS LEAD Appropriate for use with WIC families Available on e ‐ Forms Three languages English Arabic Spanish 14
6/22/2020 WELL FED MEANS LESS LEAD Regular meals and snacks may help lead from being absorbed. It fills up the receptor sites to keep the lead out. Key nutrients that can protect the body from lead’s harmful effects include Calcium : milk, cheese, yogurt, green leafy vegetables like spinach, kale, collard greens and tofu. Iron : lean meat, fish, chicken, cooked beans/lentils, iron fortified breakfast cereals, raisins. Vitamin C : oranges, grapefruit, tomatoes, melons, broccoli, cauliflower, cabbage and bell pepper. Eat less fried foods, high fat meats and chips WIC’S ROLE Your role in WIC to provide blood lead screening and nutrition education about foods that help prevent absorption of lead help women, infants and children! You do make a difference! 15
6/22/2020 MICHIGAN LEAD RESOURCES www.michigan.gov/lead ‐ Michigan Department of Health & Human Services Childhood Lead Poisoning Prevention Program, 517 ‐ 335 ‐ 8885 or 888 ‐ 322 ‐ 4453 www.mileadsafehomes.org ‐ Michigan Alliance for Lead Safe Homes www.healthyhomescoalition.org/lead ‐ Healthy Homes Coalition of West Michigan, Grand Rapids MI www.healthyhomescoalition.org/landlords ‐ lead ‐ law ‐ lead and legal information for landlords www.msue.anr.msu.edu/program/info/lead Your Local Health Department ADDITIONAL LEAD RESOURCES www.cpsc.gov ‐ Consumer Product Safety Commission: search for consumer products recalled for violation of lead standard www.cdc.gov/lead ‐ Centers for Disease Control and Prevention www.epa.gov/lead ‐ Environmental Protection Agency www.sesamestreet.org/parents/topicsandactivities/toolkits leadaway ‐ Sesame Workshop Lead Away Program materials 16
6/22/2020 ADDITIONAL LEAD RESOURCES www.youtube.com/watch?v=7FHdozMq FCQ – Sesame Street You Tube Video The National Lead Information Center: 800 ‐ 424 ‐ 5323 (LEAD) QUESTIONS? 17
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