Preventing Elevated Blood Lead Levels High Level of Lead in Sindoor - PDF document

Lead in the News Preventing Elevated Blood Lead Levels High Level of Lead in Sindoor in Children Tests find more lead in products Funded by the New Jersey Department of Health Physician’s 2 -year old son poisoned by lead in their home Learning Objectives Prevention is # 1 Summarize the role of the pediatric health care provider in Childhood lead poisoning is one of the most common preventing, identifying, and managing elevated blood lead levels in – AND PREVENTABLE – young children pediatric environmental health problems Summarize public health’s role in preventing and managing in the United States today elevated blood lead levels in children List three effects of lead exposure in the pediatric population Through family education, screening, care coordination and communication within the medical home neighborhood, the pediatric provider can educate families Identify sources, its route(s) of exposure and prevention on prevention, while at the same time screen for lead measure(s) poisoning prevalence in the community 1

Lead 101 No Safe Level of Lead What What  A naturally  It can travel via air  When the body is exactly occurring metal happens before settling to is lead? when it the ground and  Found in air, soil, exposed to lead, it enters the water, and in our  Sticks to soil can act as a poison homes environment? particles  May still be found  May move from  At very high levels, in paint, ceramics, soil to pipes and plumbing groundwater lead poisoning can materials,  May also move be fatal batteries, because of ammunition, and flooding or cosmetics damage to homes Sources of Lead Sources of Lead Lead-based paint: Lead dust Cultural  Most resulting from: Consumer Hobbies & Remedies & Soil common  Old lead paint Goods Occupations Practices for children flaking off  Found on  Home repair impact activities & friction  Tracking lead surfaces contaminated  Often found soil into home under layers  Clothing worn of new paint Contamination due to water at a job site intrusion & sediment flow 2

3,797 Most Affected New Jersey Housing 2,792 Counties in NJ 6,112 4,117 2,750 Percentage of 24,530 14,189 pre-1980 housing in NJ by municipality 2,908 11,091 Number of Housing Units Damaged National Housing Stock Who is at Risk? Children living at or below Children under poverty line 6 years of age Pregnant Children living women in older housing Children of some racial and ethnic groups 3

Health Implications Health Implications  Lead exposure in utero can lead to premature birth,  Elevated blood lead levels are smaller babies, decreased not easy to detect without a mental ability in infants, blood test learning disabilities, & reduced  Many times there are no growth in young children symptoms, or the symptoms  High level exposure in adult are the same as those of males can damage sperm more common illnesses like production an upset stomach or the flu  In pregnant women, high levels of exposure may lead to miscarriage Health Implications Health Implications If not detected early, children with high Signs of an elevated blood lead levels of lead can suffer from: level may include:  Damage to the brain & nervous system  Persistent tiredness or  Behavior & learning problems; hyperactivity hyperactivity  Irritability  Slowed growth  Loss of appetite  Hearing problems  Weight loss  Headaches  Reduced attention span  In rare cases elevated blood lead levels  Difficulty sleeping can result in seizures, coma and even  Constipation/abdominal pain death  Anemia Source: http://www.cdc.gov/lead/ 4

Health Implications Lead Poisoning: A Civil Rights Issue Child’s IQ = The rate of IQ loss per 1 μg/dL is greatest at lead levels below 10 μg/dL Aggression Impulsivity BLL increase from 1 – 10 μg/dL Crime  3.9 – 7.4 IQ points BLL increase from 10 – 30 μg/dL Removing disparities in access  2.5 – 3.0 IQ points to healthy, safe, and affordable homes is essential to improving Lower blood lead levels may have an the quality of life for minority and even greater effect on IQ than high low-income populations. BLLs Source: http://www.nchh.org/Portals/0/Contents/Childhood_Lead_Exposure.pdf National & State Lead Poisoning Prevention Goals Healthy People 2020 Objective Identification and control of lead paint Healthy People 2020 Healthy New Jersey 2020 To eliminate hazards childhood Identification and care for children lead with elevated blood lead levels poisoning as a public Surveillance of elevated blood lead levels in children to monitor progress health problem Research to further improve childhood lead poisoning prevention methods CDC shifting focus  primary prevention 5

NJ DOH Leads the Way NJ DOH Leads the Way Earlier Intervention  Create a collective voice on health policy  Combine resources across all State departments Old Rule: New Rule:  Pool data  Coordinate efforts  Prioritize and direct implementation 10 μg /dL 5 μg /dL  Catalog what each State department is already doing  Identify “hot spots” for targeted action Healthy New Jersey 2020 Objectives Healthy New Jersey 2020 Objectives To reduce mean To reduce blood lead levels in children blood lead levels in children NJ Baseline: Federal Baseline: NJ Baseline: Federal Baseline: 8.0 μg /dL 5.8 μg /dL 3.8 μg /dL 1.8 μg /dL NJ State FY 2016: NJ State FY 2016: 5.0 μg /dL 1.7 μg /dL NJ Target: Federal Target: NJ Target: Federal Target: 7.2 μg /dL 5.2 μg /dL 3.4 μg /dL 1.6 μg /dL Target-Setting Method: 10% Improvement Target-Setting Method: 10% Improvement 6

Role of the Provider: From Prevention to Care Management Role of the Provider Provide anticipatory guidance about childhood lead poisoning and its prevention New Jersey State Law (N.J.A.C. 8:51A-2.2) Provide screening for lead poisoning following established screening schedules Lead screening must be performed: Conduct appropriate diagnostic blood lead testing in children with symptoms or signs consistent with lead poisoning  1 year & 2 years of age Interpret blood lead results  Older than 26 months, but < 6 years Educate parents about reducing blood lead levels of age if never previously screened  Coordinate with local public health officials Children found to be at risk Ensure that poisoned children receive appropriate medical, environmental and social service follow-up Role of the Provider Role of the Provider Appropriate Follow-up New Jersey State Law (N.J.A.C. 8:51A-2.2) Coordination with Health Officials  Requires physicians, nurses, health care facilities to Retesting perform blood lead screening on children up to 27 months. Care Management  Parents must be given results, and its meaning, for all Education Education blood lead level results 5 μg /dL or greater. www.nj.gov/health/childhoodlead BLL 0 - 4 BLL 5+ Screening for Lead Levels 7

Role of the Provider PCP: Re-Testing Protocol If result of capillary Perform diagnostic test on *For BLLs > 5 μg/dL, PCP identifies EBLL provider has responsibility screening test ( μg /dL ) is: venous blood within: > 5 μg /dL to intervene 5-9 3 months PCP arranges for venous confirmation 10-19 3 months (if EBLL is based on capillary specimen) Local health department notified by 20-44 1 week – 1 month NJ DOH via LeadTrax of EBLL; 45-59 48 hours contacts PCP Local health department begins case 60-69 24 hours management and inspects home; informs PCP of outcomes 70 or higher Immediately as emergency PCP arranges for follow-up testing; lab test local health department & PCP monitor Source: BLL until discharge https://www.cdc.gov/nceh/lead/publications /screening.htm Role of the Provider Role of the Provider Recommended actions for parents to reduce lead exposure: Risk Assessment Questionnaire  Do not let child play in bare soil  Has there been a recent renovation of the child’s residence if  Wash child’s hands after playing outside, before eating and built before 1978, or if lead-based paint is known to be sleeping present?  Frequently clean floors and windowsills with damp cloth or  Is there deterioration of the paint in the child’s residence? mop  Has the child moved into a house built prior to 1978 that has  Put washable doormats at all entries to home peeling, chipping, or deteriorated paint?  Remove/wipe shoes before entering home  Did an adult living in the home undertake a new job or hobby that involves exposure to lead?  Wash toys with soap and water  Offer a diet high in calcium and iron, low in fat 8