Pediatric Lead Screenings Overview for the Primary Care NP

Lead can be found in a child's environment such as homes built before 1978, some toys and jewelry, jobs, soil close to airports, contaminated drinking water. Lead exposure can cause serious health problems for children (damage to brain, slowed growth and development, hearing/speech problems). Those problems can lead to problems in school or difficulty focusing. Most times, there are no obvious signs and symptoms so screening is important.

Who to screen?

The current recommendations is to screen children enrolled in Medicaid at age 12-24 months or age 24-72 months if there is no record of ever being tested. 

How to screen?

Depends on your clinic and options available. You can do a finger/heel prick or blood draw. If the finger/heel prick is elevated, confirm with a second test. The blood draw is less likely to be contaminated. There are no safe levels of lead but a level of 3.5 or above is considered high. Any amount of lead can be a concern. 

What to do if lead is elevated?

Try to identify source and limit exposure. If lead level is 3.5-19 you need to report to your state or local health department. Make sure the child does not have iron deficiency and treat if they do. Support the patient's diet, especially calcium and iron intake. Check the child's developmental milestones and provide referral interventions if needed. If the level is 20-44, consider an abdominal XR to check for lead-based paint chips or foreign bodies. Contact poison control center (ED referral). If >45, definite ED referral and possible hospital admission. 

Reference: 

https://www.cdc.gov/lead-prevention/hcp/clinical-guidance/index.html

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