MaryKate Cardon, DNP, BSN, RN
Co-Director, Northwest Pediatric Environmental Health Specialty Unit
University of Washington
There are new changes and challenges that impact the ongoing concern of pediatric lead exposure. First, the CDC recently revised the blood lead reference value (BLRV), lowering it to 3.5 µg/dL. This change reflects a population-level decline in blood lead levels (BLLs) in children aged 1-5 years, based on a nationally representative data set of U.S. children called NHANES. Second, there has been a steep decline in risk factor screening and blood lead testing to identify lead-exposed children.1,2 This decline reflects the impacts of the COVID-19 pandemic on the provision of primary care services as well as the impacts of point-of-care (POC) testing machine recalls. Lastly, newer yet prominent lead exposure sources have been identified that are not currently included in routine screening questionnaires. These sources include certain spices, like turmeric,3,4 and imported aluminum cookware.5
Lead exposure, even at relatively low levels, is a well-established risk factor for adverse neurodevelopmental health outcomes, such as reduced cognition and increased behavioral problems, including ADHD. There are no cures or treatments to reverse the damage of lead exposure once it occurs, underscoring the importance of identification of children at greater risk of exposure through screening and performing a blood lead test when indicated. Straightforward guidelines for who to test, when to test, and what to do based on the BLL are available (WA DOH testing clinical algorithm and NW PEHSU lead medical management factsheet). In short, all children enrolled in Medicaid (Apple Health) must have a blood lead test done at 12 and 24 months, or once between 24 and 72 months if testing was not done previously. Deciding if and when other children need a blood lead test depends on the caregiver’s responses to risk factor screening questions. The CDC has also published special testing recommendations for refugee children ≤ 16 years of age due to their heightened risk of lead exposure, which includes a blood lead test upon arrival.
Discussing potential sources of lead with families, as well as common child behaviors that can increase risk, provides an opportunity for primary prevention – the most powerful tool to reduce the impacts of lead on child health. Although lead-based paint remains a top exposure source for children in Washington and across the U.S., it is important to investigate other possible sources of exposure in a child’s environment beyond paint. Other potential sources include (but are not limited to) soil, imported cookware, water, nutritional supplements, folk medicines, imported food (including spices), cosmetics, toys, ceramic dishware, and cultural/religious powders. You can learn more about the wide variety of other sources here.
Consult a specialist if needed. The NW Pediatric Environmental Health Specialty Unit (PEHSU) is a center of expertise on pediatric and reproductive environmental health, serving Alaska, Idaho, Oregon, and Washington. NW PEHSU provides consultation services for clinicians, public health professionals, and families. To contact NW PEHSU, call 1-877-KID-CHEM or email pehsu@uw.edu. For more information, please visit https://deohs.washington.edu/pehsu/.
References
- Courtney JG, Chuke SO, Dyke K, et al. Decreases in Young Children Who Received Blood Lead Level Testing During COVID-19 – 34 Jurisdictions, January-May 2020. MMWR Morb Mortal Wkly Rep. 2021;70(5):155-161. Published 2021 Feb 5. doi:10.15585/mmwr.mm7005a2
- Woolf AD, Brown MJ. Old Adversary, New Challenges: Childhood Lead Exposure and Testing. Pediatrics 2022; e2021055944. doi:10.1542/peds.2021-055944
- Hore P, Alex-Oni K, Sedlar S, Nagin D. A Spoonful of Lead: A 10-Year Look at Spices as a Potential Source of Lead Exposure. J Public Health Manag Pract. 2019;25 Suppl 1, Lead Poisoning Prevention:S63-S70. doi:10.1097/PHH.0000000000000876
- Boiko-Weyrauch A. Turmeric poisoned their kids. Four Seattle-area cases show gaps in lead testing. KUOW.org. Published January 24, 2022. Accessed April 28, 2022. https://www.kuow.org/stories/turmeric-poisoned-their-kids-four-seattle-area-cases-show-gaps-in-lead-testing.
- https://www.nature.com/articles/s41370-022-00431-y (Author: Steve Whittaker, article will be available at this link May 2)