LCHM Fall 2017 - 12

FEATURE

Allentown Board of Health Urges Area Physicians to

Expand Testing for Blood
Lead Levels in Children
A

re there children in the Lehigh Valley
with elevated blood lead levels that are
not being detected? A study released in
May 2017 states that current guidelines result
in under testing of blood lead levels, and
screening questionnaires can fail to identify
children with elevated blood lead levels.
If these children are misperceived to be
at low risk and are not screened, physicians
may mistakenly believe that fewer patients
in their practices need to be screened. The
problem of undetected lead poisoning is
real, and occurs across the United States.
Children aged 1 to 5 years are at highest
risk for lead exposure and its ill effects. Without testing, patients are left to experience
the consequences of continued exposure,
which can include cognitive and behavioral
impairments, and potentially other insults
to a range of body systems.

An excellent comprehensive resource for
physicians regarding lead, its effects on children, screening guidelines and management
is the 2016 policy statement on Prevention of
Childhood Lead Toxicity from the American
Academy of Pediatrics.
The major source of lead in our community
is the aging housing found in our region.
Lead was added to interior and exterior
paints until 1978. Layers of paint are then
applied over the old paint, but as doors and
windows open and close, paint deteriorates
into dust that young children ingest.
Using a standard of 10 mcg/dL, a survey
of U.S. housing built from 1978 to 1998
showed 2.7% contained one or more lead
12 Lehigh County Health & Medicine | FALL 2017

paint hazards, rising to 11.4% of housing
built from 1960 to 1977, 39% of housing
built from 1940 to 1959 and 67% of housing
built before 1940.

level of 10 mcg/dL or higher is investigated
by a community health worker from the
AHB. Despite no available funding, the
Allentown Health Bureau has sustained a
commitment to provide case management
Lead is a known neurotoxin for which services if the blood lead level reaches 20
no safe level of exposure has been identified. mg/dL. The AHB followed 19 such children
The CDC adopted a reference value of 5 in 2016. In every case, the child resided
mcg/dL to trigger clinical and public health in a unit where lead dust was present.
interventions based on the 97.5th percentile Removing lead from a dwelling is difficult
of blood lead concentrations in population and expensive. Limited grants have been
surveys. Even low levels of lead, less than secured to remediate housing units. Besides
5 micrograms per deciliter, are strongly lead abatement, frequent cleaning to remove
associated with diminished academic abilities, dust and frequent hand washing can reduce
attention deficits, and problem behaviors. risk, as will certain improvements in diet
that can reduce lead absorption. Other less
No treatments have been shown to be common sources of lead exposure include
effective in ameliorating the permanent soil contaminated by lead, old or foreign toys
adverse effects of lead. Therefore, prevention and painted furniture, lead from parental
of lead toxicity is by identification and hobbies or occupation, some ethnic folk
elimination of sources of lead exposure. remedies and candies, and ceramics.
As members of the Board of Health in
Allentown, we urge physicians to expand
The City of Allentown participates in a
the current testing for lead.
random water testing program conducted
by the Lehigh County Authority. At this
In 2014, the CDC eliminated funding for point, there is no reason to believe that
health department lead screening. There have water has been the source of childhood
been further reductions and even elimination lead poisoning in Allentown. Families that
of funding for public health initiatives to have aging pipes are advised to seek water
educate the public, assist in management of testing on their own or to use a lead filtering
cases, and to remediate housing units. This device on their faucets if they have a concern.
brings the public health task to detect and Allowing water to run for a minute before
reduce lead exposure to the physicians in consumption and using cold water rather
our community. If you do not detect levels than warm/hot water for formula preparation
of lead, the public health sector cannot take or cooking also reduces risk.
your place.
The Allentown Health Bureau (AHB)
works with physicians to educate the family
of any child with a blood lead level of 5 mcg
or higher. Each report of a child with a lead



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