EPSDT Care for Kids Newsletter

LEAD POISONING IN IOWA’S CHILDREN
Rita Gergely, Director, Lead Poisoning Prevention Program, Division of Health Protection, Iowa Department of Public Health
Summer 1999

From July 1993 through June 1998, physicians, local health departments, and the Title V Child Health Program tested 93,229 Iowa children younger than six for lead poisoning. Of these, 12.3% were identified as lead-poisoned. This is nearly three times the national average of 4.4%, according to Phase II of the Third National Health and Nutrition Examination Survey.

The most common source of lead is deteriorated lead-based paint. Nearly 43% of Iowa’s housing was built prior to 1950, and is likely to contain lead-based paint. Deteriorating lead-based paint is a hazard. The chips end up on floors, in window wells, in household dust, and in the soil. Children are lead-poisoned when they put paint chips or soil in their mouths, or when they get house dust and soil on their hands and put their hands in their mouths.

Iowa children suffer from lead poisoning at a rate that is nearly three times the national average.

As the result of what we know about rates of lead poisoning in Iowa children, the Iowa Department of Public Health (IDPH) recommends routine blood lead testing of all children under the age of 6 years. State regulations require blood lead testing for all children under the age of 6 years who are covered by Title XIX. In addition, Iowa law requires that all blood lead testing results, for both children and adults, be reported to IDPH.

You can use the Childhood Lead Poisoning Risk Questionnaire (see below) to determine whether a child is at risk for lead poisoning. If you do not wish to use the questionnaire, IDPH recommends using the high-risk screening schedule for all children, testing at 12, 18, 24, 36, 48, and 60 months.

Children at low risk do not need to be tested as frequently as high-risk children (see Insert Page 2, "Guidelines for Identification and Management of Lead-Poisoned Children"). In Iowa, no method of risk assessment is accurate enough to determine that a child is risk-free for lead poisoning, so even low-risk children should be tested. (Several years ago, IDPH followed a case where a low-risk child was found to have a confirmed blood lead level of 72 micrograms per deciliter (µg/dL), which is dangerously high. The child had previously been classified as low-risk because the mother did not know that their home was built before 1960.)

With proper sample collection technique, you can use capillary samples for blood lead tests. It is important to wash the child’s hand with soap and water before taking the sample. This removes lead that could contaminate the sample. Wiping the child’s finger with alcohol will not remove lead.

Providers may also use venous samples. However, this is often more costly. In addition, if the family will need to go to a hospital lab or other facility for the procedure, they may not follow through and have the test completed.