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Clinical Preventive Services -
Screening -
Metabolic, Nutritional, and
Environmental Disorders -
Elevated Lead Levels
in Childhood and Pregnancy
ACPM Recommendations:
Screening for elevated lead levels
via venous or capillary blood lead
testing should be conducted for children
aged 1 year only if they are identified
as being at high risk for elevated blood
lead levels. Criteria for being at high
risk include: receipt of Medicaid or
WIC, living in a community with ³
12% prevalence of BLLs at ³
10 mdg/dL, living in a community with ³
27% of homes built before 1950, or
meeting one or more high-risk criteria
of a lead-screening questionnaire. This
questionnaire should include both
questions suggested by the CDC in their
1997 guidelines, as well as questions
developed for and tailored to specific
communities. These questions may pertain
to use of home remedies and cosmetics,
country of origin, and/or behavioral
risk factors. Risk assessment for lead
exposure should be performed beginning
during prenatal visits and continuing
until 6 years of age.
U.S. Preventive Services Task Force
Recommendations:
Screening for elevated lead levels by
measuring blood lead at least once at
age 12 months is recommended for all
children at increased risk of lead
exposure. All children with identifiable
risk factors should be screened, as
should all children living in
communities in which the prevalence of
blood lead levels requiring individual
intervention, including residential lead
hazard control or chelation therapy, is
high or is undefined (see Clinical
Intervention). Evidence is currently
insufficient to recommend an exact
community prevalence below which
targeted screening can be substituted
for universal screening. Clinicians can
seek guidance from their local or state
health department. There is insufficient
evidence to recommend for or against
routine screening for lead exposure in
asymptomatic pregnant women, but
recommendations against such screening
may be made on other grounds. There is
also insufficient evidence to recommend
for or against counseling families about
the primary prevention of lead exposure,
but recommendations may be made on other
grounds. Recommendations regarding the
primary prevention of lead poisoning by
population-wide environmental
interventions are beyond the scope of
this chapter.
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