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L E A D C E N T E R P O I N T Contributions to Childhood Lead Poisoning : A Family Affair Carrin Schottler-Thal MD F A L L - W I N T E R 2 0 1 6 V O L U M E 9 , I S S U E 2 Children are physiologically exposed to lead by ingestion, inhalation, trans-placentally and through breast milk. Various questionnaires have been used to help determine if children should be screened. A key question from the questionnaires used for both children and pregnant women is related to discerning if any other family members have a history of lead poisoning. Since family members share the same possibly lead-laden environment it is important to always take family history into account when taking a lead history. When reversing the scenario, if you have a child with lead poisoning it is very important to check a lead level on all other siblings and pregnant/lactating mothers. According to the CDC (1991) there are several groups of children who are considered priority groups for lead screening. These priority groups take household contact’s medical histories, occupations and hobbies into consideration. Some of these priority groups include children aged 6 to 72 months who are siblings, housemates or playmates of children with known lead poisoning. These are children who are exposed to the same environment where the inhalation or ingestion of lead has been known to occur in another child, as it puts them at a greater risk for lead exposure happening to them. Furthermore if they are siblings of a lead poisoned mother, the exposure could have happened trans-placentally in multiple children. There are many examples of lead laden houses, with chipping paint, exposing multiple children in one family. An interesting example of a group of siblings poisoned by a unique habit was documented in a MMWR report in 1985. A group of siblings in Virginia were introduced to gasoline sniffing by an older sibling. This resulted in six of the siblings becoming poisoned with lead levels ranging from 9-98 micrograms per deciliter. There are other groups of children aged 6 to 72 months, according to the 1991 CDC citation, who are worth mentioning as priority groups, as they can also be affected by family member’s habits. These are children whose parents or other household members participate in a lead related occupation or hobby. We have had anecdotal cases where children have been poisoned through exposure to parents’ lead laden clothing that a parent wore on the job, and other cases where children were exposed by coming in direct contact with a lead exposed hobby. The CDC reported a particular case in 2015 which described lead poisoning in a 1 and 2 year old who had blood lead levels of 18 ug/dl and 14 ug/dl respectively. In this particular case the father worked at an e-scrap recycling center crushing cathode ray tubes. He did not wear protective equipment at work and came home with dust in his hair. When he got home he played with his children who would touch his hair and ingest and inhale the dust. There are some special groups of patients that also need consideration when screening for lead. Children with developmental delay or behavioral problems need to be screened for lead risk. According to the CDC (1991) , children with developmental delays, who have more mouthing or pica behaviors, may be at an increased risk of lead poisoning even if they are above the age of 72 months. The CDC further advises health care providers to consider obtaining a blood lead level in any child with growth failure, hyperactivity, behavioral disorders, hearing loss, or anemia. Centers for Disease Control and Prevention. (1991). Preventing Lead Poisoning in Young Children. Retrieved from: 6-2 Centers for Disease Control and Prevention . (1985) MMWR. Gasoline Sniffing and Lead toxicity among Siblings – Virginia. Retrieved from: Centers for Disease Control and Prevention (2015). MMWR. Investigation of Childhood Lead Poisoning from Parental Take-Home Exposure from an Electronic Scrap Recycling Facility-Ohio 2012. Retrieved from: Contact Information: Central/Eastern New York Lead Poisoning Prevention Resource Center Howard L. Weinberger MD, Medical Director Maureen J. Butler RN, BSN, Program Coordinator Jean Szkotak, Administrative Assistant Upstate Golisano Children's Hospital Department of Pediatrics Room 5600 750 E. Adams Street Syracuse, NY 13210 Phone: [PHONE REDACTED] Fax: [PHONE REDACTED] E-mail: [EMAIL REDACTED] Carrin Schottler-Thal MD, Assistant Medical Director Albany Medical Center 391 Avenue, Suite 3A Albany, NY 12208 Phone: [PHONE REDACTED] Fax: [PHONE REDACTED] ---PAGE BREAK--- Page 2 LEAD CENTERPOINT Since 1994, the New York State Department of Health has funded Resource Centers for childhood lead poisoning across New York State. Since 2008, the combined Central/Eastern New York Resource Center has served 31 counties. The Resource Center has two locations, one at Upstate Medical University, Syracuse NY, and one at Albany Medical Center, Albany NY. The scope of activities of the Resource Center includes: Providing recommendations to health care providers for the medical management and treatment of children and pregnant women with elevated blood lead levels Increasing screening activities and testing rates for all children at ages 1 and 2 years as defined by the New York state guidelines Working with obstetrical providers to increase screening and testing of pregnant women, emphasizing anticipatory guidance to prevent lead exposure Identifying and addressing the special risk factors for lead exposure of New Americans Enhancing primary prevention activities at the local, county and state levels. Dr. Howard Weinberger is the Medical Director for the Resource Center at Upstate and has more than 40 years experience working with lead poisoned children. Dr. Travis Hobart is the Assistant Medical Director at Upstate and works with Dr. Weinberger to provide medical management and educational programs to health care providers throughout the region. Dr. Carrin Schottler-Thal is the Medical Director for the Resource Center at Albany Medical Center. Dr. Schottler-Thal is experienced in medical management and provides health education about lead to families and medical professionals. Maureen J. Butler, RN, BSN is the Program Coordinator for the Resource Center. Ms. Butler works closely with the county based lead programs within the service area to provide case management and education. Educational programs target parents, grandparents and child care providers in an ongoing effort to remind families, caregivers and other members of the public that lead poisoning is still a problem in our communities. Because the effects of exposure to lead cannot be reversed, primary prevention is our most important mission. All medical professionals caring for young families need to remind parents of the lead hazards found in older homes. Routine blood testing for lead is required in New York State at ages 1 year and 2 years. In addition, a blood lead test should be ordered at any age if exposure is suspected. The Resource Center staff is available at any time for assistance in managing a child with lead poisoning. If a blood lead level is very elevated 45 micrograms), contact the Resource Center immediately for assistance in medical treatment. Central/Eastern New York Lead Poisoning Resource Center Our Staff and Program ---PAGE BREAK--- Page 3 V O L U M E 9 , I S S U E 2 Journal Reviews Maureen Butler RN, BSN Inequitable Chronic Lead Exposure: A Dual Legacy of Social and Environmental Injustice. Leech TG et al Family and Community Health 2016, 39(3): 151-159. This article challenges the reader to think beyond the basics of childhood lead poisoning to understand why there is a disproportionate impact of lead exposure in low-income minority communities. The report indicates that it is not a random event that geographic concentrations of lead and legacy sources producing chronic exposure occur in these neighborhoods. The authors discuss the most promising types of public health action that begin to address these issues. Lead Exposure during Early Human Development and DNA Methylation of Imprinted Gene Regulatory Elements in Adulthood. Li Y et al Environmental Health Perspect 2016, 124(5):666-773. http://dx.doi.org/10.1289/ehp.1408577 The authors sought to determine if maternal, postnatal and early childhood lead exposure altered methylated regions of the brain controlling expression of imprinted genes involved in metabolism, growth and development. The researchers conclude that there is evidence that early childhood lead exposure can affect these processes. Lead Poisoning: Focusing on the Fix. Jacobs DE. J Public Health Management Practice, 2016 July-August, 22(4): 326-330. Dr. David Jacobs, one of the leaders in the field of childhood lead poisoning authored this editorial outlining his 3-Point Initiative to eliminate childhood lead poisoning. His proposal: Find It, Fix It and Fund It, provides a clear plan to resolve the ongoing public health problem of childhood lead poisoning. Dr. Jacobs challenges health care professionals, housing professionals, public health, and environmental health specialists, to finally provide a lead free environment for our children. Epidemiologic Characteristics of Children with Blood Lead Levels > 45 µg/dL. Keller B et al Journal of Pediatrics 2016 Oct. 14. (In press) www.jpeds.com. A study of a group of children in New York City with high blood lead levels obtained in the years 2005-2010 identifies common characteristics and describes outcomes. Because the consequences for children with blood lead levels > 45 can include organ damage and death, it is important to understand the demographics and risk factors associated with blood lead levels in this range. ---PAGE BREAK--- Central / Eastern New York Lead Poisoning Prevention Resource Center Upstate Golisano Children’s Hospital SUNY Upstate Department of Pediatrics, Room 5600 750 E. Adams Street Syracuse, NY 13210 Address service requested LEAD CENTERPOINT Central/Eastern New York L E A D POISONING RESOURCE CENTER Working to Eliminate Childhood Lead Poisoning SUNY Upstate Medical University [PHONE REDACTED] Albany Medical Center [PHONE REDACTED]