Pediatric Lead Testing

By Coverys Risk Management

Lead toxicity among children in the United States has been a public health issue for decades, and one that continues to shine a glaring light on healthcare disparities between socioeconomic groups. A disproportionate number of the more than 500,000 children estimated to have elevated lead levels are black, migrants, refugees, foreign adopted, and/or on Medicaid. However, lead poisoning is not confined to these demographics and it’s important to consider ways to enhance your screening, testing, and education protocols.

Here are four considerations for your medical practice:
  1. Nutrition impacts absorption of lead. It’s important to provide appropriate nutrition counseling to all families, regardless of risk for elevated blood lead level (BLL). A well-balanced diet is essential for all children and certain vitamins and minerals ― especially calcium, iron and vitamin C ― play a specific role in minimizing lead absorption. Regular assessment of the child’s nutritional status during well-child care can identify children with inadequate intake of these and other nutrients, and allow you to proactively recommend supplementation.
  2. Restoration of older homes is putting more children at risk. While screening standards should still be structured upon what we know about the socioeconomics of lead poisoning (i.e., with particular attention to children who are black, migrants, refugees, foreign adopted and/or on Medicaid), our screening criteria must become broader. An increasing trend to purchase and renovate older homes means that children in all walks of life are being exposed to lead-based paint, drinking water tainted with lead, and other sources of toxicity.
  3. Insurance guidelines put lead testing within reach for most families. Under the Affordable Care Act*, lead testing is considered a preventative service, and most insurance companies (inclusive of Marketplace and Medicaid) must provide coverage at no cost to high risk children.
  4. Your zip code matters. Find out if your medical practice is located in or near a high-risk zip code (most states maintain such zip code lists, which are available online). And consider whether there’s more you can do to partner with public health and parents to address risk in your broader community.
Back to Basics: A Quick Review of What You Can Do About Pediatric Lead Poisoning
If your medical practice is like most, you changed your frame of reference when the Centers for Disease Control and Prevention (CDC) lowered the threshold for blood lead toxicity from 10 µg per dL to 5 µg per dL (micro grams per deciliter of blood) in 2012, but you changed very little else.

When it comes to reducing the high incidence of lead poisoning among children in America, there are three key things to keep in mind:
  1. Screening and education make a world of difference. As a physician, there’s much you can do to help families understand whether their children are at risk of lead poisoning. Risk questionnaires and improved educational efforts in your office can leave you and the families in your care better informed, and ultimately safer.
  2. Testing is simple, typically covered by insurance, and should be part of the preventive healthcare for all children at high risk. Vigilance in testing at-risk children (e.g., those under the age of six and those whose environment may expose them to lead) is a responsibility that falls heavily to pediatricians and family physicians. A simple blood test can yield vital information about lead toxicity.
  3. Physicians are important members of a larger team needed to address lead exposure. The effects of lead exposure ― which can include cognitive deficiencies that impact reading, vocabulary, fine motor skills, reaction time, and hand-eye coordination ― are irreversible. As such, it’s imperative that the United States does all it can to prevent exposure. While physicians and other healthcare professionals cannot create or enforce environmental legislation, their efforts in educating families and identifying sources of lead exposure among their patients helps to protect entire communities.
A Smart Screening Strategy
It is recommended, by the CDC and others, that annual check-ups with pediatric patients (particularly those aged six and younger) include asking the parent or guardian the following questions:
  1. Does your child live in or regularly visit homes built before 1950?
  2. Does your child live in or regularly visit a home built before 1978 that has had recent or ongoing renovation?
  3. Does your child have a sibling or playmate who has had lead poisoning?
  4. Does your child spend time with an adult whose job exposes him or her to lead? (Examples: construction, painting, metalwork.)
If the answer to any of these questions is “yes,” the child should receive a blood test to measure his or her lead level. (It should be noted that, because there is a potential for exposure to infants in utero, OB/GYNs should also be asking similar questions to pregnant patients.)

When determining whether to test a patient for lead, also consider the following in your decision-making:
  • The CDC recommends that all children on Medicaid be tested because of a high correlation between poverty and elevated blood lead levels (BLL).
  • Black children have twice the risk of having elevated BLL.
  • Migrants, refugees, and foreign-adopted children are at high risk as well.
  • Any child living in a home built before 1978 is potentially at risk for exposure.
What You Should Know About Testing
For children who are considered at high risk of exposure, annual testing is recommended. Venous blood samples are preferred but finger sticks, when performed properly, can be an effective initial test. If a child tests positive through a finger stick, a follow-up venous sample should be obtained to verify the results.
According to the CDC, “Clinicians should ensure that BLL values at or above the reference value [≥5 µg/dL] are reported to local and state health and/or housing departments if no mandatory reporting exists and collaborate with these agencies in providing appropriate services and resources to children and their families.”

Educational Resources for Your Patients
Knowledge is power. Be sure to maintain a stock of educational brochures for distribution to parents during well-child visits on topics like:
  • Lead sources
  • What to do if you live in a home that was built prior to 1978
  • How to properly clean up lead dust
  • How to renovate safely
The CDC has produced a series of brochures about pediatric lead poisoning that can be downloaded, printed and shared.

And, as suggested previously, you can play an important role in educating families about adequate nutrition and the minimization of lead absorption.

What’s at Stake?
The stakes are high when the potential victims are the littlest and most innocent among us. The CDC reports that children in at least 4 million U.S. households are being exposed to high levels of lead. And while the reference value was lowered to 5 µg per dL in 2012, there is no safe level of lead in the blood. Values as low as 2 µg per dL can reduce IQ.  

There is always more to know and do to keep American children safe from lead poisoning. It’s imperative that physicians screen for risk, test children who are deemed to be at-risk, and educate families about keeping their children healthy.

Pediatricians and family physicians are necessary and important members of a larger team needed to address lead exposure. Remaining vigilant about screening and testing for lead among pediatric patients will make a meaningful difference in the health of countless children.
*As of January 2017.
No legal or medical advice intended. This post includes general risk management guidelines. Such materials are for informational purposes only and may not reflect the most current legal or medical developments. These informational materials are not intended, and must not be taken, as legal or medical advice on any particular set of facts or circumstances. 

Related Resources:

A Dose of Insight — Maternal/Fetal Risks: Using Claims Analysis to Improve Outcomes

White Paper - 1/8/2019
Each year in the United States, there are nearly 4 million births, and every birth has a story. This special report is the story of what can go wrong — the real data about maternal/fetal risk, why poor outcomes related to childbirth trigger malpractice claims, and what can be done to improve outcomes and reduce liability. Read More »

Behavioral Health Risks in Surgical Environments

Learn how to manage behavioral health issues in surgical environments and some nuances to consider for the surgical process. Read More »

Managing Behavioral Health Risks in the Emergency Department

Blog - 10/15/2018
Psychiatric admissions in EDs have reached an all-time high as the number of beds available for psychiatric inpatient services has dwindled due to changes in reimbursement for these services and other funding cutbacks. Learn how EDs can maximize safety and minimize exposures. Read More »

Seven Common Electronic Health Record Mistakes

Article - 1/10/2018
Improper use of electronic medical records may create a challenge in defending a healthcare provider’s treatment due to a perceived carelessness in documentation. Learn about seven common mistakes and how to avoid them. Read More »

Are Your Serum Lead Level Results Reliable?

Serum blood tests run on a Magellan Diagnostics’ LeadCare® analyzer may result in falsely low readings. Read More »

Seven Ways to Protect Patient Safety During Mergers and Acquisitions

Blog - 6/21/2017
Healthcare services industry mergers and acquisitions are on the rise. Find out how organizations can help protect patient safety during these complex transitions. Read More »

Surgical Claims Data: Inpatient/Outpatient Comparison

Blog - 5/26/2017
Key insights into the risks of inpatient vs. outpatient surgery from Coverys claims data. Read More »

Mitigating Surgical Risks in the Outpatient Setting

Blog - 5/26/2017
Tips to mitigate surgical risks in the outpatient setting, based on Coverys claims data. Read More »

Preventing Infection in the Outpatient Setting

Article - 5/22/2017
Many services traditionally provided in acute care and inpatient settings have moved to outpatient settings, such as surgery centers and physician offices. This article provides insight into what healthcare providers can do to prevent infection and improve patient safety in the outpatient setting. Read More »

Testing & Screening Tips for Pediatric Lead Poisoning

Blog - 4/4/2017
Lead toxicity among children in the United States has been a public health issue for decades and statistics show the problem is widespread. This article provides tips top help healthcare providers improve their lead screening and testing protocols. Read More »

Fragmented Intelligence Breeds Fragmented Care

News - 3/1/2017
Article highlights the importance of data analytics in uncovering the root causes of medical malpractice claims. Read More »

Medication Errors: The Risks We Must Reduce

Blog - 2/14/2017
A root-cause analysis of 11,000 medication-related claims reveals top areas of concern. Read More »

Legal Concerns Regarding Medical Record Alteration

Article - 12/19/2016
An actual case study is used to illustrate how altering electronic medical records after the fact can damage the defensibility of a malpractice lawsuit. Read More »

Medical Assistant Scope of Practice

Article - 12/5/2016
To help ensure medical assistants are used safely and effectively in your office or organization you must clearly define their scope of practice. This article provides tips on how to do so. Read More »

Pros and Cons of Dispensing Medication Samples

Article - 11/21/2016
Outlines the pros and cons of dispensing medication samples and steps you can take to help ensure patient safety. Read More »

Preventing Healthcare Worker Fatigue

Article - 11/7/2016
Extended work hours bring up concerns of worker fatigue and its effects on patient safety. Learn strategies to help prevent worker fatigue and mitigate risk. Read More »

How to Recognize and Respond to Zika

Blog - 9/2/2016
Tips to help physicians and healthcare providers recognize and respond to the Zika virus. Read More »

Communicating With Patients About Zika

Blog - 9/2/2016
How and what to communicate to patients regarding the Zika virus. Read More »

Reducing Zika Risk for Healthcare Providers

Blog - 9/2/2016
Identify and reduce risks to physicians and healthcare workers who treat patients with the Zika virus. Read More »

Addressing Patient Non-Compliance

Article - 8/18/2016
This article evaluates an actual non-compliance case study to illustrate why patients fail to follow treatment plans and how physicians and healthcare providers can work to promote compliance, improve patient safety, and reduce malpractice risk. Read More »

Exploring the Benefits of Root-Cause Analysis of Medical Professional Liability Claims

Article - 8/18/2016
The analysis of medical professional liability (MPL) data can offer a unique lens into a number of perspectives that are important to physicians and health systems. Most notably, it can provide intelligence to make the delivery of healthcare safer and ultimately reduce malpractice exposure for physicians and hospitals. Read More »