The following is the abstract and an extract (reprinted with permission) from Pediatrics, Vol 101 No 6 Jun 1998 p1072.

http://pediatrics.aappublications.org/content/101/6/1072.full.html

http://pediatrics.aappublications.org/content/101/6/1072.full.pdf+html

AMERICAN ACADEMY OF PEDIATRICS

Committee on Environmental Health

ABSTRACT. Although recent data continue to demonstrate a decline in the prevalence of elevated blood lead levels (BLLs) in children, lead remains a common, preventable, environmental health threat. Because recent epidemiologic data have shown that lead exposure is still common in certain communities in the United States, the Centers for Disease Control and Prevention recently issued new guidelines endorsing universal screening in areas with >27% of housing built before 1950 and in populations in which the percentage of 1- and 2-year-olds with elevated BLLs is >12%. For children living in other areas, the Centers for Disease Control and Prevention (CDC) recommends targeted screening based on risk-assessment during specified pediatric visits. In this statement, The American Academy of Pediatrics supports these new guidelines and provides an update on screening for elevated blood lead levels (BLLs). The American Academy of Pediatrics (AAP) recommends that pediatricians continue to provide anticipatory guidance to parents in an effort to prevent lead exposure (primary prevention). Additionally, pediatricians should increase their efforts to screen children at risk for lead exposure to find those with elevated BLLs (secondary prevention).

1. Testing and treating children for lead exposure must be coupled with public health programs to ensure environmental investigation, transitional lead-safe housing assistance, and follow-up for individual cases. Lead screening programs in high-risk areas should be integrated with other housing and public health activities.

2. The AAP supports efforts of environmental and housing agencies to eliminate lead hazards from housing and other areas where children may be exposed. These include financial incentives that can be used to promote environmental abatement. Training and certification of abatement workers are needed to avoid additional lead exposure during deleading activities. Local health authorities should provide oversight of abatement activities to ensure that additional environmental contamination does not occur. Also, less expensive, safe technologies for abatement are needed to make primary prevention efforts more cost-effective.

3. The AAP supports legislation to reduce the entry of lead into the environment and into consumer products with which children may come in contact.

4. Government, like the medical community, should focus its efforts on the children who are most at risk. To do this, more data about the prevalence of elevated BLLs in specific communities are needed. A better understanding of the distribution of lead in the environment would allow more efficient screening efforts.

5. Research is needed to determine the effectiveness of various strategies to prevent and treat lead poisoning, to compare methods for abating lead in households, and to determine the effectiveness of chelating agents with long-term follow-up through controlled trials. Studies to determine the effectiveness and cost of educational interventions also are needed.

6. The CDC should review studies of the efficacy of lead screening and monitor the scientific literature to ensure that screening is being performed in the most public health-protective, least intrusive, and most cost-effective manner possible. In particular, the risk-assessment questions, follow-up recommendations, and models of case management need periodic re-evaluation.

7. Federal and state government agencies and legislative bodies should require coverage of lead testing for at-risk children by all third-party payors, by statute or by regulation.

The recommendations in this statement do not indicate an exclusive course of treatment or serve as a standard of medical care. Variations, taking into account individual circumstances, may be appropriate.