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Environmental & Occupational Health -
Childhood Lead Poisoning

Providers Download the lead risk assessment questionnaire. Review screening guidelines. Obtain resources for lead testing.

 

• Services provided by the Maine
  Childhood Lead Poisoning Prevention Program (MCLPPP)
• Guidelines for lead screening
• Lead risk assessment questionnaire
• How to test for lead
• Recommended clinical management
  for elevated blood lead levels
• Billing information
• Printable MCLPPP reference materials
• Publications

Services provided by the Maine Childhood
Lead Poisoning Prevention Program

The Maine Childhood Lead Poisoning Prevention Program (MCLPPP):

• Monitors roughly 15,000 blood lead tests each year.
• Identifies children with elevated blood lead levels.
• Provides services to families based on the child's
  blood lead level.
• Lead environmental testing of residences for children
  with venous blood leads 15ug/dl and greater.
• Works with families, their physicians, visiting nurses,
  and lead inspectors to make sure blood lead levels
  return to normal.
• Provides education to professionals, parents,
  and the public on lead poisoning.
• Gathers ongoing epidemiological surveillance to
  determine what lead poisoning looks like in Maine.
  You can view this data by visiting the Maine
  Environmental Public Health Tracking Portal.

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Guidelines for lead screening

Lead screening and blood lead testing is based on a child's risk for lead poisoning. Since children rarely display symptoms of lead poisoning, a blood lead test is the only way to know for sure if a child has been exposed to lead.

Children ages 1 and 2 are especially at risk for lead exposure.

All children enrolled in MaineCare should have:

• blood lead tests at 1 year (9 -  17 months of age) and
• blood lead tests at 2 years (18-35 months of age)
• blood lead tests if they are 3 to 6 years old and have not been tested

All other children should have a blood lead test at 1 year and 2 years of age
unless the provider determines that the child is not at risk for lead exposure though a simple questionnaire.

Test all children 3-6 years of age if:

• Their risk for lead exposure has changed.
• They have changed their residence since their previous blood lead test.

Testing for lead should also be considered in:

• Children diagnosed with pica, developmental delays,
  behavioral problems, or ADHD.
• Children presenting with unexplained illness such as
  severe anemia, lethargy, or abdominal pain.

Read the Maine State Statuterequiring lead screening and blood lead testing (§1317-D)
More information on screening guidelines for immigrant/refugee children*PDF

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Lead risk assessment questionnaire

1. Does your child spend more than 10 hours per week, in any house built before 1950?
2. Does your child spend more than 10 hours per week in any house built before 1978 that was renovated or remodeled within the last 6 months?
3. Does your child spend time with an adult whose job exposes him or her to lead? (Examples: painting, construction, metal workers including metal recyclers)
4. Is your child enrolled in MaineCare?

If a child’s parent answered “yes,” or "does not know", to one or more of these questions, the child should be given a blood lead test.
Print a copy of this questionnaire (Microsoft Word*) (Adobe PDF*) to use with your patients.

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How to test blood for lead

For free blood collection supplies and mailers, providers may call the State of Maine Health and Environmental Testing Lab (HETL) at (207) 287-2727.

1. Collect either a capillary or venous specimen.
1. To prevent false positives, wash and scrub the finger or toe that you will be testing with soap. Use a surgical brush or soft toothbrush.
2. All blood lead samples for children under 6 years old must be sent to the State of Maine Health and Environmental Testing Lab. Read the Maine State Statue requiring that all blood lead samples are sent to HETL (§1319-A).

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Recommended clinical management for elevated blood lead levels

• All capillary blood lead tests resulting in a level ≥10 µg/dl should be confirmed with a venous specimen.
• Follow the chart below for recommended follow-up on all elevated venous blood lead test results:

Venous blood level	Follow-up venous blood lead test schedule	Additional laboratory tests	Suggested long-term follow-up (after first 2-4 tests)	Maine Childhood Lead Poisoning Prevention Program Interventions
<10 µg/dl	Consider retest if blood lead level is close to 10 µg/dl	None	None	None
10-14 µg/dl	3 months	None	6-9 months	Educational materials mailed to family
15-19 µg/dl	2 months	None	3-6 months	Referral for Public Health Nurse home visit Referral for environmental lead investigation
≥ 20 µg/dl	1 month	CBC ZPP	1-3 months	Referral for Public Health Nurse home visit Referral for environmental lead investigation
≥ 45 µg/dl	Repeat venous blood test immediately Chelating therapy as indicated	CBC ZPP G6PD Iron Studies	Based on chelating protocol	Referral for Public Health Nurse home visit Referral for environmental lead investigation Assistance in locating alternative lead-safe housing

Note: This is a suggested basic course of management, not a mandated protocol. It is recommended that treatment guidelines be used in conjunction with consultation with physicians experienced in treating childhood lead poisoning, especially if chelating therapy is indicated. For more information, contact the Maine Childhood Lead Poisoning Prevention Program by calling (207) 287-4311 or toll free in Maine, 866-292-3474.

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Billing information for blood lead tests

For questions about billing:

• Call your MaineCare provider relations specialist at 1-800-321-5557.
• Call Health and Environmental Testing Lab (HETL) at 207-287-2727.  

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Printable MCLPPP reference materials

 

Document/Resource	Source	Size	Type
Reference Sheet for Healthcare Providers	The Maine Childhood Lead Poisoning Prevention Program	154 KB	PDF*
Recommended Lead Screening Schedule and Recommended Clnical Management of Elevated Blood Lead Levels in Young Children	The Maine Childhood Lead Poisoning Prevention Program	127 KB	PDF*
Clinical LabRequisition	Maine Health and Environmental Testing Laboratory	814 KB	PDF*
Recommended Management Of Elevated Blood Lead Levels	The Maine Childhood Lead Poisoning Prevention Program	81 KB	PDF*
The Role Of ZPP In Lead Poisoning	The Maine Childhood Lead Poisoning Prevention Program	52 KB	PDF*

 

Call the lead program or see our resources page for DVD's and written materials for your patients on lead poisoning.

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Publications

• Environmental Health Perspectives (2008)
  US Children's Lead Exposures, 2008: Implications for Prevention
• U.S. Centers for Disease Control and Prevention, MMWR (2007) ;
  Interpreting and Managing Blood Lead Levels<10ug/dl in Children and Reducing Childhood Exposures to Lead: Recommendations of CDC's Advisory Committee on Childhood Lead Poisoning Prevention
• U.S. Centers for Disease Control and Prevention (2006)
  Recommendations for Lead Poisoning Prevention in Newly Arrived Refugee Children
• American Academy of Pediatrics Policy Statement (2005)
  Lead Exposure in Children: Prevention, Detection and Management

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*For a free viewer or to request a hard copy

 

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