Childhood Lead Poisoning

 

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NEW! In-Office Blood Lead Testing Now Permitted in Maine

As of November 5, 2012, Maine law External site disclaimer allows approved providers to perform in-office blood lead testing of children under age 6 years using a direct-read blood lead analyzer and to electronically report test results to the Maine Childhood Lead Poisoning Prevention Program. Find out more.

 

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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 StatuteExternal site disclaimerrequiring lead screening and blood lead testing (§1317-D).
More information on screening guidelines for immigrant/refugee childrenExternal site disclaimer

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Lead risk assessment questionnaire

  1. Does your child spend more than 10 hours per week, in any house built before talk to doctor1950?
  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

Providers now have two options for blood lead testing: 1) Continue to submit blood lead samples to the State Health and Environmental Testing Laboratory; 2) Perform capillary blood lead analysis using a CLIA waived in-office blood lead testing device and directly report all test results to MCLPPP. Providers must have approval from the MCLPPP before they can begin in-office testing.

  • For providers sending blood lead samples to the State Health and Environmental Testing Laboratory:
    • Collect either a capillary or venous specimen. 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.
    • For free blood collection supplies and mailers, providers may call the State of Maine Health and Environmental Testing Lab (HETL) at (207) 287-2727.
  • For providers interested in beginning in-office testing, get complete information about the approval and application process and data reporting requirements.

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Recommended follow-up schedule for elevated blood lead levels

Confirm all capillary blood lead tests resulting in a level ≥ 10 µg/dl with a venous specimen. Follow up on all venous blood lead tests according to the chart below.

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 5-9 µg/dl

None None None
10-14 µg/dl within 3 months None 6-9 months

Educational materials mailed to family

Offer for Public Health Nursing home visit

Lead dust test offered

15-19 µg/dl within 2 months None 3-6 months

Offer for Public Health Nursing home visit

Referral for environmental lead investigation

≥ 20 µg/dl within 1 month CBC 1-3 months

Offer for Public Health Nursing 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

Offer for Public Health Nursing 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. Treatment guidelines should 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 at 207-287-4311 or 866-292-3474.

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Billing information for blood lead tests

For questions about billing:

  • Call your MaineCare provider relations specialist at (866)690-5585, TTY 711.
  • 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 99 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 103 KB PDF*
Clinical Lab Requisition Form Maine Health and Environmental Testing Laboratory 164 KB PDF*
Recommended Follow-up Schedule for Elevated Blood Lead Levels in Young Children The Maine Childhood Lead Poisoning Prevention Program 83 KB PDF*
Statewide Screening Plan 2010 Update The Maine Childhood Lead Poisoning Prevention Program 1.7 MB 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

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