Screening for Elevated Blood Lead Levels.

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 1and 2-year-olds with elevated BLLs is >12%. For children living in other areas, the Centers for Disease Control and Prevention 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 BLLs. The American Academy of Pediatrics 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). ABBREVIATIONS. CDC, Centers for Disease Control and Prevention; BLL, blood lead level; AAP, American Academy of Pediatrics. In 1991, the Centers for Disease Control and Prevention (CDC) statement Preventing Lead Poisoning in Young Children1 redefined elevated blood lead levels (BLLs) as those $10 mg/dL and recommended a new set of guidelines for the treatment of lead levels $15 mg/dL. In the 1991 document, universal screening was recommended for children 9 to 72 months of age except in communities with sufficient data to conclude that children would not be at risk of exposure. Because at that time, there were few community-based data, the 1991 CDC statement, in essence, called for universal screening. In response, the 1987 Statement on Childhood Lead Poisoning2 by the American Academy of Pediatrics (AAP) was replaced in July 1993 by Lead Poisoning: From Screening to Primary Prevention.3 The revised statement supported most of the 1991 CDC recommendations. Specifically, the AAP recommended “blood lead screening as part of routine health supervision for children at about 9 through 12 months of age and, if possible, again at about 24 months of age.” Since publication of the 1993 AAP statement, although some areas of the United States have continued to find a high incidence of elevated BLLs,4–6 epidemiologic investigations have identified many locales where, because of limited exposure to lead, the prevalence of elevated BLLs is so low that targeted (selective) screening is more appropriate than universal screening.7–12 In consideration of these data, the CDC revised its 1991 guidelines. This policy statement updates the 1993 AAP statement on childhood lead screening. Significant exposure to lead is a preventable environmental threat to optimal health and developmental outcomes for young children. Many children with elevated BLLs who require individualized management still are not being identified because of inadequate screening efforts in their communities. Conversely, recent data indicate that exposure to lead is so low in some communities that cost-benefit analyses do not justify universal screening in those areas. Against this background, the CDC, after detailed review with its Advisory Committee on Childhood Lead Poisoning Prevention, updated its screening guidelines.13a The revised guidelines provide, for the first time, a basis for public health authorities to decide on appropriate screening policy using local BLL data and/or housing data collected by the US Bureau of the Census. This strategy is intended to “increase the screening and follow-up care of children who most need these services, to ensure that prevention approaches are appropriate to local conditions,” and to reduce unnecessary testing of children unlikely to be exposed to lead. These new recommendations will have important ramifications on pediatricians’ efforts to participate in the early identification, treatment, and eradication of childhood lead poisoning.14 In areas where universal screening is not warranted, the pediatrician’s focus must be to evaluate children who may be at risk and to screen as recommended by state health departments.