CE ARTICLE
Childhood lead poisoning and the new Centers for Disease Control and Prevention guidelines for lead exposure Julie Schnur, DNP, CPNP, PMHS (Certified Pediatric Nurse Practitioner, Doctor of Nursing Practice) & Rita Marie John, EdD, DNP, CPNP, PMHS (Certified Pediatric Nurse Practitioner, Doctor of Nursing Practice) Columbia University School of Nursing, New York
Keywords Lead poisoning; lead exposure; children; 2012 guidelines; primary care. Correspondence Julie Schnur, DNP, CPNP, PMHS, 864 Eastern Parkway, Brooklyn, NY 11213 Tel: 718-735-6002; E-mail: [email protected] Received: April 2013; accepted: November 2013 doi: 10.1002/2327-6924.12112 To obtain CE credit for this activity, go to www.aanp.org and click on the CE Center. Locate the listing for this article and complete the post-test. Follow the instructions to print your CE certificate. Disclosures: The authors report no competing interests.
Abstract Purpose: This article will give a brief history, review the latest guidelines, discuss risk factors and sources, and discuss screening, diagnosis, and management of lead poisoning in children. Additionally, the role of the nurse practitioner (NP) caring for children will be reviewed. Data sources: Review of published literature on lead poisoning and the 2012 lead prevention guidelines of the Advisory Committee on Childhood Lead Poisoning Prevention (ACCLPP) of the Centers for Disease Control and Prevention (CDC). Conclusions: While lead poisoning levels have decreased over the past several decades, newer research has shown that even low levels of lead in the blood can have negative effects on children’s intelligence and neurodevelopment. As a result, ACCLPP of the CDC issued new, stricter lead prevention guidelines in 2012. Implications for practice: Lead exposure and lead poisoning are pediatric public health risks. Studies have shown that no level of lead is considered safe, and the emphasis has shifted to primary prevention of lead exposure. Despite the focus on primary prevention, the NP must remain vigilant in history taking, exploring risk factors, and screening children in order to assure the best possible outcome.
A fourteen and a half month old male is seen by a nurse practitioner (NP) in the pediatric primary care office for his routine well visit, and he was noted to have had an elevated lead level of 7 μg/dL 3 months prior. At today’s visit, a complete blood count and venous lead sample are drawn. Three days later, the results show an elevated lead level of 10 μg/dL. What does the NP need to know to care for this child? What are the latest guidelines for lead poisoning in children? This article will give a brief history, review the latest guidelines, discuss risk factors, and discuss screening, diagnosis, and management of lead poisoning, while reviewing the role of the PNP.
History of lead poisoning This situation is not an uncommon one, despite continued efforts to decrease childhood lead levels over the past several decades. Lead exposure and lead poisoning remain pediatric public health risks. Children were first recognized as victims of lead in 1892, but
the negative effects of lead have been recognized as far back as 600 B.C. (Needleman, 2009; Warniment, Tsang, & Galazka, 2010). More than half of the homes in the United States built before 1950 contained lead paint (Chandran & Cataldo, 2010). In the mid-1970s through 1986, the U.S. banned lead-based paints and phased lead out of gasoline (Chandran & Cataldo, 2010). Although there has been a decline in children’s mean blood lead levels in the United States, lead poisoning still remains an issue (Jones et al., 2009). Despite the longstanding history of lead poisoning, the removal of lead from gasoline and paint, and declining blood lead levels in U.S. children, lead poisoning is still a problem around the world including the United States. In 2012, the Advisory Committee on Childhood Lead Poisoning Prevention (ACCLPP) of the Centers for Disease Control and Prevention (CDC) issued new, updated, stricter lead prevention guidelines because of increased knowledge about the long-term effects of even low-level lead exposure.
C 2014 The Author(s) Journal of the American Association of Nurse Practitioners 00 (2014) 1–10
C 2014 American Association of Nurse Practitioners
1
New lead poisoning guidelines
J. Schnur & R. M. John
New 2012 guidelines
occurs. It is of the utmost importance as the effects of lead, however low the levels may be, appear to be irreversible (ACCLPP, 2012). In the United States, the cornerstone of primary prevention efforts will be removal of children from older homes with lead-based paint or hazards (ACCLPP, 2012). Previously, most prevention efforts surrounded early identification of children with elevated lead levels by routine screening.
There are several changes to the ACCLPP’s new recommendations. First is the removal of the term “blood lead level of concern.” “Blood lead level of concern” was formerly used to indicate the threshold at which intervention was required for elevated blood lead levels. The rationale for elimination of the term “blood lead level of concern” is twofold. First, newer research has shown that any level of lead in the blood can be harmful. Children with blood lead levels below the former cutoff level of
Childhood lead poisoning and the new Centers for Disease Control and Prevention guidelines for lead exposure Julie Schnur, DNP, CPNP, PMHS (Certified Pediatric Nurse Practitioner, Doctor of Nursing Practice) & Rita Marie John, EdD, DNP, CPNP, PMHS (Certified Pediatric Nurse Practitioner, Doctor of Nursing Practice) Columbia University School of Nursing, New York
Keywords Lead poisoning; lead exposure; children; 2012 guidelines; primary care. Correspondence Julie Schnur, DNP, CPNP, PMHS, 864 Eastern Parkway, Brooklyn, NY 11213 Tel: 718-735-6002; E-mail: [email protected] Received: April 2013; accepted: November 2013 doi: 10.1002/2327-6924.12112 To obtain CE credit for this activity, go to www.aanp.org and click on the CE Center. Locate the listing for this article and complete the post-test. Follow the instructions to print your CE certificate. Disclosures: The authors report no competing interests.
Abstract Purpose: This article will give a brief history, review the latest guidelines, discuss risk factors and sources, and discuss screening, diagnosis, and management of lead poisoning in children. Additionally, the role of the nurse practitioner (NP) caring for children will be reviewed. Data sources: Review of published literature on lead poisoning and the 2012 lead prevention guidelines of the Advisory Committee on Childhood Lead Poisoning Prevention (ACCLPP) of the Centers for Disease Control and Prevention (CDC). Conclusions: While lead poisoning levels have decreased over the past several decades, newer research has shown that even low levels of lead in the blood can have negative effects on children’s intelligence and neurodevelopment. As a result, ACCLPP of the CDC issued new, stricter lead prevention guidelines in 2012. Implications for practice: Lead exposure and lead poisoning are pediatric public health risks. Studies have shown that no level of lead is considered safe, and the emphasis has shifted to primary prevention of lead exposure. Despite the focus on primary prevention, the NP must remain vigilant in history taking, exploring risk factors, and screening children in order to assure the best possible outcome.
A fourteen and a half month old male is seen by a nurse practitioner (NP) in the pediatric primary care office for his routine well visit, and he was noted to have had an elevated lead level of 7 μg/dL 3 months prior. At today’s visit, a complete blood count and venous lead sample are drawn. Three days later, the results show an elevated lead level of 10 μg/dL. What does the NP need to know to care for this child? What are the latest guidelines for lead poisoning in children? This article will give a brief history, review the latest guidelines, discuss risk factors, and discuss screening, diagnosis, and management of lead poisoning, while reviewing the role of the PNP.
History of lead poisoning This situation is not an uncommon one, despite continued efforts to decrease childhood lead levels over the past several decades. Lead exposure and lead poisoning remain pediatric public health risks. Children were first recognized as victims of lead in 1892, but
the negative effects of lead have been recognized as far back as 600 B.C. (Needleman, 2009; Warniment, Tsang, & Galazka, 2010). More than half of the homes in the United States built before 1950 contained lead paint (Chandran & Cataldo, 2010). In the mid-1970s through 1986, the U.S. banned lead-based paints and phased lead out of gasoline (Chandran & Cataldo, 2010). Although there has been a decline in children’s mean blood lead levels in the United States, lead poisoning still remains an issue (Jones et al., 2009). Despite the longstanding history of lead poisoning, the removal of lead from gasoline and paint, and declining blood lead levels in U.S. children, lead poisoning is still a problem around the world including the United States. In 2012, the Advisory Committee on Childhood Lead Poisoning Prevention (ACCLPP) of the Centers for Disease Control and Prevention (CDC) issued new, updated, stricter lead prevention guidelines because of increased knowledge about the long-term effects of even low-level lead exposure.
C 2014 The Author(s) Journal of the American Association of Nurse Practitioners 00 (2014) 1–10
C 2014 American Association of Nurse Practitioners
1
New lead poisoning guidelines
J. Schnur & R. M. John
New 2012 guidelines
occurs. It is of the utmost importance as the effects of lead, however low the levels may be, appear to be irreversible (ACCLPP, 2012). In the United States, the cornerstone of primary prevention efforts will be removal of children from older homes with lead-based paint or hazards (ACCLPP, 2012). Previously, most prevention efforts surrounded early identification of children with elevated lead levels by routine screening.
There are several changes to the ACCLPP’s new recommendations. First is the removal of the term “blood lead level of concern.” “Blood lead level of concern” was formerly used to indicate the threshold at which intervention was required for elevated blood lead levels. The rationale for elimination of the term “blood lead level of concern” is twofold. First, newer research has shown that any level of lead in the blood can be harmful. Children with blood lead levels below the former cutoff level of
