CHILDHOOD LEAD POISONING IN MICHIGAN Lab Training PowerPoint slides - - PDF document

6/22/2020 1

CHILDHOOD LEAD POISONING IN MICHIGAN

Lab Training

PowerPoint slides courtesy of Healthy Homes Coalition of West Michigan

WHY LEAD IS AN ISSUE

Number one ENVIRONMENTAL HEALTH THREAT to children in the United States. According to the Center for Disease Control, half a million U.S. children ages 1 – 5 have unsafe lead levels.

6/22/2020 2

LEAD TESTING

This Photo by Unknown Author is licensed under CC BY‐NC‐ND

6/22/2020 3

LEAD SCREENING REQUIREMENTS FOR MANAGEMENT EVALUATION

 Are all children assessed for lead screening? Circle what records are used to assess: MCIR

• Med. Record

MI‐WIC  If no lead test have been performed, is the client referred for lead testing?

THE EFFECTS OF LEAD ON THE BRAIN

• Most damage occurs in the brain
• Disrupts growing brain connections
• Results in decreased intelligence
• Causes learning disabilities
• Creates behavior problems
• Effects every child differently

6/22/2020 4

RESEARCH 1999‐2013

 Environmental lead exposure associated with an increased risk for numerous conditions and diseases:

• reading problems
• school failure
• delinquent behavior
• hearing loss
• renal disease
• cardiovascular disease

HISTORY

• Before 1970 lead exposure was defined by a blood lead level of

60 µg/dL (micrograms per deciliter) or higher

• Blood lead concentration for defining lead exposure has steadily

been reduced:

• 40 µg/dL in 1971, 30 µg/dL in 1978, 25 µg/dL in 1985, 10

µg/dL in 1991 and 5 µg/dL in 2014.

• Reductions occurred because blood lead levels as low as 10 were

associated with adverse effects, such as lower intelligence.

6/22/2020 5

µg/dL micrograms per deciliter

CHILDREN ADULTS

Coma/Seizures

100 50 40 30 20 10 150

Anemia Decreased lifespan Decreased ability to make red blood cells Nerve problems Hypertension Coma/Seizures Death Kidney Damage Anemia Decreased ability to make red blood cells Nerve Problems Interference with Brain Development (IQ/hearing/growth)

Elevated Blood Levels

WHAT HAPPENS TO LEAD IN THE BODY?

 Stored for long periods in mineralizing tissue such as teeth and bones  Can be released again into the bloodstream during times of bodily stress, such as: ~ pregnancy ~ breastfeeding ~ calcium deficiency ~ osteoporosis (thinning of the bones)

6/22/2020 6

WHY ARE KIDS AT HIGHER RISK?

 Lead becomes dust from peeling/chipping paint and is present in soil  Children explore the environment using their hands and mouths  They spend a lot of time on the floor where sources of lead are found  Children absorb and retain 50% more of the lead they ingest than adults

HOW DO I KNOW IF A CHILD HAS ELEVATED BLOOD LEAD LEVELS?

 Child may not look or act sick  Symptoms are vague, mimic other illnesses  Common symptoms: stomach upset, fatigue, hyperactivity, poor appetite, sleeping difficulties  Testing is the ONLY way to know ‐ One Poke = Two Tests  Blood tests should be done at 12 and 24 months

6/22/2020 7

LEAD AND PREGNANCY

 Lead passes from mom to her unborn baby  Too much lead increases risk of brain, kidney, nervous system damage to baby as well as miscarriage, premature birth and low birth weight  Remodeling, occupational exposure and pica are risk factors that warrant testing for lead in pregnancy  Breastfeeding is encouraged even with elevated lead levels (< 40 ug/dL)  CDC does not recommend universal testing of all pregnancy women

WHO IS AT RISK?

Anyone can have elevated lead levels Infants and children up to 6 years are most at risk Children living in a home built before 1978 Pregnant women Children adopted from a foreign country Refugee and immigrant children

6/22/2020 8

SOURCES OF LEAD

Lead‐based paint usually in homes built before 1978 Chipping and peeling paint High friction areas Contaminated soil Contaminated drinking water from old plumbing

SOURCES OF LEAD

 Old painted toys  Imported spices and herbs  Imported food cans with lead soldered seams  Imported lead‐glazed pottery  Home or Folk remedies including Greta, Azarcon, Liga and Paylooah  Imported Cosmetics including Kohl, Surma and Kaj

This Photo by Unknown Author is licensed under CC BY‐NC‐ND

6/22/2020 9

SOURCES OF LEAD

Lead brought into the home on clothes by those working in lead related industries: manufacturing, construction, automotive repair, plumbing, electronics. Hobbies such as making fishing sinkers, stained glass, pottery, firearms.

This Photo by Unknown Author is licensed under CC BY‐SA‐NC

REMEMBER….EDUCATION IS THE KEY

6/22/2020 10

WHERE DO CHILDREN GET TESTED ?

• Well Child Checks at primary

care provider or Clinics

• Medicaid pays
• Commercial insurance pays
• WIC
• Check with Local Public Health

Department

This Photo by Unknown Author is licensed under CC BY‐NC‐ND

DIAGNOSIS

 A simple blood test  A capillary test of ≥ 5 µg/dL (micrograms per deciliter) needs to have a venous confirmatory test  An elevated Venous Blood Lead Level ≥ 5 µg/dL (211+)  Follow up with doctor and health department

6/22/2020 11

WHY WIC CHILDREN ARE AT RISK

• Children in WIC share some of the same risk factors as children who

become lead‐poisoned.

• Risk factors include:
• Infant and toddler behaviors (putting stuff in their mouths)
• Low income
• May live in older housing
• Have nutritional needs (especially anemia).

LEAD SCREENING

 Testing:

 First test at 1 year cert (coincide with Hgb test)  Must be at least 12 months between tests  2nd test ~30 month CEVAL (if 18 month Hgb was ok)  If child enrolled at older age, should test at least once between 3‐5 years if never tested

 Results of lead screenings listed on MICR

6/22/2020 12

LEAD SCREENING

 If this is a WIC visit that will involve a capillary stick for hemoglobin for a child under 3, ask the parent if the child has had a blood lead test within the last year.  If the child has not been tested, prepare the extra supplies that will be needed to obtain a blood lead sample at the same time as the hemoglobin.  One Poke = TwoTests

RISK CRITERIA 211+

Criteria (PG, BE, BP, NPP, IBE, IBP, IFF, C1 – C4) Elevated blood lead levels: Venous blood lead level at or above 5 micrograms per deciliter within the past 12 months

6/22/2020 13

25

Record date of test, value >10 and venous Method to generate risk ≥5 Enter lead value when results received from State lab, if desired.

6/22/2020 14

WIC’S ROLE Assignment of risk code 211+ results in referral to RD;

• thers can be referred as indicated

Nutrition Education Referrals Appropriate for use with WIC families Available on e‐Forms Three languages English Arabic Spanish

WELL FED MEANS LESS LEAD

6/22/2020 15

WELL FED MEANS LESS LEAD

Regular meals and snacks may help lead from being absorbed. It fills up the receptor sites to keep the lead out. Key nutrients that can protect the body from lead’s harmful effects include  Calcium : milk, cheese, yogurt, green leafy vegetables like spinach, kale, collard greens and tofu.  Iron : lean meat, fish, chicken, cooked beans/lentils, iron fortified breakfast cereals, raisins.  Vitamin C : oranges, grapefruit, tomatoes, melons, broccoli, cauliflower, cabbage and bell pepper.  Eat less fried foods, high fat meats and chips

WIC’S ROLE

Your role in WIC to provide blood lead screening and nutrition education about foods that help prevent absorption of lead help women, infants and children! You do make a difference!

6/22/2020 16

MICHIGAN LEAD RESOURCES

 www.michigan.gov/lead ‐ Michigan Department of Health & Human Services Childhood Lead Poisoning Prevention Program, 517‐335‐8885 or 888‐322‐4453  www.mileadsafehomes.org ‐ Michigan Alliance for Lead Safe Homes  www.healthyhomescoalition.org/lead ‐ Healthy Homes Coalition of West Michigan, Grand Rapids MI  www.healthyhomescoalition.org/landlords‐lead‐law ‐ lead and legal information for landlords  www.msue.anr.msu.edu/program/info/lead  Your Local Health Department

ADDITIONAL LEAD RESOURCES

 www.cpsc.gov ‐ Consumer Product Safety Commission: search for consumer products recalled for violation of lead standard

 www.cdc.gov/lead‐Centers for Disease Control and Prevention

 www.epa.gov/lead ‐ Environmental Protection Agency  www.sesamestreet.org/parents/topicsandactivities/toolkits  leadaway ‐ Sesame Workshop Lead Away Program materials

6/22/2020 17

www.youtube.com/watch?v=7FHdozMq FCQ – Sesame Street You Tube Video The National Lead Information Center: 800‐424‐5323 (LEAD)

ADDITIONAL LEAD RESOURCES

QUESTIONS?