Title: Featured Article: Eliminate Childhood Lead Poisoning by 2010
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Section/SPIG: Food and Nutrition
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The National Healthy People 2010 goal of eliminating elevated blood lead levels in children by 2010 is also the goal of California's Childhood Lead Poisoning Prevention Branch.
Currently elevated blood lead levels are defined as blood lead levels at or greater than 10 micrograms per deciliter. Children with even higher lead levels, persisting at 15 micrograms per deciliter or greater, or one value of 20 micrograms per deciliter, receive special public health and environmental services. Hispanic children make up over 80 percent of those with these higher blood lead levels in California. In addition to contact with contaminated paint, dust and soil in homes built before 1978, Hispanic children may also eat food prepared, served or stored in pottery that contains lead. Other potential sources of lead for Hispanic children include:
• brightly colored ethnic remedies such as azarcon and greta;
• several types of Mexican candy; and
• grasshoppers, a traditional snack food in Oaxaca and other parts of Mexico.
To ensure that risk factors are adequately identified, when assessing Hispanic child clients, it is important for health professionals to be aware of these problem areas.
Poor nutrition is a common problem for lead-poisoned children. Low-income minority children are particularly at risk and are frequently found to be anemic and have inadequate intakes of iron, calcium and vitamin C, which can impact healthy growth and development. Adequate intake of these three critical nutrients may protect against lead absorption.
Nutrition assessment and counseling should focus particular attention on dietary calcium, iron and vitamin C, as well as help these children obtain a well-balanced and age-appropriate diet. Advice to caregivers may include one or two of the following, prioritized to the assessed need of the child:
• participate in the WIC program if they are eligible.
• introduce pureed meat as soon as the child is developmentally ready.
• provide one serving of lean red meat per day to older children.
• provide iron supplements only when iron deficiency is documented, and only under the supervision of a physician or nutritionist.
• provide two servings of fruit or fruit juice per day.
• provide two servings of dairy products or other calcium-rich foods per day.
Each child participating in a publicly funded program for low-income children is considered at risk for lead poisoning. Every health care provider is required by California regulation to test each child who receives services from a publicly funded program for low-income children such as Medicaid, the Early Periodic Screening, Diagnosis and Treatment (EPSDT) Program, Child Health Insurance Program (CHIP), or WIC for lead. Blood lead testing should be done when the child is 12 and 24 months of age, or anytime up to 72 months if the child has not previously been tested at the indicated times. A blood lead test may be done concurrently with a hemoglobin test. Keep the health care providers you work with aware of this requirement.
Children not in low-income programs should also be evaluated to determine if they are at risk for exposure to lead-based paint. Families should be asked if they have spent time in a place built before 1978 that has peeling or chipped paint or that has recently been renovated. If the answer is "yes" or "don't know," a blood lead test should be done. Medical providers should also be aware that recent immigrants may have been exposed to cultural sources of lead (discussed earlier in this article) in their native country, and may warrant a blood lead test.
Jan Schilling, MPH, MS, RD
California Department of Health Services, Childhood Lead Poisoning Prevention Branch