CHILDHOOD LEAD POISONING Blood Lead Level (BLL) Quick Reference for Primary Care Providers (Updated 9/17/2016) REMINDER: Medicaid requires all children to be tested at 12 and 24 months of age. Children between 36 and 72 months who were not previously tested must be tested at least once. provide nutritional counseling Evaluate child for acute lead Not Yet Tested FOLLOW UP: Retest related to calcium and iron toxicity. Consider BLL 5-14µg/dL venous sample within 1-3 hospitalization and/or Consider screening ALL Confirm capillary results with months to ensure BLL is Consider specific evaluation chelation therapy children between between venous blood sample not rising of the based on 1-72 months. environmental history e.g. Confirm capillary results with Review venous sample an abdominal x-ray re pica venous blood sample within BLL 15-44 µg/dL Need for testing can be with family behavior 48 hours based on risk factors Confirm capillary results with Any treatment should be venous sample Take environmental history to Refer to Local health performed in consultation identify sources of lead; Department for additional BLL <5 µg/dL with an expert at the provide advice about Review venous sample assessment and Michigan Poison Control reducing/eliminating exposure with family Review lead levels with interventions Center: 1-800-222-1222 family Work with Local Health Consider children who Take environmental history to FOLLOW UP: Retest Department to coordinate may be exposed identify sources of lead; Provide anticipatory venous sample monthly case management with provide advice about guidance on common until levels are <15, repeat family and ensure that Consider iron sufficiency; reducing/eliminating sources of environmental every 1-3 months until child does not return to a exposure lead exposure. provide nutritional counseling levels are <5 lead-contaminated home. related to calcium and iron Consider other children who FOLLOW UP: Retest in BLL FOLLOW UP: As directed Refer to Local Health may be exposed months if child is at >44µg/dL by expert. Monthly venous high risk Department for additional samples will be required. assessment and interventions Consider iron sufficiency,
CHILDHOOD LEAD POISONING Blood Lead Level (BLL) Quick Reference for Primary Care Providers (Updated 9/17/2016) REMINDER: Medicaid requires all children to be tested at 12 and 24 months of age. Children between 36 and 72 months who were not previously tested must be tested at least once. Not Yet Tested Consider screening ALL children between between 1-72 months. Need for testing can be based on risk factors BLL <5 µg/dL Review lead levels with family Provide anticipatory guidance on common sources of environmental lead exposure. FOLLOW UP: Retest in months if child is at high risk BLL 5-14µg/dL Confirm capillary results with venous blood sample Review venous sample with family Take environmental history to identify sources of lead; provide advice about reducing/eliminating exposure Consider children who may be exposed Consider iron sufficiency; provide nutritional counseling related to calcium and iron Refer to Local Health Department for additional assessment and interventions FOLLOW UP: Retest venous sample within 1-3 months to ensure BLL is not rising BLL 15-44 µg/dL Confirm capillary results with venous sample Review venous sample with family Take environmental history to identify sources of lead; provide advice about reducing/eliminating exposure Consider other children who may be exposed Consider iron sufficiency, provide nutritional counseling related to calcium and iron Consider specific evaluation of the based on environmental history e.g. an abdominal x-ray re pica behavior Refer to Local health Department for additional assessment and interventions FOLLOW UP: Retest venous sample monthly until levels are <15, repeat every 1-3 months until levels are <5 BLL >44µg/dL Evaluate child for acute lead toxicity. Consider hospitalization and/or chelation therapy Confirm capillary results with venous blood sample within 48 hours Any treatment should be performed in consultation with an expert at the Michigan Poison Control Center: 1-800-222-1222 Work with Local Health Department to coordinate case management with family and ensure that child does not return to a lead-contaminated home. FOLLOW UP: As directed by expert. Monthly venous samples will be required.
EBL%20Case%20Management%20Guide%20Updated%201_24_2017.docx