streamlined childhood lead screening - josiah hill iii clinic
TRANSCRIPT
Streamlined Childhood lead SCreening
A ToolkiT for Busy CliniCs
multnomah County health department • 503-988-4000 • www.leadline.org
Co
nt
en
tS
4 introduction: lead poisoning is Still a problem for Children in multnomah County
5 Foreword: Streamlined Childhood lead Screening
6 three Ways pediatric Care providers Can prevent Childhood lead poisoning
7-10 hands on medicine: how one Clinic did it
11 Stepwise approach to universal risk-assessment and risk-Based testing for lead poisoning
12-13 provider Self assessment: assessing lead risks
14-15 provider Self assessment: risk-Based Blood level testing
16-17 provider Self assessment: Communicating results
18-19 provider Self assessment: Case management
20-21 Capillary or Venous Blood lead levels and indicated provider protocol
22-23 reporting results to the oregon lead poisoning prevention program
24-27 Case management for Children with elevated Blood lead levels
28-29 lead poisoning disease: reporting and Follow-up guidelines
30 adding Quality assurance for lead Screening and testing to your emr
2
appendiCeS33 provider resources for lead prevention
34 Filter paper lead Samples acceptability
35 reporting Form for oregon lead poisoning prevention program
36-39 Waiting room Screening tool– english, russian,
Vietnamese, Spanish
40 Sample patient letter Communicating test results
41-42 dhS medical information Form
43-52 Frequently asked Questions about lead
53-54 understanding your Child’s lead test
55 Community resources for lead prevention
56 possible Sources of lead
57-58 possible lead Containing home remedies and Cosmetics
59-66 lead poisons Kids– english, Spanish, russian, Vietnamese
pr
oB
le
m
lead poiSoning iS Still a proBlem For Children in multnomah County
Jonathanan 18-month old childliving in a 1916 house in the midst of a kitchen and bathroom re-model had a blood lead level of38. the interior paint was lead-based, and the child was inhaling and ingesting lead dust from contaminated floors. once the remodel was finished and the home extensively cleaned, the child’s blood lead levels decreased to eight within a year.
Sareenaa one-year-old girl was found to have an elevated blood lead level even though her family’s home and soil tested negative for lead. her father renovates boats, which are still allowed to be treated with lead paint. the father was passing the lead dust to the child when he held her after work without changing his clothes, and when his clothing was laundered in the same load as hers.
Sasha and Isobeltwo sisters presented with elevated blood lead levels due to children’s pottery items from mexico, which were painted and unglazed. they handled a small tea set extensively as they played. another young girl had a blood lead level of 44 –she had been eating small toy pottery items from her tea set.
4
multnomah County environmental health Services developed this toolkit to provide local clinics with an easy-to-use model for incorporating consistent lead exposure risk assessment into pediatric visits. if you have wanted to increase your lead screening rates, but haven’t had the time to design and construct an efficient system, these resources are for you! We use a stepwise approach to universal risk assessment and risk-based testing which has proven successful in early identification of risk factors for hypertension, diabetes, cancers and other chronic illness, and apply it to childhood lead poisoning.
the toolkit was developed in response to a 2004 study of oregon medical providers which showed that only half of providers treating children routinely assess lead exposure risk in their pediatric patients. the most frequently reported reason for not assessing risk was not having a clinic system that supports the risk assessment. (VanArsdale and leiker: Childhood lead screening in oregon, 2004)
We aim to aid people who provide medical care to children in adopting or strengthening practice of three preventive measures: • educating parents about the risks associated with lead exposure • assessing all children under six for lead exposure risk • identifying children with elevated blood lead levels (eBlls) as early as possible
We hope that this toolkit will increase risk assessment and risk-based screening rates in your clinic, and we thank you for your commitment to improving the health and well-being of children in our community.
With appreciation to Shelda holmes and the staff at hands on medical Clinic for their work in testing and developing this toolkit.
Streamlined Childhood lead SCreeningA ToolkiT for Busy CliniCs
MCHD leaDlIne • 503-988-4000 • www.leadline.org
F o r e W o r d
So
lu
ti
on
• educate parents and caregivers about lead hazards
• assess all children under the age of six for lead exposure risk
• identify children with elevated blood lead levels early to minimize neurological damage
three WayS pediatriC Care proViderS Can preVent Childhood lead poiSoning
MCHD leaDlIne • 503-988-4000 • www.leadline.org
6
hands on medicine (hom) is a small community clinic in north portland, serving around 600 patients, approximately a third of whom are children and three quarters of whom use medicaid.
the staff at hom is comprised of 4 people- Shelda holmes, a Family nurse practitioner and the owner of the clinic; lelan Ferguson, Shelda’s medical assistant; tisha Walker, the medical receptionist; and Shelda’s husband Chip Shields, the business manager.
prior to 2007, Shelda wanted to add pediatric lead risk assessment and risk-based blood lead testing to her clinic’s regular well-child visits, but lacked the time and resources to implement a system. as a result, lead testing at hom was ad hoc, and difficult to track. When multnomah County environmental health Services approached her to pilot this toolkit and give advice on implementation of a systematic universal risk assessment and risk-
based blood lead testing process, Shelda saw it as a good opportunity to inform public health officials about the needs of practitioners in the field, and a mechanism for setting up a reliable system in her clinic. Following are some of the issues she has faced in establishing a lead screening system at hom.
neurodevelopmental effects oflead PoisoningShelda was eager to begin regular pediatric lead exposure risk assessments because it would allow her to protect her patients from neurodevelopmental damage in the form of decreased iQ, developmental delays and behavioral disturbances such as aggression, impulsivity and short attention span.
lead Poisoning is easily Mitigated-Prevention and early Detection are BestBecause many of her pediatric patients live in homes built before 1978, or have other risk factors such as use of ayurvedic medicine, a parent who
handS on mediCine:how one CliniC did iT
Cu
re
S
works with lead in their job (painters), or use of imported food serving dishes, Shelda feels it is important to educate parents about in-home lead hazards and detect potential risks early so that they can be corrected before a child requires significant medical interventions.
Parent Perceptions of Blood lead Testingparents of children seen in the clinic generally appreciate Shelda’s efforts to educate them about the risks of lead exposure, and filling out the screening questionnaire prior to meeting with a provider greatly increases their comfort with allowing the capillary lead test. Some parents, however, forgo lead testing even if a risk assessment questionnaire identifies that a child is at risk of eBlls due to environmental factors because they see it as one more invasive thing that happens during the visit, especially if the child is getting a series of vaccinations at the same time.
Using Parent Discussions about Vaccine Safety to Introduce lead exposure RisksShelda often uses parents’ expressed concerns about the safety of vaccines (often related to the perception of exposure to heavy
metals) to highlight the relative environmental risk factors for heavy metal exposure, and point out the ways in which children are potentially exposed to lead in their day-to-day lives.
When asked by parents about her philosophy of care, she explains that she embraces two concepts: as little intervention as possible & First do no harm. as she sees it, vaccines and screenings are part of the latter, in the form of harm prevention, and takes the opportunity to educate parents on the unknown ways in which they may be introducing heavy metals into their child’s environment; fishing weights, ayurvedic medicines and other home remedies, occupational hazards (such as the patient whose father is a welder and would come home from work and play with his kids before changing clothing, unaware that he was exposing his kids to lead, cadmium, mercury and other toxic materials.)
BaRRIeRS To SCReenIng PaTIenTSin setting up the system for risk assessment and risk-based blood lead testing at the clinic, Shelda noted several factors that complicated implementation of full universal pediatric risk assessment:
handS-on mediCine, ConT’d8
integration into the Clinic work flow:Paper Charts vs. eMr Shelda’s electronic medical records system does not have a pre-set field in which to record lead levels or administration of the risk assessment questionnaire. they currently have to scan paper records to add them to the emr, which is time consuming, and requires double locking the file cabinet to comply with hipaa. this complicated the incorporation of a lead risk assessment screening questionnaire into a well-child visit.
Parent literacy literacy issues appear to be frequent among hom’s adult clients. therefore, flexibility around methods of administration of the risk assessment questionnaire is important. For those clients with literacy problems or those who have written “don’t know” on all of the survey items, Shelda has taken the time to administer the questions verbally.
staff Turnover the clinic staff has to remember to hand out the questionnaire when patients are waiting to be seen, which adds a step to the visit and which new staff have to be trained to do consistently. to avoid this problem, hom added the lead risk assessment questionnaire to the new patient packet for children, which parents are supposed to fill out before they arrive.
Choosing In-House Testing over Sending Filter Samples to Med-Tox:When they first began risk-based testing, hom had a significant number of blood samples rejected by med tox because of incorrect sample collection. additionally, the time it takes to get the tests sent off and returned from minnesota is excessive, and it is difficult to get kids back into the clinic for a second blood sample if the first was rejected. multiple visits outside of the well-child visit are also not reimbursable. in the initial stages of blood lead testing at hom, 2 children had to come back 3 times each for re-sampling. Cont’d on page 10
MUlTnoMaH CoUnTy leaDlIne • 503-988-4000 • www.leadline.org
handS-on mediCine, ConT’d
Because of these factors, Shelda switched to a blood lead analyzer that can be used in the clinic, which allows her to give results during the patient’s visit. the cost for a lead Care ii lead screening machine from magellan Biosciences, test kits and several accessories for labeling to cover 192 individual tests came to $3,555.
Pros of the in-house test:1. immediate feedback on blood lead levels plus immediate feedback on whether or not a sample is testable2. the opportunity to provide lead information to parents at the same visit 3. ability to attend health fairs and screen large numbers of children in quick succession
Cons of the in-house test:1. inability to obtain reimbursement for tests and visits when lead is the only topic for the visit2. low reimbursement rates relative to the cost of the supplies for the analyzer3. high initial investment in the analyzer – may not be cost effective4. not all hom clinicians like using the analyzer, some are used to the procedure for sending samples out to med tox
and have not yet adopted new process5. if hom is screening for anemia and lead at the same time, the most efficient thing to do is to send blot samples to medtox and not use the analyzer
Reporting to the statereporting to the state is not at all difficult, but it has to be a regular part of the staff work flow. this is a point of weakness when it comes to staff turnover.
ReimbursementsKids who come in solely for a capillary blood lead test are denied coverage by Careoregon because lead tests done outside of regular well-child visits are not reimbursed. many children in Shelda’s practice do not follow a regular well-child visit schedule- either because they don’t see well-child visits as high-priority, or because they are breaking up vaccines into a different schedule than the state recommends. Since testing is not covered for those kids who are going on an individualized schedule, parents either get billed because their insurance won’t cover it, or if the child has medicaid benefits, it is a “below the line” case, and the clinic doesn’t get reimbursed.
10
StepWiSe approaCh to uniVerSal riSK aSSeSSment and riSK-BaSed teSting For lead poiSoning
RISk aSSeSSMenT
RISk-BaSeD TeSTIng
CoMMUnICaTIngReSUlTS
CaSeManageMenT
assess lead exposure risk of
every patient under age 6 using parent
questionnaire
educate parent: lead exposure risks
and prevention measures
educate parent:why do questionnaire
responses indicatetesting?
perform capillaryblood test or order
venous test
if first test wascapillary and levelsare elevated, order
venousconfirmation
testing
low blood leadlevels – educateparent: nutrition,risk prevention
Send test resultsand indications to
parents inwriting
if test wasperformed in-house,
report test resultsto state lead
program
Send medical information
Form to state
planfollow-up
testing and neurodevelopment tracking with family, ensure assessment of home by county
environmental health’sleadline
see Case Management section on page 25 for appropriate testing schedule, depending on initial Blls.
elevated bloodlead levels – educate
parent: lead poisoning symptoms, details
of case management plan
Close the case when Bll is below 10 μg/dl for two
consecutive blood draws
If parent answers
“yes” or “don’t know”
to any question
If b
lood
lea
d lev
els
ab
ove
10 μ
g/d
l, c
hild
nee
ds
follow
-up
aSSeSSing lead riSKS
proVider SelF-aSSeSSment
DoeS yoUR ClInIC PeRFoRM UnIVeRSal leaD exPoSURe RISk aSSeSSMenT?
q Does the clinic use a waiting room lead exposure risk assessment questionnaire?
q are parents given the questionnaire at the child’s first visit to your office?
q are parents given the questionnaire at the 12 month well-child visit?
q are parents given the questionnaire at the 24 month well-child visit?
q Do parents fill out a questionnaire sometime between 36 and 72 months of age?
12
RISk aSSeSSMenT
aSSeSSing lead riSKS
proVider SelF-aSSeSSment KeyQueStionS• Does child live in pre-1978 home?
• Have there been recent repairs or remodels to pre-1978 home?
• Recent painting in pre-1978 home?
• Sibling or friend with elevated Blood lead levels?
• Caregiver works with or uses lead in hobbies? (see appendix “Possible sources of Lead” pg. 56)
• Imported food-serving dishes?
• Traditional/home remedies?
• Visited or lived outside of US?
• Behavioral or development concerns?
The full screening questionnaireis in appendix, on pg.36
q are you asking the right questions? (see ”key Questions”) we’ve updated the questionnaire for the state of oregon, according to the most recent evidence on childhood lead poisoning. see appendix starting on page 36 for reproducible questionnaire with recommended questions in english, spanish, russian and Vietnamese.
q If parent answers yes or unknown to one or more questions is child administered a capillary blood test?
q Is there a Quality assurance protocol in place to assure that all children are assessed for lead exposure risk? A field in the eMr for recording risk assessment results (see page 30 for sample questions) A check-box on the paper chart indicating if questionnaire was administered and filed in the chart
proVider SelF-aSSeSSment
DoeS yoUR ClInIC TeST all aT-RISk CHIlDRen FoR eleVaTeD BlooD leaD leVelS?
q Does the provider discuss with parents their answers to the risk assessment and why their answers indicated their child was at risk for elevated blood lead levels?
q Does the provider discuss the neurological effects of lead in children? even at levels <10 µg/dl, iQ can decrease, and behaviors such as distractibility, impulsivity, aggression, short attention span, poor organization & lack of persistence can increase.
q Does the provider give parents educational resources at time of testing? see appendix for reproducible handouts: “frequently Asked Questions” pg. 43-52 “lead Poisons kids” (english, spanish, russian, Vietnamese) pg. 59-66 “Possible sources of lead” pg. 56 “Community resources for lead Prevention” pg. 55
14
RISk-BaSeD TeSTIng
riSK-BaSedBlood leVel teSting
proVider SelF-aSSeSSmentreCommended SChedule For oBtaining a ConFirmatory VenouS Sample
Capillary test perform venousresult (μg/dl) confirmation test within:5-9 3 months10-19 1 month20-44 1 –2 days45-70 immediately as an emergency lab test
if a child is less than 12 months old, or there is reason to believe that the Bll is rising rapidly, earlier diagnostic confirmation may be indicated.
q When lab results are returned do you have a clear protocol to determine next steps? see page 20 for protocols depending on blood lead levels.
q Do you have a Quality assurance step to ensure that all at-risk children are tested? An eMr field to record blood lead test results A field in the paper chart to record blood lead test results
reCommended SChedule For FolloW-up Blood lead teSting
Venous blood Follow-uplead level (μg/dl)
10-19 3 mo.
20-44 1 mo.
> 45 Chelation with follow-up testing aSap
proVider SelF-aSSeSSment
DoeS yoUR ClInIC HaVe an aDeQUaTe noTIFICaTIon SySTeM In PlaCe?
q Does the clinic notify parents of blood lead test results in writing? see appendix for “sample Patient letter Communicating Test results” pg. 40.
q are parents sent information explaining what the test results indicate? see appendix for “understanding your Child’s lead Test” pg. 53-54.
q If blood is tested in-house, are all tests reported to the State lead Poisoning Prevention Program? By law, facilities must report all blood lead levels on oregon residents and non-oregon workers. see pg. 35 for “reporting form for oregon lead Poisoning Prevention Program.”
16
CoMMUnICaTIngReSUlTS
CommuniCatingreSultS
proVider SelF-aSSeSSment
eleVated Bll meSSageS• hearing, speech, growth and neurodevelopment delays can result from elevated blood lead levels.
• early intervention can reduce harm.
• nutrition can help decrease lead levels.
• Staying on planned schedule of testing and treatment is important.
q Is one staff member responsible for reporting within the required time frame? non-elevated Blls (<10) must be reported within seven days after laboratory analysis. elevated Blls (>10) must be reported by fax within 24 hours after laboratory analysis. see pg. 35 for “reporting form for oregon lead Poisoning Prevention Program.”
loW Bll preVention meSSageS• nutrition can decrease lead absorption (iron, calcium, vitamin c).
• if the home environment changes (remodeling, moving to older home, new job) child’s risk can increase.
For CaregiVerS
proVider SelF-aSSeSSment
DoeS yoUR ClInIC HaVe a Plan FoR CaSe ManageMenT oF CHIlDRen WITH eleVaTeD BlooD leaD leVelS?
q Does the clinic list elevated Blood lead levels in the child’s permanent medical problem list? even if eBll has resolved, these children need surveillance for problems that may develop later.
q Is follow-up venous testing ordered for all children with blood lead levels over 10?
q are all children with elevated blood lead levels given a physical exam? see pg. 26 for areas of the physical exam that deserve special attention.
q Does the child’s provider submit the Medical Information Form to the State lead Poisoning Prevention Program? see appendix for “Medical information form” pg. 41-42.
q For children with blood lead levels over 10, does the clinician ensure that an environmental investigation is performed in the child’s home by Multnomah County lead Poisoning Prevention Program, and receive investigation results? Call the Multnomah County leadline: (503) 988-4000.
18
CaSeManageMenT
CaSe management
proVider SelF-aSSeSSment parentreSponSiBil it ieS• Feed child a nutritious diet with plenty of calcium, iron and vitamin C
• make sure child follows case management plan, is re-tested until blood lead tests show two consecutive levels under ten
• Work with county environmental health to identify and mitigate lead exposure in the home
• pay attention to child’s development and note delays in reaching milestones, report these to child’s teachers and medical providers
q are all caregivers of children who are diagnosed with elevated blood lead levels given eBll-specific nutritional advice or referred to the Woman Infants and Children (WIC) prorgam? see page 28 for nutritional advice.
q Is chelation therapy performed for any child diagnosed with blood lead levels >45?
q Is child referred to formal neurodevelopmental testing if any abnormalities are found on developmental screening or concern about other neurodevelopmental risk factors? e.g. teen-age mother, poor parenting skills, inadequate cognitive or emotional stimulation, child abuse, poverty, genetic disorder, poor nutrition
q Is child monitored for developmental problems due to lead poisoning? Any child that has ever had an eBll should have on-going neurodevelopmental monitoring with special attention during critical transition points: first grade: Children begin acquiring academic skills. fourth grade: They use these basic skills to learn new material. sixth or seventh grade: They need higher order planning and organizational skills.
if you cannot answer yes to every question, your clinic can improve universal risk assessment and risk-based blood lead testing practices.
proViderreSponSiBil it ieS• list eBll in child’s permanent medical problem list
• perform complete physical exam on all children with lead levels above 20, include hearing/speech assessment, growth and neurodevelopmental assessment
• educate parents about how to reduce lead exposure in the home
• educate parents about nutrients that reduce lead absorption
• develop a case management plan, and re-test until two consecutive lead levels below ten
State/CountyreSponSiBil it ieS• Coordinate case management with parents and medical provider
• perform in-home lead hazard assessments when indicated
• Follow up with parents to assure adherence to re-testing schedule
Capillary or VenouS Blood lead leVelSand indiCated proVider protoCol
5-9 μg/dl (micrograms of lead per deciliter of blood)notify family of test results and inform them that there is no safe level of lead in a child’s blood.• provide family with lead poisoning prevention information.• provide family with information about nutrients that can decrease lead absorption.• Confirmatory blood lead test recommended within 3 months, discuss with parents. if recent known exposure, perform confirmation as soon as possible.
10-19 μg/dlnotify family of test results and provide nutritional and environmental education materials.• Contact multnomah County leadline (503-988-4000) to assure that home is assessed for environmental risk factors.• perform confirmatory venous test as soon as possible, within 30 days.• re-test every three months until two consecutive results <10.
20-44 μg/dlrecall child for immediate clinical evaluation within 1-2 days.• Confirm with venous test within 1-2 days, re-test every month until level is <19, then every three months until two consecutive results <10• perform full clinical evaluation (see pg 24 for components of the physical exam).• Contact multnomah County leadline (503-988-4000) to assure that home is assessed for environmental risk factors.
45-69μg/dllead poisoning at these levels requires prompt treatment. Chelation therapy is indicated for lead levels of >44. Call oregon poison Center (1-800-222-1222) to talk to a medical toxicologist for immediate consultation.
20
Capillary or VenouS Blood lead leVelSand indiCated proVider protoCol
70 μg/dlmedical emergency. Call oregon poison Center (1-800-222-1222) immediately to consult with a medical toxicologist, and transfer child to emergency care.
Components of Clinical evaluation of Child with elevated Blood lead level (eBll):medical history: • developmental history • mouthing activities/picaenvironmental history: • age, condition, remodeling, repairs of residence or other locations where child spends time • occupations/hobbies of parents and other caregivers. • Family history of lead exposure (pottery, use of folk remedies, recent immigration)nutritional history: • dietary history • look for decreased Calcium and iron intake (these deficiencies may increase lead absorption). • Screen for anemia (see anemia protocol). • high fat diet may contribute to increased lead absorption. • absorption of lead may be increased when the stomach is empty, therefore, encourage small frequent meals. • Consider referral to WiC for nutritional assessment and food supplementation.physical exam: • Full physical with careful neuro exam. • labs for anemia, as above. • Screen for developmental delays and monitor developmental milestones. • Consider referral to early intervention program if any delays suspected.
oregon administrative rules (oar) 333-017 and 333-018 mandate that your facility report Blood lead levels on all oregon residents and non-oregon resident workers, when testing occurs. non-elevated Blls must be reported within seven days after laboratory analysis, elevated Blls must be sent by fax within 24 hours after lab analysis.
elevated Blls are defined as:adults (age 18 years and over): 25 μg/dl blood* • Children (age 17 years and under): 10 μg/dl blood *unless adult is pregnant, in which case follow pediatric guidelines.
electronic reporting:if performing in-house analysis of lead samples, contact the oregon lead poisoning prevention program to set up electronic reporting of results, or to receive a template. (971) 673-0440. this is the best method for reporting; it is easiest for staff, and you will receive assistance from the state.
re
po
rt
in
g
reporting Blood lead teStS to oregonlead poiSoning preVention program
22
Reporting by Fax :When transmitting by fax, please utilize a cover sheet to ensure your information is appropriately directed.oregon State public health division, lead poisoning prevention program Fax: 971-673-0457
Reporting by Phone:oregon State public health division, lead poisoning prevention program phone: 971-673-0440
Reporting by Mail:*attention: office Specialistoregon State public health divisionlead poisoning prevention program800 ne oregon St., Suite 640portland, or 97232-2132
all Blood lead leVel reporting Should inClude:• patient last name
• patient first name
• patient middle initial
• patient residential street
address
• patient residential city
• patient residential state
• patient residential zip
• patient residential phone
• patient date of birth
• patient race
• patient ethnicity
• Blood lead level (Bll)
• Specimen collection date
• Specimen type (venous/capillary)
• provider name and contact information503-988-4000 • www.leadline.org
the following information has been excerpted from the State of oregon’s disease reporting and Follow-up guidelines. the full document can be found at www.healthoregon.org/lead.
DeSCRIPTIon oF leaD PoISonIngFor the purpose of these guidelines, persons with eBlls are considered to have lead poisoning. lead poisoning can affect both children and adults, although the effects may vary markedly with age. it is convenient, albeit somewhat artificial, to divide lead poisoning into an acute disease that relates to current Blls, and a chronic disease that relates to the cumulative effects of body lead burden. Bear in mind that persons with very high BLLs ( ≥ 70 μg/dl in children) should be treated as medical emergencies, regardless of overt symptomatology. ingestion of a metallic object that may contain lead can result in an eBll within hours. any child that has ingested such an object should receive immediate medical attention including a blood lead test and abdominal x-ray. absorbed lead is detectable in blood, soft tissue, and bone. the half-life of lead varies from about a month in blood, 1-1.5 months in soft tissue, and about 25-30 years in bone.
aCUTe DISeaSeacute exposure to lead generally means exposure for a short times, but at high levels. there are few data sources available for acute exposures in humans. this may be a function of the time required for the expression of effects (decreased heme synthesis, neurobehavioral changes, increased blood pressure, and interference with Vitamin d metabolism) and the modes of exposure in humans, which are repeated ingestion of lead containing dust and/or dirt for children and continuous occupational inhalation exposures for adults. the most common symptom of acute lead poisoning is colicky abdominal pain evolving over days to weeks. Constipation, diarrhea, and nonspecific complaints of irritability, fatigue, weakness and muscle pain may also occur. these symptoms are seldom caused by Blls less than 50 μg/dl. in more severe cases, warning signs of acute, serious brain swelling include vomiting, irritability, restlessness, tremors, and progressive drowsiness. these symptoms may herald the onset of seizures, coma, and possibly death. the Blls associated with encephalopathy in children vary from study to study, but Blls of 70-80 μg/dl or greater appear to indicate serious risk.F
ol
lo
W-
up
lead poiSoning diSeaSe: reporting and FolloW-up guidelineS
24
CHRonIC eFFeCTSChronic lead exposure generally means exposure to low to moderate levels of lead over a long period of time. recent studies suggest that lead absorption is harmful at any concentration. relatively low blood lead levels rarely cause overt signs and symptoms, but such exposure can cause permanent damage-especially in young children-including decreased iQ, developmental delays, and behavioral disturbances.
CHelaTIon THeRaPyChelating agents solubilize lead, depleting it from soft and hard tissue and thereby reducing its acute toxicity. While chelation therapy is considered a mainstay in the medical management of children with Blls >45 μg/dl, it should be used with caution. primary care providers (pCp) should consult with an expert in the management of lead chemotherapy prior to using chelation agents.if unaware of a center with such expertise, pCps should contact the oregon poison Center or the state lead poisoning prevention program for the names of accessible experts. in the short term, chelation can redistribute body lead, causing an increase in lead concentrations in soft tissue, including the brain. Some chelators may remove essential minerals as well as lead. there is general agreement that individuals with very high Blls (in children > 45 μg/dl; in adults >100 μg/dl) should be chelated. patients with lower Blls (children, < 20 μg/dl; adults, < 65 g/dl) are usually not chelated unless symptomatic and/or unresponsive to removal from exposure. For patients with in-between Blls, chelation may or may not be appropriate.
FolloW-UP SCHeDUle FoR CHIlDRen WITH eBlls
Bll(μg/dl)
Confirmation Testing * (venous)
Follow-Up Testing (Venous)
Duties of Primary Care Provider (PCP)
Case Management Duties of local/County Health Dept.
5-9 Confirmation recommended within3 months
3 months provide source identification and risk reduction education.
no case management required.
10-19 30 days 3 months Complete and return medical information form received from county/local health department. assure follow-up blood lead testing. physical exam recommended. include history of eBll in problem list of child’s permanent medical record. if WiC enrolled, notify local program of eBll. monitor for developmental problems.
have pCp complete medical info form. Send letter to caregiver confirming child’s Bll. Complete questionnaire over phone to identify possible hazards. provide nutritional and risk reduction education. refer to WiC, social services or public assistance programs as needed. assure follow-up testing. Send copies of forms to dhS and pCp.
20-44 1-2 days 1 month above actions. pluscomplete physical exam
above actions plus: perform on-site investigation. advise pCp of environmental results. refer family to lead hazard control services if applicable and/or available. Send copies of forms to dhS.
45-59 48 hours Chelation with subsequent follow-up
above actions plus chelation therapy.
above actions.
60-69 24 hours Chelation with subsequent follow-up
above actions plus chelation therapy.
above actions.
> 70 immediately as an emergency lab test
Chelation with subsequent follow-up
above actions, plus hospitalize child for chelation therapy immediately. the child should not be permitted to return to any environment that would expose him/her to lead.
environmental on-site investigation and sampling must be done as soon as possible. the child should not be permitted to return to any environment that would expose him/her to lead.
* if a child with an elevated screening test result is less than 12 months old, or if there is reason to believe that a child’s Bll may be increasing rapidly (e.g. foreign body ingestion of leaded object) consider performing the confirmatory test sooner than indicated in the accompanying schedule.
Any screening Bll above 10 µg/dl must be confirmed with a venous sample. The higher the Bll on the screening test, the more urgent the need for confirmatory testing.
yo
ur
r
ol
e
Case management of children with eBlls involves the efforts of an organized team that includes the child’s caregivers, medical providers and the county and state health departments. ongoing communication with caregivers and other service providers, and a cooperative approach to problem solving and elimination of lead hazards in the child’s environment will be vital to ensuring the speedy resolution of elevated blood lead levels.
the following is adapted from a document by Jessica Van arsdale, md medical consultant for oregon lead poisoning prevention program.
geneRal ReCoMMenDaTIon:all children with a current or past eBll need to have this listed in their permanent medical problem list. even if eBll has resolved, these children need surveillance for problems that may develop later.
PHySICal exaM:all children with venous eBll >20 μg/dl must have a complete physical exam. For levels between 10-19 μg/dl a physical exam is recommended.
Following are areas of the physical exam that deserve special attention.
HeaRIng/SPeeCH: auditory function in children can be impaired, even at blood lead levels < 10 μg/dl. Speech delays can also occur.
HeenT: lead lines on gingival tissue (rarely seen today unless severe prolonged exposure)Growth: Several studies have shown a negative correlation between blood lead level and stature.third national health and nutrition examination Survey (nhaneS iii) found a significant negative association between blood lead concentration and stature and head circumference in children ages
CaSe management oF eleVated Blood lead leVelS: role oF pediatriC Care proVider
26
1-7 years. regression models predicted reductions of 1.57 cm in stature and 0.52 cm in head circumference for each μg/dl increase in blood lead concentrations.
neURoDeVeloPMenT: lead exposure can: decrease iQ, even at levels <10 μg/dl and increase behaviors such as distractibility, impulsivity, aggression, short attention span, poor organization, lack of persistence and daydreaming. neurologic: Findings suggestive of acute encephelopathy (rarely seen with Bll < 70 μg/dl).referral for formal neurodevelopmental testing:Formal neurodevelopmental testing is recommended if any abnormalities found on developmental screening or concern about other neurodevelopmental risk factors (e.g. teen-age mother, poor parenting skills, inadequate cognitive or emotional stimulation, child abuse, poverty, genetic disorder, poor nutrition). although chelation therapy has not been shown to be effective at reversing neurodevelopmental deficits due to lead poisoning, it is possible that early intervention/stimulation programs may be helpful.
DeVeloPMenTal SURVeIllanCe:developmental surveillance is recommended for all children with eBlls or prior eBlls. the period of increased risk for the expression of lead associated neurodevelopmental problems continues after lead exposure has been remediated and Blls reduced. any child that has ever had an eBll should have on-going neurodevelopmental monitoring with special attention during critical transition points: First grade: Children begin acquiring academic skills, Fourth grade: they use these basic skills to learn new material, Sixth or seventh grade: they need higher order planning and organizational skills.
SexUal DeVeloPMenT: a cross-sectional study found that african american and mexican american girls with Bll of 3 μg/dl had delayed pubertal development compared with girls with Bll of 1 μg/dl.
laBS: how long should it take for an eBll to decrease to < 10 μg/dl ?time (# of months required to achieve a blood lead level < 10 μg/dl ) = 0.845 x peak lead level. a retrospective analysis of children with venous blood lead levels 10-29 μg/dl, receiving case management, but not receiving chelation found a linear relationship between mean time for blood lead to decline to <10 μg/dl and peak blood lead level. important: after chronic lead exposure, increased metabolic activity (i.e. broken bones, growth spurts, pregnancy) can result in increased Bll due to mobilization of lead stored in body tissues.
HgB/HCT: all children should be assessed for anemia regardless of their lead exposure. lead can cause anemia from:(a) acute high lead exposure causing hemolytic anemia(b) Chronic lead exposure interferes with heme synthesis and decreases rBC lifespan. Frank anemia is not an early manifestation of lead exposure and is evident only when Bll is significantly elevated for prolonged periods. peripheral smear: not recommended (findings are non-specific). iron studies: Children with eBll often have associated iron deficiency. Serum ferritin is the best measure of iron status in children.kIDney FUnCTIon: no evidence to support routine evaluation of renal function in children with
MUlTnoMaH CoUnTy leaD lIne • 503-988-4000 • www.leadline.org
yo
ur
ro
le
C
on
t’d
asymptomatic eBlls, but if chelation to be used test kidney function prior and during treatment.
HaIR/FIngeRnaIl/TooTHleaD MeaSUReMenTS:not recommended (not a reliable method of estimating body burden of lead)Zpp (zinc protoporphyrin) [aka erythrocyte porphyrin (ep) or free erythrocyte protoporphyrin (Fep) ]a measure of past lead exposure. not sensitive for lead levels < 25 μg/dl. may be used for evaluating children with Bll >25 μg/dl without a steady decline despite medical or environmental interventions. these measurements may help differentiate eBll due to ongoing exposure versus rebound after treatment. iron deficiency can also cause an elevated ep. ep >150 is almost always due to lead. ep 35-150 may be due to lead or iron deficiency.
IMagIng STUDIeS:abdominal X-ray: obtain if acute ingestion of objects that may contain lead (e.g. lead sinkers, curtain weights, jewelry, paint chips) or if prolonged eBll and unable to identify source of exposure. X-ray of long bones: “lead lines” due to growth arrest indicate chronic exposure (not present unless Bll >50 μg/dl). rarely provide information for case management.
x-Ray FlUoReSCenCe oF long BoneS:use of radioactive source to provide non-invasive estimation of lead in bone. Currently used only for research.
nUTRITIon:all children with eBlls are at risk for poor nutrition.
IRon: Children with eBlls may be at risk for iron deficiency due to behavioral, nutritional, and socioeconomic factors. an iron rich diet
CaSe management oF eleVated Blood lead leVelS: role oF pediatriC Care proVider ConT’d
28
may decrease lead absorption. encourage adequate iron intake by introducing iron-fortified cereals and pureed meats at appropriate developmental stages. iron supplementation recommended when iron deficiency anemia is documented.
CalCIUM: dietary calcium competitively inhibits lead absorption (adequate intake (ai): 0-6 months 210 mg/day; 7-12 months 270 mg/day; 1-3 years 500 mg/day; 4-8 years 800 mg/day). no clinical evidence that supplementation beyond ai level in children with eBlls has a clinical effect on Bll, so calcium supplementation is not necessary if child is consuming adequate dietary calcium.
VITaMIn D: lead impedes Vitamin d conversion into active form, 1, 25- dihydroxyvitamin d. assure adequate Vitamin d and calcium in the diet.
ZInC: animal studies suggest high zinc inhibits absorption and retention of lead, but human studies have not shown a significant effect. Zinc supplementation is not recommended in children with eBlls. Chelation therapy can deplete zinc so if administering chelation therapy it is important to monitor and replace zinc.
VITaMIn C: to improve iron absorption in children six months of age and older, encourage two servings per day of foods rich in Vitamin C (e.g., fruits, vegetables, or juice).WiC: if WiC enrolled, notify local WiC program of eBll. Children with eBlls should be referred to WiC in order to assure nutritional counseling and access to healthy foods.
RegUlaR MealS & SnaCkSencourage caregivers to provide regular meals & snacks. more lead may be absorbed in the fasting state.
503-988-4000 • www.leadline.org
if you use an electronic medical records system that does not currently include lead screening and testing information as part of the pediatric chart, consider adding the fields below the next time you make changes to your emr template.
• Date lead Risk assessment Questionnaire administered (12 months well-child visit, 24 months well-child visit, between 36-72 months)
• elevated Risk: y/n
• Date of Blood lead Test
• lead Value (μg/dl)
• Previous lead Risk assessment/Test Date
• Result of Previous Risk assessment/Test – elevated risk: y/n – lead Value
adding Quality aSSuranCe CheCKS For lead riSK aSSeSSment and teSting to your emr: SuggeSted FieldS
Qu
al
it
y
30
n o t e S
ap
pe
nd
iC
eS
3233 provider resources for lead prevention
34 Filter paper lead Samples acceptability
35 reporting Form for oregon lead poisoning
prevention program
36-39 Waiting room Screening tool– english, russian,
Vietnamese, Spanish
40 Sample patient letter communicating test results
41-42 dhS medical information Form
43-52 Frequently asked Questions about lead
53-54 understanding your Child’s lead test
55 Community resources for lead prevention
56 possible Sources of lead
57-58 possible lead Containing home remedies and Cosmetics
59-66 lead poisons Kids– english, Spanish, russian, Vietnamese
Pages in the appendices are meant to be easily removed and duplicated for clinic use and
distribution to patients. electronic versions of appendices are available online at www.leadline.org
Pro
vid
er
Reso
urc
es f
or
Le
ad P
revention
Ore
go
n S
tate
Le
ad
Po
iso
nin
g P
reve
nti
on
Pro
gra
m
S
tate
wid
e p
rogra
m w
ork
ing t
o e
lim
inate
lea
d p
ois
on
ing in
Ore
go
n
9
71
-67
3-0
44
0
h
ttp
://w
ww
.ore
go
n.g
ov/D
HS
/ph
/lea
d/ind
ex.s
htm
l
CD
C L
ea
d P
ois
on
ing
Pre
ve
nti
on
Pro
gra
m
h
ttp
://w
ww
.cd
c.g
ov/n
ce
h/lea
d/d
efa
ult.h
tm
Min
ne
so
ta D
ep
art
men
t o
f H
ea
lth
S
tate
wid
e lea
d p
ois
on
ing p
reve
ntio
n p
rogra
m
G
rea
t pa
tien
t ha
nd
outs
in
En
glish
, H
mo
ng,
Spa
nis
h a
nd
Som
ali
h
ttp
://w
ww
.he
alth
.sta
te.m
n.u
s/d
ivs/e
h/le
ad/f
s/
Me
dT
ox
® L
ab
P
riva
te la
b s
pe
cia
lizin
g in
filte
r pa
pe
r te
stin
g fo
r b
lood
le
ad
le
ve
ls
O
n-lin
e v
ide
o w
ith
blo
od
co
lle
ction
in
str
uctio
ns
h
ttp
://w
ww
.me
dto
x.c
om
/Defa
ult.a
sp
x?
go
=L
ea
d
ES
A M
ag
ell
an
Bio
sc
ien
ce
s
M
an
ufa
ctu
rer
of
Le
ad
Ca
re®
II, C
LIA
wa
ive
d in
off
ice
blo
od
lea
d te
st kit
h
ttp
://w
ww
.esa
inc.c
om
/prin
t/p
rod
ucts
/typ
e/b
loo
d-le
ad_
an
aly
ze
rs/c
lia
-wa
ive
d
Qu
es
t D
iag
no
sti
cs
- N
ich
ols
In
sti
tute
L
oca
l la
b f
or
ve
no
us b
loo
d le
ad
te
stin
g
5
11
SW
10
th A
ve
Ste
70
5, P
ort
lan
d, O
R 9
720
5-2
70
8
w
ww
.nic
ho
lsin
stitu
te.c
om
(5
03
) 30
6-1
44
5
Ore
go
n M
ed
ica
l L
ab
s
O
rego
n la
b fo
r ve
no
us b
loo
d le
ad t
estin
g
1
23
In
tern
ation
al W
ay, S
prin
gfie
ld,
OR
97
47
7
8
00
.82
6.3
61
6
h
ttp
://w
ww
.om
lab
s.c
om
/
Filter Paper Lead Samples
Acceptable Samples
Front Back
Optimal Sam
ple: Free falling drops of blood will produce spots that soak through uniform
ly to back side of paper. Two spots provide adequate sam
ple for complete analysis.
Sampled Card: This card has been
sampled for analysis. Two punches
are taken for initial analysis; up to six punches m
ay be necessary to report a final result for sam
ples initially>=10 ug/dl. Areas that are sam
pled m
ust have soaked through to back side of filter paper.
Unacceptable Samples
Front Back
Insufficient Specimen Collected:
Blood drop not allowed to accumulate
to adequate size to fall freely. Blood drop was touched to filter paper.
Overly Saturated or Wet Filter
Paper:Sample does not dry and
cannot be punched.
Blood Smeared on Filter Paper:
Finger surface touched to filter paper; blood spot does not soak through to back side.
Non-Homogenous Sam
ple: Spotsare not uniform
in appearance; possible contam
ination with hand soap, lotion, or latex powder or sam
ple collected after blood has begun to clot.
Transferred Sample: Capillary tube
or other device was used to transfer sam
ple; spots do not soak through to back side of filter paper.
Filter Paper Disrupted: Capillarytube or other device was used to transfer sam
ple; front of card has been scratched or disrupted.
To: O
rego
n St
ate
Publ
ic H
ealth
Div
isio
n, L
ead
Pois
onin
g Pr
even
tion
Prog
ram
P
atie
ntla
stn
ame_
____
____
____
____
____
____
____
____
____
____
____
___
Patientfirstnam
e________________________________________________
P
atie
ntm
iddl
ein
itial
____
____
____
____
____
____
____
____
____
____
____
__
Patientresidentialstreetaddress____________________________________
Patientresidentialcity____________________________________________
Patientresidentialstate________Patientresidentialzip__________________
Patientresidentialphone__________________________________________
Patientdateofbirth______________________________________________
Patientrace____________________________________________________
Patientethnicity_________________________________________________
Bloodleadlevel(BLL)____________________________________________
Specimentype:VenousorCapillary(circleone)
Specimencollectiondate__________________________________________
Medicalproviderlastandfirstnam
e__________________________________
Medicalproviderphonenum
ber____________________________________
Emai
l passw
ord-protectedresultstoDavidDreher,ResearchAnalystOLP
PP
david.m.dreher@
state.or.us
FaxwithaCoversheetto:O
regonStatePublicHealthDivision,LeadPoisoning
PreventionProgram
Fax:971-673-0457
Phon
eOregonStatePublicHealthDivision,LeadPoisoningPrevention
Program
:(971)673-0440
Mai
l:*Attention:OfficeSpecialist
OregonStatePublicHealthDivision
LeadPoisoningPreventionProgram
800NEOregonSt.,Suite640
Portland,O
R97232-2132
N
on-e
leva
ted
BLL
s (<
10 μ
g/dL
blo
od)m
ust bereportedwithinseven
daysafterlaboratoryanalysis.E
leva
ted
BLL
s ( 1
0 μg
/dL
bloo
d) m
ust b
e
sent
by
fax
with
in 2
4 ho
urs
afte
r lab
ana
lysi
s
Is Y
ou
r Ch
ild a
t Ris
k fo
r Le
ad
Po
iso
nin
g?
Pa
ren
ts a
nd
care
giv
ers
: ple
ase
an
sw
er th
es
e b
rief q
ue
stio
ns
an
d g
ive
this
s
he
et b
ac
k to
the
rec
ep
tion
ist.
Na
me
of C
hild
:___
___
___
___
___
__
___
____
___
Da
te o
f Birth
:___
___
___
Da
te:_
__
__
__
___
_
Ad
dre
ss
:___
___
__
___
___
___
___
__
___
_ C
ity: _
__
__
__
___
__
__ S
tate
: __
__
_ Z
ip: _
____
___
Th
is is
a q
ue
stio
nna
ire a
bou
t lea
d. L
ea
d is
a d
an
ge
rou
s m
ate
rial th
at s
om
etim
es g
ets
into
ch
ildre
n’s
bo
die
s. It c
an
ma
ke
them
sic
k a
nd
affe
ct th
eir b
eha
vio
r and
ab
ility to
lea
rn.
An
sw
ers
to th
ese
qu
estio
ns w
ill he
lp th
e h
ea
lth c
are
pro
vid
er s
ee
if yo
ur c
hild
ne
ed
s a
blo
od
le
ad
test. If th
ese
qu
estio
ns a
re c
onfu
sin
g p
lea
se
ask th
e c
linic
sta
ff for h
elp
. Fo
r mo
re
info
rma
tion
abo
ut le
ad a
nd
ho
w it c
an
affe
ct c
hild
ren
ca
ll the
Le
ad
Lin
e a
t 50
3-9
88
-400
0
Ple
ase c
ircle
an
an
sw
er to
each
qu
estio
n:
1. D
oe
s y
ou
r ch
ild s
pen
d tim
e in
an o
ld h
om
e o
r bu
ildin
g b
uilt
befo
re 1
97
8?
Ye
s
Do
n’t
Kn
ow
N
o
2. H
as y
ou
r ch
ild re
ce
ntly
sp
en
t time
in a
ho
me
or b
uild
ing b
uilt
befo
re 1
97
8 w
he
re re
pa
irs a
nd / o
r rem
od
elin
g is
be
ing d
on
e?
Ye
s
Do
n’t
Kn
ow
N
o
3. H
as y
ou
r ch
ild re
ce
ntly
sp
en
t time
in a
ho
me
or b
uild
ing b
uilt
befo
re 1
97
8 w
he
re p
ain
ting
is b
ein
g d
on
e in
sid
e o
r ou
tsid
e th
e
ho
me
?
Ye
s
Do
n’t
Kn
ow
N
o
4. D
oe
s y
ou
r ch
ild h
ave
a b
roth
er o
r sis
ter w
ho
ha
s le
ad
po
iso
nin
g o
r do
es y
ou
r ch
ild k
no
w a
nyo
ne
with
lead
po
iso
nin
g?
Ye
s
Do
n’t
Kn
ow
N
o
5. D
oe
s y
ou
r ch
ild s
pen
d tim
e w
ith a
nyo
ne
wh
o u
se
s le
ad
in
the
ir wo
rk o
r ho
bb
ies?
Exam
ple
s: P
ain
ting, re
modelin
g, a
uto
rad
iato
rs, b
atte
ries, a
uto
repa
ir, sold
erin
g, m
akin
g s
inkers
, bulle
ts, s
tain
ed g
lass, p
otte
ry, go
ing to
sh
ootin
g
ranges, h
untin
g o
r fishin
g
Ye
s
Do
n’t
Kn
ow
N
o
6. D
o y
ou
use
imp
orte
d p
otte
ry, c
era
mic
s, le
ad
cry
sta
l or p
ew
ter
for c
oo
kin
g o
r sto
ring/s
erv
ing fo
od?
Y
es
D
on
’t K
no
w
No
7. H
as y
ou
r ch
ild e
ve
r take
n tra
ditio
na
l or h
om
e re
me
die
s o
r u
se
d m
ake
-up
impo
rted
into
the
US
?
Exam
ple
s: A
zarc
on, A
larc
on, G
reta
, Ru
eda, P
ay-lo
o-a
h, o
r Ko
hl
Ye
s
Do
n’t
Kn
ow
N
o
8. H
as y
ou
r ch
ild v
isite
d o
r live
d o
uts
ide
the
US
in th
e la
st 6
m
onth
s?
Ye
s
Do
n’t
Kn
ow
N
o
9. D
o y
ou
ha
ve
co
nce
rns a
bo
ut y
ou
r ch
ild’s
be
ha
vio
r or
de
ve
lop
me
nt?
Co
nce
rn(s
):___
___
__
__
___
___
___
__
___
____
___
___
___
__
__
Ye
s
No
t S
ure
N
o
Ple
ase a
nsw
er th
e fo
llow
ing
qu
estio
ns:
Ha
s y
ou
r ch
ild h
ad
a b
loo
d le
ad
test in
the
past?
If y
es, W
here
?_
___
___
___
___
___
__
___
____
___
___
When
? _
__
__
___
___
___
__
___
__
Ha
ve
yo
u b
ee
n g
ive
n a
lea
d s
cre
en
ing fo
rm (lik
e th
is o
ne
) in th
e p
ast?
If y
es, W
here
?_
___
___
___
___
___
__
___
____
___
___
When
? _
__
__
___
___
___
__
___
__
Mu
ltno
mah C
ou
nty
Hea
lth D
epartm
ent
En
viro
nm
enta
l Hea
lth
¿Cor
re s
u hi
jo(a
) el r
iesg
o de
suf
riren
vene
nam
ient
o po
r plo
mo?
Padr
es y
cui
dado
res:
por
favo
r con
test
en e
stas
pre
gunt
as b
reve
s y
devu
elva
n es
ta h
oja
a la
rece
pcio
nist
a.
Nom
bre
del m
enor
:___
____
____
____
____
Fec
ha d
e na
cim
ient
o:__
____
_ Fe
cha:
____
____
Dom
icili
o:__
____
____
____
____
____
__C
iuda
d: _
____
____
__ E
stad
o: _
___
C.P
.: __
____
__
Este
es
un c
uest
iona
rio s
obre
el p
lom
o. E
l plo
mo
es u
n m
ater
ial p
elig
roso
que
alg
unas
vec
es
entra
al c
uerp
o de
los
niño
s. P
uede
hac
er q
ue s
e en
ferm
en y
afe
ctar
su
com
porta
mie
nto
y ca
paci
dad
para
apr
ende
r.
Las
resp
uest
as a
est
as p
regu
ntas
le a
yuda
rán
al p
rove
edor
de
aten
ción
de
salu
d ve
r si s
u hi
jo(a
) nec
esita
aná
lisis
de
sang
re p
ara
el p
lom
o. S
i est
as p
regu
ntas
no
son
clar
as, p
or fa
vor
pida
ayu
da a
l per
sona
l de
la c
línic
a. P
ara
más
info
rmac
ión
acer
ca d
el p
lom
o y
cóm
o pu
ede
afec
tar a
los
niño
s, ll
ame
a la
líne
a de
l plo
mo LeadLine
al 5
03-9
88-4
000
Favo
r de
ence
rrar
en
un c
írcul
o un
a re
spue
sta
para
cad
a pr
egun
ta:
1. ¿
Su h
ijo(a
) pas
a tie
mpo
en
una
casa
vie
ja o
edi
ficio
vie
jo
cons
truid
os a
ntes
de
1978
?Sí
N
o sé
N
o
2. ¿
Su h
ijo(a
) pas
ó tie
mpo
reci
ente
men
te e
n un
a ca
sa v
ieja
o e
dific
io
viej
o co
nstru
idos
ant
es d
e 19
78 d
onde
se
esta
ban
real
izan
do
repa
raci
ones
y/o
rem
odel
ació
n?
Sí
No
sé
No
3. ¿
Su h
ijo(a
) pas
ó tie
mpo
reci
ente
men
te e
n un
a ca
sa v
ieja
o e
dific
io
viej
o co
nstru
idos
ant
es d
e 19
78 d
onde
se
esta
ba p
inta
ndo
dent
ro o
fu
era
de la
cas
a?
Sí
No
sé
No
4. ¿
Tien
e su
hijo
(a) u
n(a)
her
man
o(a)
que
suf
re e
nven
enam
ient
o po
r pl
omo
o co
noce
a a
lgui
en q
ue s
ufre
env
enen
amie
nto
por p
lom
o?Sí
N
o sé
N
o
5. ¿
Pasa
tiem
po s
u hi
jo(a
) con
alg
uien
que
usa
plo
mo
en s
u tra
bajo
o
pasa
tiem
pos?
Por e
jem
plo:
Pin
tar,
rem
odel
ar, r
adia
dore
s de
aut
omóv
iles,
bat
ería
s, re
para
cion
es d
e au
tom
óvile
s,
sold
adur
a, fa
bric
ació
n de
plo
mad
as, b
alas
, vitr
ales
, cer
ámic
a, a
sist
ir a
cam
pos
de ti
ro, c
aza
o pe
sca
Sí
No
sé
No
6. ¿
Usa
cer
ámic
a im
porta
da, c
rista
l de
plom
o o
peltr
e pa
ra c
ocin
ar,
guar
dar o
ser
vir a
limen
tos?
Sí
No
sé
No
7. ¿
Algu
na v
ez s
u hi
jo(a
) tom
ó re
med
ios
tradi
cion
ales
o c
aser
os o
us
ó co
smét
icos
impo
rtado
s a
E.U
.?
Por e
jem
plo:
Aza
rcón
, Ala
rcón
, Gre
ta, R
ueda
, Pay
-loo-
ah, o
Koh
l
Sí
No
sé
No
8. ¿
Su h
ijo(a
) ha
visi
tado
o v
ivid
o fu
era
de E
.U. e
n lo
s úl
timos
6
mes
es?
Sí
No
sé
No
9. ¿
Tien
e pr
eocu
paci
ones
ace
rca
del c
ompo
rtam
ient
o o
desa
rrollo
de
su h
ijo(a
)?
Preo
cupa
ción
(es)
:___
____
____
____
____
____
____
____
____
____
__
Sí
No
sé
No
Por f
avor
con
test
e la
s pr
egun
tas
sigu
ient
es:
¿Se
le h
an h
echo
aná
lisis
de
plom
o en
la s
angr
e a
su h
ijo(a
) en
el p
asad
o?D
e se
r así
, ¿en
dón
de?_
____
____
____
____
____
____
__ ¿
Cuá
ndo?
___
____
____
____
¿Ha
reci
bido
ust
ed u
n fo
rmul
ario
de
prue
ba d
el p
lom
o (c
omo
éste
) en
el p
asad
o?D
e se
r así
, ¿en
dón
de?_
____
____
____
____
____
____
¿C
uánd
o? _
____
____
____
____
_
Mul
tnom
ah C
ount
y H
ealth
Dep
artm
ent
Envi
ronm
enta
l Hea
lth
Угрожает ли вашему ребенку риск отравления свинцом?
Родители и опекуны! Пожалуйста, заполните этот краткий вопросник и верните его регистратору.
Имя, фамилия ребенка: ___________________________ Дата рождения: _________ Дата: ___________
Адрес: __________________________ Город: ______________ Штат: _____ Почтовы
й индекс: ________
Этот вопросник посвящен возможности отравления свинцом. Свинец —
опасное вещество, иногда проникающ
ее в детский орга-низм. Свинец может вызывать заболевания, влиять на поведение детей и препятствовать их способности к обучению. Ответы на эти вопросы помогут обслуживающ
ему вас медицинскому учреждению определить, нуждается ли ваш ребенок в ана-лизе крови на содержание свинца. Если вы не понимаете какие-либо их этих вопросов, обратитесь за помощ
ью к персоналу кли-ники. Дополнительные сведения о свинце и о том, как он может воздействовать на детей, можно получить по телефону 503-988-4000 службы помощ
и при отравлениях свинцом (LeadLine).
Пожалуйста, обведит
е ответ
на каждый из вопросов 1. Проводит ли ваш ребенок время в старом доме или в здании, построенном до 1978 года?
Да Не знаю
Нет 2. Находился ли ваш ребенок, в последнее время, в доме или в здании, построенном до 1978 года,
где производились ремонт и (или) модернизация? Да
Не знаю Нет
3. Находился ли ваш ребенок, в последнее время, в доме или в здании, построенном до 1978 года, где производилась покраска во внутренних помещ
ениях или снаружи? Да
Не знаю Нет
4. Есть ли у вашего ребенка брат или сестра, страдающие от отравления свинцом, и знает ли ваш
ребенок кого-нибудь, кто страдает от отравления свинцом? Да
Не знаю Нет
5. Проводит ли ваш ребенок время с кем-нибудь, кто пользуется содержащими свинец материа-
лами, выполняя свою работу или занимаясь любимым делом? К таким занятиям относятся, например, покраска, модернизация помещ
ений, починка автомобильных радиаторов, работа с аккумуляторными батареями, пайка, изготовление грузил, пуль, витражного стекла или керамики, посещ
ение стрельбищ
, охота и рыбалка.
Да Не знаю
Нет
6. Пользуетесь ли вы импортированными гончарными или керамическими изделиями, свинцо-вым хрусталем или изделиями из сплава олова со свинцом при приготовлении, хранении или потреблении пищ
и?
Да Не знаю
Нет
7. Принимал ли ваш ребенок когда-либо традиционные лекарственные средства или лекарствен-ные препаратами домашнего приготовления, и пользовался ли ваш ребенок косметическими препаратами, импортированными в СШ
А? К таким средствам и препаратам относятся, например, Azarcon, Alarcon, Greta, Rueda, Pay-loo-ah и Kohl.
Да Не знаю
Нет
8. Проживал ли ваш ребенок где-либо за пределами США на протяжении последних 6 месяцев?
Да Не знаю
Нет 9. Беспокоит ли вас что-либо в поведении или развитии вашего ребенка? Явления, вызывающ
ие беспокойство: ________________________________________
Да Не знаю
Нет
Пожалуйста, от
ветьт
е на следующие вопросы
Делали ли вашему ребенку в прошлом анализ крови на содержание свинца? Если да, где?_______________________________ Когда? _____________________
Заполняли ли вы раньше вопросник, посвященный возможности отравления свинцом (подобный этому вопроснику)?
Если да, где?_______________________________ Когда? _____________________
Multnom
ah County H
ealth Departm
ent Environm
entalHealth
Con
Em
ca
Quý
V c
ó N
guy
C N
gc
Ch
t Chì
Khô
ng?
P
h H
uynh
và
Ng
i Gi
Tr
: xi
n tr
li n
hng
câu
hi n
gn
này
và tr
ao b
n nà
y l
i cho
tip
viên
.
Tên
Tr E
m:_
____
____
____
____
____
____
__ N
gày
San
h:__
____
___
Ngà
y___
____
___
a C
h:_
____
____
____
_Thà
nh P
h: _
____
____
_Ti
u B
ang:
___
__ S
Bu
Cc:
___
____
_
ây là
nh
ng c
âu h
i v c
ht c
hì.
Chì
là m
t lo
i vt l
iu
nguy
hi
môi
khi
xâm
nh
p và
o th
ân th
ca
tr e
m.
Ch
t chì
có
th là
m c
ho c
ác e
m b
bnh
và
nh h
ngn
hành
vi
và k
h n
ng h
c t
p c
acá
c em
.
Tr l
i nh
ng c
âu h
i này
s g
iúp
ni c
ung
cp
dch
v y
t b
it n
u co
n em
ca
quý
v c
ó c
n th
máu
v
ch
t chì
hay
khô
ng.
Nu
nhng
câu
hi n
ày k
hông
c
rõ rà
ng, x
in h
i nhâ
n vi
ên c
hn
y vi
nc
giúp
.
Mu
n bi
t thê
m ti
n t
c v
ch
t chì
và
nh h
ngn
con
em c
a qu
ý v
nh
th n
ào,
hãy
gi
in
tho
i cho
ng
Dây
i
n Th
oi v
Ch
t Chì
(Lea
dLin
e) t
i s 5
03-9
88-4
000
Xin
kho
anh
tròn
mt c
âu tr
li c
ho m
i câu
hi:
1. C
on e
m c
a qu
ý v
có
n m
t cn
nhà
hoc
cao
c c
c xâ
y c
t tr
c n
m 1
978
khôn
g?C
ó K
hông
B
it
Khô
ng
2. G
nây
con
em
ca
quý
v c
ó n
mt c
n nh
à ho
c ca
o c
cc
xây
ct t
rc
nm
197
8, n
i va
mi h
oàn
thàn
h vi
cs
ach
a và
/ho
ctâ
n tr
ang
khôn
g?
Có
Khô
ng
Bi
tK
hông
3. G
nây
con
em
ca
quý
v c
ó n
mt c
n nh
à ho
c ca
o c
cc
xây
ct t
rc
nm
197
8, n
i va
mi h
oàn
thàn
h vi
cs
n bê
n tro
ng h
oc
bên
ngoà
i nhà
khô
ng?
Có
Khô
ng
Bi
tK
hông
4. C
on e
m c
a qu
ý v
có
anh
hoc
chã
b n
him
c ch
t chì
ho
cco
n em
ca
quý
v c
ó bi
t ai
ã b
nhi
mc
cht c
hì k
hông
?C
ó K
hông
B
it
Khô
ng
5. C
on e
m c
a qu
ý v
có
n ch
i vi n
gi s
dng
ch
t chì
tron
g cô
ng v
ic
làm
ho
c th
eo s
thíc
h c
a h
khô
ng?
Thí d
: S
n, tâ
n tra
ng n
hà c
a, b
ình
nc
gim
nhi
t xe
hi,
bình
i
n, s
a xe
hi,
hàn
chì,
làm
bn
nc,
n d
c, k
ing
nhu
m m
, g
m,
n x
trng
, sn
bn
hoc
câu
cá.
Có
Khô
ng
Bi
tK
hông
6. Q
uý v
có
s d
ng g
m n
hp
cng
, g
m,
thy
tinh
có c
ht
chì h
oc
hp
kim
thi
c (p
ewte
r)
nu
n ho
c t
n tr
/ng
thc
nkh
ông?
Có
Khô
ng
Bi
tK
hông
7. C
on e
m c
a qu
ý v
có
bao
gi u
ng th
uc
bc
hoc
thu
c na
m h
ay
s d
ng m
ph
m n
hp
cng
vào
nc
M k
hông
?
Thí d
: A
zarc
on, A
larc
on, G
reta
, Rue
da, P
ay-lo
o-ah
, ho
c K
ohl
Có
Khô
ng
Bi
tK
hông
8. C
on e
m c
a qu
ý v
có
i th
m v
ing
ho
c s
ng
ngo
ài n
c M
trong
6 th
áng
va
qua
khôn
g?C
ó K
hông
B
it
Khô
ng
9. Q
uý v
có
quan
tâm
v h
ành
vi h
oc
s p
hát t
rin
ca
con
em m
ình
khôn
g?
Qua
n Tâ
m:_
____
____
____
____
____
____
____
____
____
____
Có
Khô
ng
Ch
cC
hn
Khô
ng
Xin
tr l
i nh
ng c
âu h
i sau
ây
:C
on e
m c
a qu
ý v
ã th
máu
v c
ht c
hì tr
cây
khô
ng?
Nu
có,
âu?_
____
____
____
____
____
____
____
__ K
hi n
ào?
____
____
____
_
Quý
v c
ó c
a m
u ki
m tr
a ch
t chì
(nh
bn
này)
trc
ây k
hông
?N
u có
, âu
?___
____
____
____
____
____
____
____
Khi
nào
? __
____
____
___
Mul
tnom
ah C
ount
y H
ealth
Dep
artm
ent
Envi
ronm
enta
lHea
lth
SA
MP
LE LE
TT
ER
TO PAT
IEN
T C
OM
MU
NIC
ATIN
G T
ES
T R
ES
ULT
S
Your Clinic N
ame
M
onth Date, 2008
1234 NE
Blank S
treet P
ortland, OR
97200
Patient N
ame
1234 SE
Other S
treetP
ortland, OR
97200
Dear P
atient Nam
e:
At your child’s recent visit your answ
ers to a screening questionnaire indicated that your child m
ay be at risk for lead exposure. Since lead in children’s blood can lead to neurological, de-
velopmental and other health problem
s, we conducted a test to determ
ine the level of lead in your child’s blood. A
blood lead level will tell if a child has been exposed to lead in the last 3-4
months.
We have received the test results and the level of lead in your child’s blood is _____μg/dl
(microgram
s per deciliter)
Because of these results
q
No action is needed, w
e will continue to m
onitor your child’s lead exposure risk as usual.
q
We m
ust follow up w
ith another blood test to confirm the level. P
lease call to schedule
an appointm
ent sometim
e within: (circle 1)
T
he next three months
T
he next month
P
lease call the clinic imm
ediately to schedule another test this week
q
We m
ust see your child imm
ediately for treatment
Please read the enclosed inform
ation: Understanding Your C
hild’s Lead Test” and “Frequently A
sked Questions about Lead” to learn how
to reduce exposure to lead hazards. There is also
a list of healthy foods you can feed your child to fight lead on page 6. If you have any ques-tions or concerns about your child’s test or lead levels, please feel free to call our office or the LeadLine at 1-800-368-5060.
Sincerely,
Dr. S
o and So
Your Clinic N
ame
Telephone number
Ore
go
n D
epa
rtm
ent
of
Hu
ma
n S
erv
ices
Ch
ild
ho
od
Lea
d P
ois
on
ing
Pre
ven
tio
n P
rog
ram
Med
ica
l In
form
ati
on
Fo
rm
Pro
vid
er n
ame:
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
_ P
ho
ne:
__
__
__
__
__
__
__
__
__
__
__
_ D
ate:
__
__
__
__
__
_
Ch
ild
’s n
ame:
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
Ch
ild
’s d
ate
of
bir
th _
__
__
__
__
__
__
__
Wh
en w
as t
he
last
tim
e yo
u e
xam
ined
th
is c
hil
d? _
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
_
Is t
he
chil
d a
rece
nt
ado
pte
e o
r im
mig
ran
t fr
om
ou
tsid
e th
e U
.S.?
__
__
__
___
__
__
__
__
__
__
__
__
__
__
__
__
__
__
Ch
eck a
ll p
oss
ible
sym
pto
ms
and
ris
k i
ndic
ators
lis
ted
bel
ow
th
at m
ay a
pp
ly:
Neu
rolo
gic
al
De v
elo
pm
enta
l G
ast
roin
test
ina
l O
ther
S
eizu
res
D
evel
op
men
tal
del
ays
A
bd
om
inal
pai
n
N
on
e
E
nce
ph
alo
pat
hy
G
row
th d
elays
L
oss
of
app
etit
e
Let
har
gy
H
ead
ach
e
Lan
gu
ag
e d
elays
W
eigh
t lo
ss
S
leep
less
nes
s
A
uti
sm
Pic
a
Nau
sea
Ir
rita
bil
ity
H
yp
erac
tiv
ity/a
tten
tio
n
def
icit
dis
ord
er
A
typ
ical
han
d t
o m
ou
th
beh
avio
r
V
om
itin
g
B
ehav
iora
l ch
ange
H
eari
ng d
efic
its
D
iarr
hea
Mu
scle
wea
kn
ess
C
on
stip
atio
n
M
usc
le s
ore
nes
s
A
nem
ia
No
tes:
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
_
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
_
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
_
Per
tin
ent
med
ical
his
tory
& r
emar
ks:
__
__
__
__
__
__
__
__
__
__
___
__
__
__
___
__
__
__
__
__
___
__
__
__
___
__
__
__
__
__
___
__
__
__
___
__
__
__
__
__
___
__
__
__
___
__
__
__
__
__
__
__
__
__
__
___
__
__
__
___
__
__
__
__
__
___
__
__
__
___
__
__
__
__
__
___
__
__
__
___
__
__
__
__
__
___
__
__
__
___
__
__
__
__
__
__
__
__
__
__
___
__
__
__
___
__
__
__
__
__
___
__
__
__
___
__
__
__
__
__
___
__
__
__
___
__
__
__
__
__
___
__
__
__
___
If c
hil
d h
as g
row
th d
elay h
as c
hil
d r
ecei
ved
a n
utr
itio
nal
ev
alu
atio
n?
Yes
No
Res
ult
:
Is c
hil
d t
akin
g s
up
ple
men
ts (
Ca,
Fe,
Zin
c)?
Has
ch
ild
bee
n r
efer
red
to
WIC
?
Has
ch
ild
rece
ived
or
bee
n r
eferr
ed f
or
form
al n
euro
-dev
elo
pm
enta
l as
sess
men
t?
Yes
No
Res
ult
:
No
te:
Incl
ud
e h
isto
ry o
f el
eva
ted
blo
od
lea
d l
evel
(E
BL
L)
in p
rob
lem
lis
t o
f ch
ild
’s p
erm
an
ent
med
ica
l
reco
rd.
OC
LP
PP
MIF
01
(7
/200
4)
P
age
1
If
ch
ild
ho
spit
ali
zed
or
chel
ate
d s
ee b
ack
of
form
.
Oth
er t
ests
Dat
e p
erfo
rmed
R
esu
lts
Hem
oglo
bin
Hem
ato
crit
Ser
um
Iro
n
Iro
n B
ind
ing
Fer
riti
n
Wh
y w
as t
he
blo
od
lea
d t
est
per
form
ed?
(1
) E
PS
DT
(ea
rly p
erio
dic
scr
eenin
g,
dia
gno
stic
& t
reat
men
t)
(2
) R
outi
ne
Scr
een
(3
) K
no
wn
ex
po
sure
to
lea
d
(4
) P
aren
tal
req
ues
t
(5
) S
pec
ial
scre
enin
g p
roje
ct
(6
) A
nem
ia/I
ron
def
icie
ncy
(7
) S
ym
pto
ms
of
lead
pois
on
ing
(8
) D
on
’t k
no
w
(9
) O
ther
__
__
__
__
__
___
__
__
__
___
__
__
__
__
_
Ab
do
min
al X
-ray
Was ch
ild h
osp
italized fo
r lead p
oiso
nin
g?
Y
es
N
o
Do
n’t k
no
w
If yes, w
here h
osp
italized
?
Nam
e of H
osp
ital:
Ad
dress an
d p
ho
ne:
Date ad
mitted
: D
ate disch
arged
:
Blo
od
Lea
d L
evel (B
LL
)C
ollectio
n D
ate:
BL
L R
esult:
On
adm
ission:
g/d
l
Oth
er BL
L:
g/d
l
Oth
er BL
L:
g/d
l
Oth
er BL
L:
g/d
l
On
disch
arge:
g/d
l
Was ch
ild ch
elated?
Y
es N
o
Do
n’t k
no
w If y
es, date started
? _
__
__
__
__
__
__
__
__
If yes, w
ith w
hat (C
heck
all that ap
ply
): E
DT
A
BA
L
DM
SA
/Su
ccimer (C
hem
et) P
enicillam
ine
D
on
’t kn
ow
O
ther _
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
Was ch
ild ch
elated o
n an
ou
tpatien
t basis?
Y
es N
o
Do
n’t k
no
w
If yes, d
ate started? _
__
__
__
__
__
__
__
__
__
__
_ D
ate end
ed: _
__
__
__
__
__
__
__
__
__
__
__
_
If yes, w
ith w
hat (C
heck
all that ap
ply
): D
MS
A/S
uccim
er (Ch
emet)_
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
D
on
’t kn
ow
O
ther _
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
Pertin
ent m
edical h
istory
& rem
arks:
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
__
OC
LP
PP
MIF
01
(7/2
00
4) P
age 2
oregon department of hum
an services
1
Freq
uent
ly A
sked
Que
stio
ns
GEN
ERA
L IN
FOR
MA
TIO
N
Wha
t is
lead
?
Lead
is a
nat
ural
ly o
ccur
ring
met
al fo
und
in th
e ea
rth’s
cru
st. L
ead
has b
een
min
ed, p
roce
ssed
, and
us
ed in
com
mer
cial
and
hou
seho
ld p
rodu
cts f
or th
ousa
nds o
f yea
rs. I
n th
e pa
st le
ad w
as u
sed
in
pain
t, ga
solin
e, p
otte
ry, w
ater
pip
es a
nd o
ther
pro
duct
s. W
hen
lead
get
s int
o th
e bo
dy it
is a
poi
son
and
harm
s peo
ple.
Onc
e le
ad e
nter
s the
hum
an e
nviro
nmen
t, th
ere
is n
o w
ay to
des
troy
it or
mak
e it
harm
less
. The
refo
re, w
e m
ust c
ontro
l exp
osur
e to
lead
.
Wha
t is
lead
poi
soni
ng?
Lead
poi
soni
ng o
ccur
s whe
n le
ad b
uild
s up
in th
e bo
dy. C
hild
ren
and
adul
ts c
an g
et le
ad p
oiso
ning
by
bre
athi
ng o
r sw
allo
win
g du
st th
at c
onta
ins l
ead.
You
r bod
y do
es n
ot h
ave
a us
e fo
r lea
d. W
hen
it is
abs
orbe
d, it
aff
ects
alm
ost e
very
bod
y sy
stem
.Eve
n sm
all a
mou
nts c
an b
e ha
rmfu
l. N
o on
e kn
ows e
xact
ly h
ow m
uch
lead
it ta
kes t
o ca
use
heal
th p
robl
ems.
A p
iece
of l
ead
as s
mal
l as
a gr
ain
of s
and
is e
noug
h to
poi
son
a ch
ild.
(Cen
ters
for D
isea
se C
ontr
ol, 1
991)
Who
can
get
lead
poi
soni
ng?
Any
one
can
get l
ead
pois
onin
g. L
ead
is m
ost d
ange
rous
to y
oung
and
unb
orn
child
ren
beca
use
thei
r bo
dies
and
bra
ins a
re st
ill g
row
ing
and
deve
lopi
ng. L
ead
can
inte
rfer
e w
ith n
orm
al b
rain
de
velo
pmen
t, re
sulti
ng in
per
man
ently
redu
ced
IQ a
nd b
ehav
iora
l pro
blem
s. Y
oung
chi
ldre
n ar
e m
ore
at ri
sk fo
r exp
osur
e to
lead
bec
ause
chi
ldre
n ex
plor
e th
eir e
nviro
nmen
t by
putti
ng th
eir t
oys,
hand
and
oth
er o
bjec
ts in
thei
r mou
ths.
Any
of t
hese
obj
ects
cou
ld h
ave
lead
dus
t on
them
. If
child
ren
put o
bjec
ts w
ith le
ad d
ust i
n th
eir m
outh
s, th
ey c
an b
ecom
e le
ad p
oiso
ned.
In a
dditi
on, t
hey
spen
d a
lot o
f tim
e on
the
floor
whe
re so
urce
s of l
ead
are
likel
y to
be
foun
d. Y
oung
chi
ldre
n al
so
abso
rb le
ad m
ore
easi
ly th
an a
dults
. Lea
d po
ison
ed c
hild
ren
may
suff
er li
fe-lo
ng p
robl
ems a
s a
resu
lt of
thei
r exp
osur
e at
a y
oung
age
.
Whe
re d
o le
ad h
azar
ds c
ome
from
?
Pain
tLe
ad w
as u
sed
in p
aint
unt
il 19
78 w
hen
its u
se w
as li
mite
d in
hou
seho
ld p
aint
. Man
ybu
ildin
gs b
uilt
befo
re 1
978
have
lead
-bas
ed p
aint
insi
de a
nd o
utsi
de. N
atio
nwid
e, le
ad re
mai
ns in
app
roxi
mat
ely
74 %
of a
ll ho
usin
g bu
ilt b
efor
e 19
78 (H
ousi
ng a
nd U
rban
Dev
elop
men
t). H
ousi
ng b
uilt
befo
re
1950
is m
ore
likel
y to
con
tain
lead
-bas
ed p
aint
. Lea
d pa
int i
n go
od c
ondi
tion
is n
ot u
sual
ly a
pr
oble
m e
xcep
t in
plac
es w
here
pai
nted
surf
aces
rub
agai
nst e
ach
othe
r and
cre
ate
dust
, suc
h as
w
here
win
dow
s ope
n an
d cl
ose.
Chi
ppin
g, p
eelin
g or
cha
lkin
g le
ad p
aint
is a
com
mon
sour
ce o
f le
ad d
ust a
nd m
ay b
e a
haza
rd. L
ead-
base
d pa
int m
ay a
lso
be fo
und
on o
lder
toys
, fur
nitu
re a
nd
play
grou
nd e
quip
men
t.
Lea
d Po
ison
ing
Prev
entio
n Pr
ogra
m
800
NE
Ore
gon
St.,
Suite
608
Po
rtlan
d, O
R 9
7232
(9
71) 6
73-0
440
oreg
on d
epar
tmen
t of h
uman
ser
vice
s
2
Dust
Lead dust is the main cause of lead poisoning in children. W
indows, doors, steps and porches are
areas where surfaces rub together and create lead dust. Lead dust can gather on floors, in carpets, on
toys and other objects that children may put into their m
ouths. Lead dust is increased during rem
odeling or repainting. Hom
e renovations and remodeling contribute to nearly half of the
childhood lead poisonings in Oregon.
Lead dust, which you can't alw
ays see can be a serious health hazard to young children.
SoilSoil and dirt around hom
es and apartment buildings m
ay contain lead. Soil may contain lead from
lead-based paint or from
exhaust fumes from
cars. Children m
ay come into contact w
ith lead by playing in bare dirt. Lead in the soil m
ay enter vegetables planted in the garden. Outside play areas
and food gardens should be located away from
houses and buildings and away from
areas that could be contam
inated by heavy car traffic.
Pottery Im
ported, old, handmade or poorly glazed ceram
ic dishes and pottery may have lead in the glaze.
Lead may also be found in leaded crystal, pew
ter and brass dishware. A
cidic foods stored in im
properly glazed containers are the most dangerous. A
cidic foods or drinks (such as orange, tom
ato and other fruit juices, tomato sauces, w
ines, and vinegar) may cause an increase in the
release of lead from these types of tablew
are. You cannot alw
ays tell by looking at a dish whether it
contains lead. The only way to know
for sure is to test or have the tableware tested for lead. If it is
not known w
hether or not a particular tableware item
contains lead, the item should not be used to
store, cook or serve food or beverages. If any tableware starts to show
a dusty or chalky gray residue after w
ashing, discontinue using the item. Purchase dishes w
ith labels that state the item is
lead-free or suitable for food use.
Workplaces &
Hobbies
Lead can also be brought into the home from
the workplace or hobbies. W
elding, auto or boat repair, the m
aking of ceramics, stained glass, bullets, and fishing w
eights are hobbies that may use
lead. Other hobbies that carry a potential for exposure to lead include furniture refinishing, hom
e rem
odeling, painting and target shooting at firing ranges. By follow
ing a few sim
ple precautions, hobbyists can reduce the risk of exposure to lead and protect them
selves and their families. People
who w
ork in a lead environment m
ay bring lead dust into their car or home on their clothes and
bodies exposing family m
embers. G
ood hygiene needs to be observed to avoid bringing lead dust into the hom
e from the w
ork place.
Water Pipes &
SolderM
ost well or city w
ater does not naturally contain lead. Lead in drinking water is not a com
mon
source of lead poisoning in Oregon. Lead m
ay get into drinking water from
household plumbing.
Lead solder that connects the pipes or brass faucets may contain lead. Lead from
solder is most
comm
only found in homes built betw
een 1970 and 1985. Lead may get into the w
ater when w
ater sits in pipes. If this happens, the w
ater you use for drinking, cooking or mixing baby form
ula can cause lead poisoning. If lead in plum
bing is suspected, water from
a hot water tap should not be
used for drinking or food preparation. The cold-water tap should be flushed for several m
inutes each m
orning or after sitting until there is a noticeable change in temperature of the w
ater before any w
ater is consumed.
3
Food
In re
cent
yea
rs, l
ead
has b
een
foun
d in
can
dy im
porte
d fr
om M
exic
o. L
abor
ator
y te
stin
g do
ne in
C
alifo
rnia
foun
d le
ad in
som
e M
exic
an c
andy
, the
wra
pper
s and
the
clay
pot
s tha
t som
e of
the
cand
y co
mes
in.
Hom
e R
emed
ies
& C
osm
etic
s So
me
fam
ilies
may
use
hom
e re
med
ies t
o cu
re si
ck p
eopl
e. M
any
hom
e re
med
ies m
ay c
onta
in u
p to
10
0% le
ad a
nd a
re v
ery
dang
erou
s to
child
ren.
Aza
rcon
, a b
right
ora
nge
pow
der,
and
Gre
ta, a
ye
llow
pow
der,
may
be
used
in th
e H
ispa
nic
com
mun
ity fo
r ind
iges
tion
or u
pset
stom
ach.
Sim
ilar
rem
edie
s are
kno
wn
as L
iga,
Ala
rcon
, Rue
da, M
aria
Lui
sa, C
oral
, and
Alb
ayal
de. P
ay-lo
o-ah
, G
hasa
rd, B
ali G
oli,
and
Kan
du a
re re
med
ies c
onta
inin
g le
ad th
at m
ay b
e us
ed in
som
e A
sian
co
mm
uniti
es. C
erta
in c
osm
etic
s, es
peci
ally
thos
e fr
om th
e M
iddl
e Ea
st, I
ndia
, and
Asi
a, m
ay a
lso
cont
ain
high
leve
ls o
f lea
d. C
osm
etic
s kno
wn
to c
onta
in le
ad a
re K
ohl,
Sum
a, a
nd C
eris
e. T
hese
are
co
mm
only
use
d as
eye
liner
. Koh
l (or
alk
ohl),
whi
ch is
use
d in
Mid
dle
East
ern
and
East
Indi
an
cultu
res,
is a
lso
appl
ied
to sk
in in
fect
ions
. Man
ufac
ture
d co
smet
ics g
ener
ally
do
not c
onta
in le
ad.
LEA
D P
OIS
ON
ING
AN
D C
HIL
DR
EN
How
can
my
child
be
expo
sed
to le
ad?
Mos
t chi
ldre
n ar
e ex
pose
d to
lead
from
hou
seho
ld d
ust c
onta
inin
g le
ad fr
om le
ad-b
ased
pai
nt.
Prio
r to
1978
, and
esp
ecia
lly b
efor
e 19
50, l
ead
was
a c
omm
on a
dditi
ve to
hou
se p
aint
. Hom
es
pain
ted
with
lead
-bas
ed p
aint
are
an
ongo
ing
risk
as p
aint
ed su
rfac
es b
reak
dow
n ov
er ti
me
and
whe
n pa
int i
s dis
turb
ed in
rem
odel
ing
by sa
ndin
g an
d sc
rapi
ng. W
indo
ws,
door
s, st
eps a
nd p
orch
es
are
area
s whe
re su
rfac
es m
ay ru
b to
geth
er a
nd m
ake
lead
dus
t.
Lead
-bas
ed p
aint
can
als
o be
foun
d in
soil
arou
nd h
omes
as a
resu
lt of
pee
ling
and
chip
ping
pai
nt
and
rem
odel
ing
activ
ities
, suc
h as
sand
ing
and
scra
ping
of p
aint
. Soi
ls n
ear r
oads
may
con
tain
lead
du
st fr
om a
utom
obile
exh
aust
dep
osite
d be
fore
lead
ed g
asol
ine
was
pha
sed
out.
Peop
le tr
ack
this
so
il in
to h
omes
whe
re c
hild
ren
play
on
the
floor
, and
som
etim
es c
hild
ren
play
in b
are
soil
cont
amin
ated
with
lead
.
Lead
can
als
o be
foun
d in
lead
pip
es o
r sol
der,
impo
rted
or o
lder
cer
amic
s and
pot
tery
, cer
tain
ho
bbie
s, an
d fo
lk m
edic
ines
. Par
ents
who
wor
k in
lead
-rel
ated
indu
strie
s can
brin
g le
ad h
ome
on
thei
r clo
thin
g, e
xpos
ing
child
ren
to th
e ha
zard
.
Hom
e re
nova
tions
and
rem
odel
ing
cont
ribut
e to
nea
rly
half
of th
e ch
ildho
od le
ad p
oiso
ning
s in
Ore
gon
Wha
t are
sym
ptom
s of
lead
poi
soni
ng in
chi
ldre
n?
Sign
s of l
ead
pois
onin
g ar
e no
t alw
ays e
asy
to se
e. C
hild
ren
can
be p
oiso
ned
by le
ad a
nd
may
not
look
or a
ct si
ck. M
any
child
ren
who
are
lead
poi
sone
d lo
ok a
nd a
ct h
ealth
y.
Som
etim
es th
e va
gue
sym
ptom
s may
be
mis
take
n fo
r oth
er il
lnes
ses s
uch
as st
omac
h up
set
or fl
u. B
ecau
se o
f thi
s, le
ad p
oiso
ning
may
go
unre
cogn
ized
. A b
lood
lead
test
is th
e on
ly
way
to fi
nd o
ut if
a c
hild
has
lead
poi
soni
ng.
4
Some possible signs and sym
ptoms of lead poisoning in children are:
Tiredness or loss of energy H
yperactivityR
educed attention spanIrritability or crankiness Poor appetite W
eight loss Trouble sleeping C
onstipationA
ches or pains in stomach
How
can lead poisoning affect my child?
Children can get lead in their bodies by sw
allowing or breathing in dust that contains lead. Lead is a
poison that affects every organ and system in the body. There is no function or need for lead. V
ery high levels of lead exposure can cause com
a, seizures and death.Even a little lead can make
children slower learners. Exposure to lead can cause:
Brain dam
age and lower intelligence
Behavior and learning problem
s Im
paired speech and language Slow
ed growth
Kidney and liver dam
age H
earing damage
The effects of lead on a child can be perm
anent and irreversible.
How
can I find out if my child has been exposed to lead?
Your health care provider w
ill ask you some questions to see if your child is at risk for lead
poisoning. The only way to know
for sure if your child has been exposed to lead is to have their blood tested. B
lood tests are used to find out how m
uch lead is in a child’s blood. The test is simple.
A health care provider takes blood from
your child and a lab will test the blood.
Is my child at risk for lead poisoning?
A “yes” or “I don’t know
” answer to any of the eight follow
ing questions means that your
child could be at risk for lead poisoning and should have a blood lead test.
Does your child live in or regularly visit a hom
e, child care, or other building built before 1950? (C
all your county tax assessor if you do not know w
hen your home w
as built).
During the past 6 m
onths has your child lived in or regularly visited a home, child care, or other
building built before 1980 with recent or ongoing painting, repair, rem
odeling, or damage?
5
Doe
s you
r chi
ld h
ave
a br
othe
r, si
ster
, oth
er re
lativ
e, h
ouse
mat
e or
pla
ymat
e w
ith le
ad
pois
onin
g?
Doe
s you
r chi
ld sp
end
time
with
an
adul
t tha
t has
a jo
b or
hob
by w
here
they
may
wor
k w
ith
lead
(suc
h as
pai
ntin
g, re
mod
elin
g, a
uto
radi
ator
s,ba
tterie
s, au
to re
pair,
sold
erin
g, m
akin
g si
nker
s, bu
llets
, sta
ined
gla
ss, p
otte
ry, g
oing
to sh
ootin
g ra
nges
, hun
ting
or fi
shin
g)?
Do
you
have
pot
tery
or c
eram
ics m
ade
in o
ther
cou
ntrie
s or l
ead
crys
tal o
r pew
ter t
hat a
re u
sed
for c
ooki
ng, s
torin
g or
serv
ing
food
or d
rink?
Has
you
r chi
ld e
ver u
sed
any
tradi
tiona
l, im
porte
d or
hom
ere
med
ies o
r cos
met
ics s
uch
as
Aza
rcon
, Ala
rcon
, Gre
ta, R
ueda
, Pay
-loo-
ah, o
r Koh
l?
Has
you
r chi
ld b
een
adop
ted
from
, liv
ed in
or v
isite
d a
fore
ign
coun
try in
the
last
6 m
onth
s?
Do
you
have
con
cern
s abo
ut y
our c
hild
’s d
evel
opm
ent?
Wha
t doe
s m
y ch
ild’s
lead
test
mea
n?
The
amou
nt o
f lea
d fo
und
in a
chi
ld’s
blo
od is
cal
led
a bl
ood
lead
leve
l. B
lood
lead
test
s tel
l how
m
any
mic
rogr
ams (
mill
iont
h of
a g
ram
) of l
ead
are
in e
ach
deci
liter
(ten
th o
f a li
ter)
of a
chi
ld’s
bl
ood
(µg/
dl).
A b
lood
lead
leve
l will
tell
if a
child
has
bee
n ex
pose
d to
lead
in th
e la
st 3
-4 m
onth
s.
To fi
nd o
ut h
ow m
uch
lead
is in
a c
hild
’s b
lood
, a sm
all a
mou
nt o
f blo
od is
take
n fr
om a
chi
ld’s
ar
m, f
inge
r or h
eel.
Taki
ng b
lood
from
a c
hild
’s fi
nger
or h
eel i
s cal
led
a fin
ger o
r hee
l-stic
k or
a
capi
llary
test
. Som
etim
es th
e bl
ood
from
a c
apill
ary
test
may
be
cont
amin
ated
by
a sm
all a
mou
nt o
f le
ad o
n th
e ch
ild’s
han
d or
foot
. Thi
s may
cau
se a
n in
accu
rate
or f
alse
ele
vate
d te
st re
sult.
Blo
od
take
n fr
om a
n ar
m v
ein
(ven
ous b
lood
test
) is a
mor
e re
liabl
e te
st.
Is le
ad p
oiso
ning
pre
vent
able
?
Lead
poi
soni
ng is
pre
vent
able
if h
azar
ds a
re d
etec
ted
and
rem
oved
. The
war
ning
sign
s of l
ead
pois
onin
g ar
e no
t alw
ays n
otic
eabl
e, so
par
ents
nee
d to
car
eful
ly c
heck
thei
r chi
ld’s
env
ironm
ent f
or
poss
ible
sour
ces o
f lea
d. P
aren
ts c
an h
elp
prot
ect t
heir
child
ren
from
lead
poi
soni
ng b
y re
duci
ng
expo
sure
to le
ad in
the
envi
ronm
ent,
and
by p
rom
otin
g go
od n
utrit
ion
and
heal
thy
habi
ts.
How
can
I pr
otec
t my
child
?
Find
out
whe
n yo
ur h
ome
was
bui
lt. H
omes
bui
lt be
fore
197
8 m
ay h
ave
been
pai
nted
with
lead
-ba
sed
pain
t.
Freq
uent
ly in
spec
t you
r hom
e fo
r sig
ns o
f chi
ppin
g, p
eelin
g or
det
erio
ratin
g pa
int.
Cle
an u
p pa
int c
hips
imm
edia
tely
and
kee
p pa
int i
n go
od c
ondi
tion.
Loo
k fo
r pai
nted
are
as w
here
surf
aces
m
ay ru
b to
geth
er a
nd c
reat
e le
ad d
ust.
Use
lead
-saf
e w
ork
prac
tices
or h
ire a
lead
-saf
e pr
ofes
sion
al fo
r mai
nten
ance
, ren
ovat
ions
, pa
intin
g an
d re
pair.
Cle
an a
reas
whe
re c
hild
ren
play
. Reg
ular
ly w
et-w
ipe
floor
s, w
indo
wsi
lls, p
orch
es a
nd o
ther
su
rfac
es to
rem
ove
lead
dus
t. C
aref
ully
cle
an fr
ictio
n or
impa
ct su
rfac
es su
ch a
s win
dow
s, do
ors,
and
cabi
nets
.
6
Wash children’s hands often, especially before m
eals and after playing outside.
Wash toys, stuffed anim
als, bottles and pacifiers often to remove lead dust.
Clean or rem
ove shoes before entering the home to avoid tracking in soil that m
ay contain lead.
Have children play on grass instead of bare soil. Provide a sandbox w
ith lead-free sand.
Inspect painted playground equipment for peeling or chipping paint.
Only use non-toxic art supplies.
Use cold w
ater for drinking, cooking, or making baby form
ula. Run the w
ater for 15-30 seconds until it feels noticeably colder.
Do not use im
ported, old or handmade pottery to cook, store or serve food or drinks.
Do not use hom
e remedies or cosm
etics that may contain lead.
Don’t bring lead dust from
hobbies or work places into the hom
e. If you work w
ith lead in your job or hobby, change clothes and show
er before you go home or into your vehicle. If possible
wash w
ork clothes at work. If you m
ust wash the clothes at hom
e, carry them in a plastic bag
and then wash them
separately from those of other fam
ily mem
bers.
Provide regular healthy meals and snacks. M
eals or snacks high in iron, vitamin C
, and calcium
may help children absorb less lead.
If your child is at risk, have their blood tested for lead exposure.
How
can a healthy diet fight lead poisoning?
A w
ell-balanced diet is very important. C
hildren with em
pty stomachs absorb m
ore lead than children w
ith full stomachs. Provide your child w
ith four to six small healthy m
eals during the day. A
diet rich in calcium and iron can reduce the am
ount of lead a child absorbs. Eating foods with
vitamin C
helps increase the amount of iron in the blood. Eating a variety of foods as part of a w
ell-balanced diet helps a child grow
up healthy and strong.
HE
AL
TH
Y FO
OD
S TO
FIGH
T L
EA
D
Foods High in
Calcium
Foods High in
IronFoods H
igh in V
itamin C
Milk
Yogurt
Cheese
TofuG
reen leafy vegetables(spinach, kale, broccoli)
Lean red meat
Fish and chicken D
ried beans and peasTofuR
aisins, prunes Iron fortified cereal
Oranges/or juice
Grapefruit/or juice
Tomatoes/ or juice
Strawberries
Broccoli
Brussels sprouts
7
LEA
D P
OIS
ON
ING
AN
D A
DU
LTS
How
are
adu
lts e
xpos
ed to
lead
?
Adu
lt le
ad p
oiso
ning
com
mon
ly o
ccur
s fro
m e
xpos
ure
to le
ad u
sed
in th
e w
orkp
lace
. Wor
kers
may
in
hale
lead
dus
t and
fum
es d
irect
ly, o
r sw
allo
w le
ad d
ust w
hile
eat
ing,
drin
king
, or s
mok
ing
on-th
e-jo
b. A
dults
can
als
o be
exp
osed
dur
ing
certa
in h
obbi
es a
nd a
ctiv
ities
whe
re le
ad is
use
d.
Adultscanbeexposedtoleadiftheyw
orkin:
Pain
ting,
rem
odel
ing
or re
nova
tion
Rad
iato
r, ba
ttery
or a
utom
otiv
e re
pair
Cer
amic
s mak
ing
and
glaz
e m
ixin
g
Sold
erin
g or
cut
ting
met
al
Brid
ge c
onst
ruct
ion
and
repa
ir
Jew
elry
mak
ing
Dem
oliti
on o
f old
bui
ldin
gs
Foun
drie
s and
scra
p m
etal
ope
ratio
ns
Adultscanbeexposedtoleadiftheyhavethefollowing
hobb
ies:
Usi
ng a
nd m
akin
g/m
eltin
g fis
hing
sink
ers
Mak
ing
bulle
ts o
r sho
otin
g in
indo
or fi
ring
rang
es
Wel
ding
, aut
o or
boa
t rep
air
Mak
ing
of c
eram
ics,
stai
ned
glas
s, or
jew
elry
Fu
rnitu
re re
finis
hing
, hom
e re
mod
elin
g or
pai
ntin
g
Peop
le w
ho w
ork
in le
ad re
late
d in
dust
ries o
r hav
e ho
bbie
s inv
olvi
ng le
ad m
ay b
ring
lead
dus
t int
o th
e ho
me
on th
eir c
loth
es a
nd b
odie
s exp
osin
g fa
mily
mem
bers
. Goo
d hy
gien
e ne
eds t
o be
obs
erve
d to
avo
id b
ringi
ng le
ad d
ust i
nto
the
hom
e fr
om th
e w
ork
plac
e. B
y fo
llow
ing
a fe
w si
mpl
e pr
ecau
tions
, hob
byis
ts c
an a
lso
redu
ce th
e ris
k of
exp
osur
e to
lead
and
pro
tect
them
selv
es a
nd th
eir
fam
ilies
.
Wha
t are
the
sym
ptom
s of
lead
poi
soni
ng in
adu
lts?
Peop
le w
ith h
igh
leve
ls o
f lea
d in
thei
r bod
ies o
ften
do n
ot se
em si
ck. T
he sy
mpt
oms t
hat
occu
r are
ver
y ge
nera
l and
can
hap
pen
for m
any
reas
ons.
Ove
rexp
osur
e to
lead
can
cau
se
serio
us d
amag
e ev
en if
the
pers
on h
as n
o sy
mpt
oms.
A b
lood
lead
test
is th
e on
ly w
ay to
fin
d ou
t if a
n ad
ult h
as le
ad p
oiso
ning
. Lea
d is
a p
ower
ful p
oiso
n th
at st
ays i
n yo
ur b
ody
a lo
ng ti
me.
It c
an b
uild
up
in y
our b
ody
to d
ange
rous
leve
ls e
ven
if yo
u ar
e ex
pose
d on
ly to
sm
all a
mou
nts o
f lea
d ov
er a
long
per
iod.
An
elev
ated
blo
od le
ad le
vel s
how
s tha
t lea
d is
bu
ildin
g up
in y
our b
ody
fast
er th
an it
can
be
elim
inat
ed.
8
Signs or symptom
s that may be related to over-exposure to lead:
Tiredness or weakness
IrritabilityTrouble sleeping H
eadacheD
ifficulty concentrating A
ches or pains in stomach
Loss of appetite C
onstipationN
auseaW
eight loss
How
does lead affect adults?
Impotency
Brain and nervous system
damage
High blood pressure
Digestive problem
sK
idney problems
Anem
ia R
eproductive system problem
s H
earing, vision and muscle coordination problem
s
How
can I protect my fam
ily and myself?
Do not eat, sm
oke or drink when you are w
orking. Before breaks or eating, w
ash your hands and face to avoid sw
allowing lead dust.
Keep your w
ork area clean using wet cleaning m
ethods or a vacuum w
ith a high efficiency (H
EPA) filter. D
o not dry sweep or use com
pressed air to remove lead dust.
Store your street clothes in your locker. Change out of your w
ork clothes and shoes before going hom
e.
Shower and change into clean clothes and shoes before you leave your w
orkplace or hobby area.
If you wash your ow
n work clothes, w
ash them separately from
those of other family
mem
bers.
Keep your car or vehicle free of lead dust and contam
ination.
Keep children out of w
ork and hobby areas.
If you work w
ith lead, follow the health and safety instructions given in your w
orkplace.
If you are provided with a respirator, use it and clean it after use. M
ake sure you understand how
to check to see that it fits correctly and is working properly.
If you work w
ith lead in your job or hobby, get a blood lead test.
9
How
can
I le
arn
mor
e ab
out l
ead
in th
e w
orkp
lace
?
Ore
gon
offic
e of
Occ
upat
iona
l Hea
lth a
nd S
afet
y A
dmin
istra
tion
(OR
-OSH
A) r
ules
requ
ire
that
em
ploy
ers p
rote
ct w
orke
rs o
n th
e jo
b fr
om th
e ha
zard
s of l
ead.
The
se re
quire
men
ts
cove
r not
onl
y w
orke
rs d
irect
ly e
ngag
ed in
lead
-rel
ated
jobs
, but
als
o an
y w
orke
rs a
llied
w
ith o
r sup
porti
ng th
em (e
.g.,
offic
e st
aff)
or w
ho m
ay b
e af
fect
ed b
y th
e ac
tiviti
es o
f the
w
orke
rs, s
uch
as e
mpl
oyee
s wor
king
in a
bui
ldin
g be
ing
reno
vate
d.
For m
ore
info
rmat
ion
abou
t lea
d in
the
wor
kpla
ce a
nd O
SHA
’s le
ad st
anda
rds a
nd re
gula
tions
co
ntac
t Ore
gon
Occ
upat
iona
l Hea
lth a
nd S
afet
y A
dmin
istra
tion
(OR
-OSH
A) t
ollfr
ee a
t (80
0) 9
22-
2689
or o
n th
eir w
ebsi
te a
t ww
w.o
rosh
a.or
g
MA
INTA
ININ
G A
LEA
D-S
AFE
HO
ME
I liv
e in
an
olde
r hom
e ar
e m
y ch
ildre
n at
risk
?
In g
ener
al, t
he o
lder
the
hom
e th
e m
ore
likel
y bo
th th
e in
terio
r and
the
exte
rior w
ere
pain
ted
with
le
ad p
aint
.. Th
is is
esp
ecia
lly tr
ue fo
r hom
es b
uilt
prio
r to1
950,
but
lead
-bas
ed p
aint
s wer
e w
idel
y us
ed u
p to
the
time
they
wer
e ba
nned
for r
esid
entia
l pur
pose
s in
1978
. Als
o, th
e pr
esen
ce o
f lea
d pa
int d
oes n
ot n
eces
saril
y m
ean
that
it p
rese
nts a
haz
ard.
To
pres
ent a
hea
lth th
reat
, it m
ust
som
ehow
ent
er th
e bo
dy. P
aint
that
is w
ell c
ared
for g
ener
ally
doe
s not
pos
e a
dang
er. H
owev
er,
even
in w
ell-m
aint
aine
d ho
mes
, fric
tion
and
impa
ct su
rfac
es, s
uch
as d
oor j
ambs
or s
lidin
g w
idow
s, ca
n cr
eate
fine
lead
dus
t tha
t can
be
inha
led
or sw
allo
wed
.
How
can
I te
ll if
lead
is a
haz
ard
in m
y ho
me?
The
sure
st m
etho
d is
to u
se th
e se
rvic
es o
f a c
ertif
ied
lead
-bas
ed p
aint
insp
ecto
r or a
risk
ass
esso
r. A
n in
spec
tor c
an te
ll yo
u if
ther
e is
lead
in th
e ho
me;
a ri
sk a
sses
sor c
an te
ll yo
u th
e ex
tent
of t
he
haza
rd. H
ome
test
kits
for l
ead
are
avai
labl
e, b
ut m
ay n
ot a
lway
s be
accu
rate
. Con
sum
ers s
houl
d no
t re
ly o
n th
ese
kits
to d
eter
min
e if
lead
is a
haz
ard
in th
eir h
ome.
The
hom
e te
st k
it ca
n on
ly te
ll yo
u if
lead
is p
rese
nt o
n a
surf
ace.
It c
anno
t tel
l you
how
muc
h le
ad th
ere
is, i
f the
re is
a le
ad p
aint
ha
zard
, or w
hat n
eeds
to b
e do
ne to
repa
ir th
e ha
zard
.
How
can
I sa
fely
rem
odel
or p
aint
my
hom
e?
Han
dle
with
car
e. O
nce
rele
ased
into
the
envi
ronm
ent,
lead
doe
sn't
brea
k do
wn,
and
its d
ust
can
be in
visi
ble
to th
e ey
e an
d st
ill c
ause
lead
poi
soni
ng. W
heth
er y
ou a
re p
lann
ing
to d
o th
e w
ork
your
self,
or t
o hi
re a
pro
fess
iona
l, it
is im
porta
nt th
at y
ou e
duca
te y
ours
elf a
bout
how
'le
ad-s
afe'
rem
odel
ing
can
be d
one.
The
LB
PP h
as se
vera
l pub
licat
ions
on
lead
-saf
e re
mod
elin
g fo
r do-
it-yo
urse
lfers
, pro
perty
ow
ners
, pro
perty
man
ager
s, an
d pr
ofes
sion
als.
If
you
are
goin
g to
hire
a p
rofe
ssio
nal p
aint
er o
r rem
odel
er, a
sk th
e co
ntra
ctor
bef
ore
the
wor
k st
arts
wha
t he
or sh
e kn
ows a
bout
lead
-saf
e w
ork
prac
tices
and
the
step
s tha
t he
or sh
e pl
an
to ta
ke to
redu
ce o
r elim
inat
e le
ad-b
ased
pai
nt h
azar
ds d
urin
g th
e jo
b. T
he L
ead-
Bas
ed P
aint
Pr
ogra
m c
an su
pply
you
with
a b
roch
ure
that
list
s the
que
stio
ns y
ou n
eed
to a
sk a
rem
odel
er
or p
aint
er to
ens
ure
that
they
hav
e th
e pr
oper
trai
ning
to p
rote
ct y
our f
amily
and
hom
e. A
ny
pers
on re
mov
ing
or st
abili
zing
pai
nt o
n ho
usin
g or
chi
ld c
are
setti
ngs b
uilt
befo
re 1
978
mus
t al
so h
ave
a Le
ad-B
ased
Pai
nt P
erm
it fr
om th
e Le
ad-B
ased
Pai
nt P
rogr
am (L
BPP
).
10
What kind of professional lead paint services are available in O
regon?
There are several types of services available. The Lead-Based Paint Program
(LBPP) certifies lead-
based paint Inspectors, Risk A
ssessors, Supervisors, Project Managers, and W
orkers. LBPP can
provide you with a List of C
ertified Lead-Based Paint Professionals. These professionals are trained
in abatement, w
hich means they can perm
anently remove lead hazards from
a property.
What if m
y neighbor’s home is being professionally painted and paint
chips and dust are getting in my yard and hom
e?
Any professional rem
oving or stabilizing (painting/remodeling) lead-based paint m
ust: (1) O
btain a Lead-Based Paint Perm
it; (2) U
se lead-safe work practices and
(3) Post a sign visible from 30 feet, w
arning the public of possible lead-based paint hazards.
The Lead-Based Paint Program
regulates these professionals and actively enforces violations of unsafe w
ork practices. Program staff follow
up on all tips and complaints. To file a com
plaint call the Lead-B
ased Paint Program at (971) 673-0440 or the LeadLine a toll-free phone service at
1-800-368-5060. You can also subm
it a compliant on our w
ebsite at ww
w.healthoregon.org/lead.
The Lead-Based Paint Program
can provide a list of certified lead inspectorsand risk assessors, if
you need to test for lead contamination in your hom
e or in the soil. A list of certified specialists in
cleaning up lead contamination is also available.
What if I live in an older rental property?
When you rent a property built before 1978 the landlord is required to have you sign a standard
Disclosure form
, as required under Federal law. The landlord is also required to give you a
pamphlet entitled "Protect Y
our Family from
Lead in Your H
ome". A
ccording to the Federal law,
the landlord is only required to disclose to you any knowledge that he or she has of lead-based paint
(LBP) in the house. If he/she has no know
ledge of LBP, he/she is not required to conduct an
inspection or make a special effort to find out if lead based paint is present. The only obligation is to
disclose current knowledge.
Lead-based paint is usually not a hazard if it is in good condition and is not on a window
, door, or other area w
here the surfaces may rub together and create lead dust. C
hipping, peeling, cracking or dam
aged paint is a hazard and needs attention. If you see any chipping paint or other lead paint hazards, notify your landlord.
Where can I get m
ore information?
For more inform
ation about lead poisoning prevention and lead-safe work practices contact the
Lead Poisoning Prevention Program:
Phone: 971-673-0440
Toll free: 1-800-368-5060
Website: w
ww
.healthoregon.org/lead
Ore
gon
Lea
d Po
ison
ing
Prev
entio
n Pr
ogra
m
80
0 N
E O
rego
n St
., Su
ite 6
40
Port
land
, OR
972
32
Tel
epho
ne: 9
71-6
73-0
440
Fax:
971
-673
-045
7 w
ww
.hea
lthor
egon
.org
/lead
Und
erst
andi
ng Y
our
Chi
ld’s
Lea
d T
est
The
amou
nt o
f lea
d fo
und
in a
chi
ld’s
blo
od is
cal
led
a bl
ood
lead
leve
l. B
lood
lead
test
s te
ll ho
w
man
y m
icro
gram
s (m
illio
nth
of a
gra
m) o
f lea
d ar
e in
eac
h de
cilit
er (t
enth
of a
lite
r) o
f a c
hild
’s
bloo
d (µ
g/dl
). A
blo
od le
ad le
vel w
ill te
ll if
a ch
ild h
as b
een
expo
sed
to le
ad in
the
last
3-4
mon
ths.
To fi
nd o
ut h
ow m
uch
lead
is in
a c
hild
’s b
lood
, a s
mal
l am
ount
of b
lood
is ta
ken
from
a c
hild
’s a
rm,
finge
r or h
eel.
Taki
ng b
lood
from
a c
hild
’s fi
nger
or h
eel i
s ca
lled
a fin
ger o
r hee
l-stic
k or
a c
apill
ary
test
. Som
etim
es th
e bl
ood
from
a c
apill
ary
test
may
be
cont
amin
ated
by
a sm
all a
mou
nt o
f lea
d on
the
child
’s h
and
or fo
ot. T
his
may
cau
se a
n in
accu
rate
or f
alse
ele
vate
d te
st re
sult.
Blo
od ta
ken
from
an
arm
vei
n (v
enou
s bl
ood
test
) is
a m
ore
relia
ble
test
.
5-9
µg/d
l
If th
e bl
ood
was
take
n fr
om y
our c
hild
’s fi
nger
or h
eel i
t may
be
in th
is ra
nge
due
to c
onta
min
atio
n. If
th
e te
st w
as a
ven
ous
draw
it M
AY
be
a si
gn o
f rec
ent e
xpos
ure
to le
ad. A
t thi
s le
vel n
o m
edic
al
man
agem
ent i
s ne
eded
, but
par
ents
sho
uld
take
ste
ps to
iden
tify
poss
ible
sou
rces
of l
ead
in th
eir
child
’s e
nviro
nmen
t in
orde
r to
prev
ent a
ny fu
rther
exp
osur
e. T
here
is n
o to
tally
saf
e le
vel o
f lea
d fo
r ch
ildre
n. R
ecen
t res
earc
h ha
s sh
own
that
lead
leve
ls b
elow
10
µg/d
l can
low
er in
telli
genc
e. Y
ou
shou
ld k
eep
your
chi
ld a
way
from
lead
aro
und
the
hom
e an
d gi
ve y
our c
hild
hea
lthy
food
s. L
ead
abso
rptio
n is
incr
ease
d w
hen
ther
e is
not
eno
ugh
iron
or c
alci
um in
a c
hild
’s d
iet.
Serv
e fo
ods
high
in
calc
ium
, iro
n, a
nd v
itam
in C
and
low
in fa
t.
10-1
4 µg
/dl
Any
leve
l abo
ve te
n is
con
side
red
elev
ated
. If a
cap
illar
y te
st is
abo
ve te
n, a
ven
ous
bloo
d le
ad te
st
(fro
m a
n ar
m v
ein)
will
nee
d to
be
take
n w
ithin
3 m
onth
s to
con
firm
the
bloo
d le
ad le
vel.
Chi
ldre
n ca
n be
hur
t by
lead
and
may
not
look
or a
ct s
ick.
If th
e le
ad le
vel d
oesn
’t dr
op d
own,
chi
ldre
n ca
n ex
perie
nce
perm
anen
t hea
lth p
robl
ems.
Iden
tify
and
rem
ove
poss
ible
lead
haz
ards
and
feed
you
r ch
ild a
die
t tha
t will
hel
p pr
otec
t the
m fr
om le
ad. L
ead
abso
rptio
n is
incr
ease
d w
hen
ther
e is
not
en
ough
iron
or c
alci
um in
a c
hild
’s d
iet.
Serv
e fo
ods
high
in c
alci
um, i
ron,
and
vita
min
C a
nd lo
w in
fa
t. Y
our c
hild
will
nee
d an
othe
r blo
od te
st in
3 m
onth
s to
see
if th
e le
vel o
f lea
d ha
s lo
wer
ed.
15-1
9 µg
/dl
A le
vel o
f 15-
19 µ
g/dl
mea
ns th
ere
is a
gre
ater
risk
for p
robl
ems
with
gro
wth
and
lear
ning
. Chi
ldre
n ca
n be
hur
t by
lead
and
may
not
look
or a
ct s
ick.
If a
cap
illar
y te
st is
at t
his
leve
l, a
veno
us b
lood
lead
te
st (f
rom
an
arm
vei
n) w
ill n
eed
to b
e ta
ken
with
in 1
mon
th to
con
firm
the
bloo
d le
ad le
vel.
Sour
ces
of le
ad c
an b
e fo
und
in th
e ho
me,
sch
ool,
yard
or p
lace
s a
child
freq
uent
ly v
isits
. It i
s im
porta
nt to
id
entif
y an
d re
mov
e le
ad h
azar
ds. T
he lo
cal h
ealth
dep
artm
ent w
ill c
onta
ct y
ou a
nd s
ched
ule
a ho
me
visi
t to
help
you
iden
tify
lead
haz
ards
. Lea
d ab
sorp
tion
is in
crea
sed
whe
n th
ere
is n
ot e
noug
h iro
n or
ca
lciu
m in
a c
hild
’s d
iet.
Serv
e fo
ods
high
in c
alci
um, i
ron,
and
vita
min
C a
nd lo
w in
fat.
The
child
w
ill n
eed
anot
her b
lood
test
in 3
mon
ths
to s
ee if
the
leve
l of l
ead
has
low
ered
.
oreg
on d
epar
tmen
t of h
uman
ser
vice
s
Protect Your Child From Lead
No m
atter what the level of lead in your child’s blood, you should:
Learn about lead and its effects on children
Keep children aw
ay from lead around your hom
e
Wash children’s hands, pacifiers and toys often to rem
ove lead dust
Give your child healthy foods that w
ill help protect their bodies from lead
Talk to your medical provider about the next tim
e your child should have a lead test
Learn more about how
to prevent lead poisoning by calling:
Call the LeadLine
503-988-4000 Portland Metro A
rea 1-800-368-5060 Statew
ide
20-44 µg/dl
If a capillary test is at this level, a venous blood lead test (from an arm
vein) will need to be taken
within 1 w
eek to a month to confirm
the blood lead level. The higher the blood lead level on the screening or capillary test, the m
ore urgent the need for a confirmation test. A
child with a confirm
ed venous draw
in this range has a high lead level and needs to be seen by a doctor or health care provider for a m
edical exam. Sources of lead can be found in the hom
e, school, yard or places a child frequently visits. It is im
portant to identify and remove lead hazards. The county health departm
ent w
ill contact you and schedule a home visit to identify lead hazards. Lead hazards m
ust be found and reduced as quickly as possible. Lead absorption is increased w
hen there is not enough iron or calcium
in a child’s diet. Serve foods high in calcium, iron, and vitam
in C and low in fat. The child’s m
edical provider should be involved in helping bring this blood lead level dow
n by managing the child’s diet
and providing vitamin supplem
ents if needed. Your child w
ill need another blood test in 1 month to
see if the level of lead has lowered.
Above 45 µg/dl
If a capillary test is at this level, a venous blood lead test (from an arm
vein) will need to be taken
imm
ediately or within 48 hours to confirm
the blood lead level. The higher the blood lead level on the screening or capillary test, the m
ore urgent the need for a confirmation test. A
child with a
confirmed venous draw
in this range has a dangerous lead level and may need m
edical treatment.
Very high levels of lead can dam
age the brain and kidneys. Lead hazards in the child’s environment
must be found and elim
inated. The child’s medical provider should be involved in helping bring this
blood lead level down by m
anaging the child’s diet and providing vitamin supplem
ents if needed. Y
our child will need regular m
edical follow-up and re-testing to see if the level of lead has low
ered.
Com
mun
ity R
eso
urc
es
for
Le
ad P
reve
ntio
n
Jo
sia
h H
ill
Cli
nic
M
on
thly
Co
mm
un
ity B
ase
d C
linic
s w
ith f
ree
lea
d te
stin
g
h
ttp
://w
ww
.jhill
clin
ic.o
rg/s
che
du
le.h
tml
for
loca
tion
s a
nd s
ched
ule
Mu
ltn
om
ah
Co
un
ty H
ea
lth
De
pt.
– C
om
mu
nit
y I
mm
un
iza
tio
n C
lin
ic (
CIC
)
T
ue
sda
y a
nd
Thu
rsd
ay
9-1
1:3
0 A
M &
1-4
:30 P
M
5
329
NE
ML
Kin
g B
lvd
, P
ort
lan
d, O
R,
(503
) 98
8-3
81
6
F
ree
Lea
d T
est
ing f
or
child
ren
age
6 m
onth
s th
rou
gh
6 y
ea
rs o
f a
ge.
h
ttp
://w
ww
.mch
ea
lth.o
rg/im
mun
iza
tion
s/
Co
mm
un
ity E
ne
rgy P
roje
ct
4
22
NE
Alb
ert
a,
Po
rtla
nd
, O
R 9
72
11 (
50
3)
284
-68
27
L
ead
Safe
ty C
lass
es
h
ttp
://w
ww
.co
mm
un
itye
ne
rgyp
roje
ct.o
rg/
Le
ad
Lin
e (
50
3)
98
8-4
00
0
H
otli
ne
to
an
swe
r qu
est
ion
s ab
out
Le
ad P
ois
on
ing a
nd
Pre
ven
tion
Po
rtla
nd
Re
gio
nal
Le
ad
Ha
zard
Co
ntr
ol
Pro
gra
m
F
ina
nci
al A
ssis
tan
ce f
or
qu
alif
yin
g in
div
idu
als
to
re
du
ce le
ad
ha
zard
s in
the
h
om
e.
h
ttp
://w
ww
.pd
c.u
s/le
adh
aza
rd
4
Sources of Lead
Occupational
PaintersH
ome rem
odelers/renovators C
onstruction/demolition w
orkers B
ridge maintenance/repair
Auto body repairers/painters
Battery m
anufacturers/recyclers R
adiator repairers/manufacturing
Furniture refinishers Plum
bers, pipe fitters R
oofersLead m
iners, smelters, &
refiners G
lass, copper and brass manufacturers
Boat builders/painters/repair/m
aintenance C
eramics m
aking /glaze mixing
Printers (ink) Plastic &
rubber manufacturers
Police officers Firing range instructors Steel w
elders or cutters Jew
elry-making
Gas station attendants
Aircraft repair
X-ray shielding/film
radiology
Hobbies and R
elated Activities
Hom
e remodeling/renovation
Car or boat repair
Glazing/m
aking pottery R
eloading/target shooting at firing ranges Furniture refinishingM
aking/handling lead shot and fishing w
eights/sinkers U
sing lead soldering/welding
Oil painting (artistic)
Using pastel art pencils
Making stained glass
Jewelry m
aking U
sing/making diving &
exercise weights
Repairing old painted w
ooden or m
etal toys
Environm
ental/Other
Lead-based paint (pre-1978)
Soil/dust near lead industries, roadw
ays, lead-painted houses Plum
bing and solder C
osmetics &
hair dye Im
ported vinyl mini-blinds
Imported ceram
ic tiles for the kitchen/bathroom
B
uilding materials:
Gutters, flashing,
tile, window
glazing C
eramicw
are/glazed pottery Porcelain bathtubs Leaded glass/pew
ter Leaded gasoline (race, collector cars) Soldered seam
s-imported canned food
Soldered copper pipes Subm
ersible pumps in w
ells B
rass plumbing fixtures
Bronze, pew
ter, leaded crystal Electronics m
anufacturers PesticidesIm
ported crayons Storage batteries Plastic insulation on electrical w
iring and old telephone wiring
Candle w
icks
Ingested Sources
Traditional/home rem
edies ( Azarcon,
Greta, Pay-loo-ah, K
ohl, Ayurvedic).
See our website for a listing of other
home rem
edies that may contain lead.
Imported candy and candy w
rappers Supplem
ents (calcium)
For more on sources of lead or
preventing lead poisoning call971-673-0440.
Po
ss
ible
Le
ad
-Co
nta
inin
g H
om
e R
em
ed
ies
an
d C
os
me
tics
Re
gio
n o
f o
rig
inN
am
eA
pp
ea
ran
ce
Us
eM
isc
.
Me
xic
o
Aza
rco
n (
rue
da
, C
ora
l, m
aria
lu
isa
, A
larc
on
, L
iga
, lu
iga
)
Re
d/o
ran
ge
p
ow
de
r E
mpa
cho
(v
om
itin
g,
co
lic),
a
pa
thy,
leth
arg
y.
95
% lea
d
Me
xic
o
Grie
ta
Ye
llow
p
ow
de
r
Se
e a
bo
ve
.
97
% lea
d
Me
xic
o,
an
d
Ce
ntr
al A
me
rica
A
lba
ya
lde
or
alb
aya
idle
W
hite p
ow
de
r S
ee
ab
ove
.
93
% lea
d
Do
min
ican
R
ep
ub
lic
Lita
rgirio
Y
ello
w o
r p
ea
ch
-co
lore
d
po
wd
er
De
od
ora
nt,
fo
ot
fun
gic
ide
, bu
rn
tre
atm
ent
79
% lea
d.
So
ld in
2-
inch
by 3
-in
ch
cle
ar
pa
cke
ts.
La
os (
Hm
on
g)
Pa
y-lo
o-a
h (
als
o
kn
ow
n a
s
pe
jluam
or
Pe
Lua
)
Re
d p
ow
de
r G
ive
n f
or
rash
o
r fe
ve
r
90
% lea
d.
Asia
/Ind
ia
Gh
asa
rd
Bro
wn
p
ow
de
r
Giv
en
as a
n a
id
to d
ige
stio
n M
ay
be
giv
en
as a
d
aily
to
nic
.
2%
le
ad
.
Asia
/Ind
ia
Ba
li go
li R
ou
nd, fla
t,
bla
ck b
ea
n
Giv
en
to
tre
at
sto
ma
ch
ach
e
Dis
so
lve
d
in “
grip
e”
wa
ter.
A
sia
/Ind
ia
Ka
ndu
R
ed
po
wd
er
G
ive
n t
o t
reat
sto
ma
ch
ach
e
Asia
, In
dia
D
esh
i D
ew
a
F
ert
ility
pill
1
2%
lea
d.
Afr
ica
, A
sia
, In
dia
, P
akis
tan
, M
idd
le E
ast
Ko
hl (A
lkoh
l,
Tiro
, S
urm
a,
Sa
ott
)
Bla
ck p
ow
de
r C
osm
etic
astr
inge
nt fo
r e
ye
in
jurie
s,
skin
infe
ction
s
Tee
thin
g
po
wd
er.
U
se
d o
n
um
bili
ca
l stu
mp
of
ne
wb
orn
ch
ild.
Asia
C
hu
ifo
ng
toku
wa
n ?
Ch
ina
H
ai G
e F
en
(a
lso
kn
ow
n a
s S
ai
Me
i A
n).
Cla
msh
ell
po
wd
er.
G
ive
n t
o t
reat
sto
ma
ch
ach
e,
ulc
ers
or
mo
uth
so
res.
Bre
we
d in
te
a.
Re
gio
n o
f o
rigin
Na
me
Ap
pe
ara
nc
eU
se
Mis
c.
Ch
ina
Ju
Hu
a (fo
rme
rly
kn
ow
n a
s X
yo
o
Fa
).
Tea
, so
lutio
n,
pills
. G
ive
n to
treat
he
ad
ache
, feve
r, d
izzin
ess, &
sto
ma
ch
ach
e.
Ava
ilab
le
in
diffe
rent
form
s.
Ch
ina
L
itha
rge
(als
o
kn
ow
n a
s M
i Tu
o
Se
ng)
Gre
en
/red
p
ow
de
r. A
va
ilab
le in
d
iffere
nt fo
rms.
Co
nta
ins
lea
d
oxid
e.
Ch
ina
C
ord
yce
ps
H
erb
al m
ed
icin
e
trea
tme
nt fo
r h
yp
erte
nsio
n,
dia
bete
s,
ble
ed
ing.
Ch
ina
B
a B
ow
Se
n
H
yp
era
ctiv
ity &
n
igh
tma
res in
ch
ildre
n.
Ind
ia/P
akis
tan
K
ush
ta
D
ise
ase
s o
f the
h
art, b
rain
, live
r, sto
ma
ch
.
Als
o u
sed
as a
n
aphro
dis
iacs &
tonic
.
Ind
ia, P
akis
tan
, S
ri La
nka
, B
urm
a, B
hu
tan
, M
on
go
lia, T
ibe
t
Un
kn
ow
n
(Ayu
rve
dic
)
Me
tal-m
ine
ral
ton
ic, S
low
s
de
ve
lop
me
nt.
1.3
5-
72
,99
0
ug/g
of
lea
d p
er
ca
psu
le.
Mid
dle
Ea
st
An
zro
ot
G
astro
en
teritis
.
Mid
dle
Ea
st
Ce
ba
gin
Tee
thin
g p
ow
er
51
% le
ad
M
idd
le E
ast
He
nn
a H
air a
nd
skin
dye
.
Om
an
, Sa
ud
i A
rab
ia, In
dia
B
int a
l da
ha
b,
bin
t or b
ent
da
ha
b
D
i arrh
ea
, co
lic,
co
nstip
atio
n,
ge
ne
ral n
eo
nata
l u
se
.
98
% le
ad
Sa
ud
i Ara
bia
B
okh
oo
r (and
n
oqd
)
Wood a
nd
lea
d
su
lfide
bu
rned
on
ch
arc
oa
l to
pro
du
ce
ple
asa
nt
fum
es a
nd
ca
lm
infa
nts
S
au
di A
rab
ia
Al M
urra
h
C
olic
, sto
ma
ch
a
ch
es, d
iarrh
ea
. S
au
di A
rab
ia
Fa
rou
k &
S
an
trinj
T
ee
thin
g p
ow
de
r.
(Com
pile
d b
y th
e N
SW
Le
ad R
efe
rence
Cen
tre, 1
997
from
"Le
ad is
a S
ilent H
azard
", 199
4, p
p 1
54-
156 a
nd a
ssorte
d a
rticle
s in
the m
ed
ical lite
ratu
re)
KIDSLEAD POISONS
? Are YOUR KIDS at risk
DHS 8151 (7/05)
If you have trouble reading this and need this publication in large print oranother format, call 1-800-723-3638or visit our Web site at: http://www.healthoregon.org/lead
HOW CAN I Protect My Child?
Use only cold water for drinking, cooking or making baby formula. Run the water 15-30 seconds until it feels colder.
Do not use home remedies or cosmetics that may contain lead.
Do not use imported, old, or handmade pottery to cook, store or serve food or drinks.
If you work with lead in your job or hobby, change clothes and shower before you go home.
If your children are at risk, have their blood lead level tested.
Call the LEADLINE 1.800.368.5060
Portland Metro 503.988.4000
Find out when your home was built. Homes built before 1978 may have been painted with lead-based paint.
Inspect your home for signs of chipping, peeling or deteriorating paint.
Clean up paint chips immediately and keep paint in good condition.
Keep the places where children play clean and dust free. Regularly wet-wipe floors, window sills and other surfaces that may contain lead dust.
Use lead-safe work practices or hire a lead-safe professional for maintenance, renovations or repair.
Wash children’s hands often, especially before meals and after playing outside.
Wash toys, stuffed animals, bottles and pacifiers often to remove lead dust.
Clean or remove shoes before entering your home to avoid tracking in soil that may contain lead.
Have children play on grass instead of bare soil. Provide a sandbox with lead-free sand.
Provide meals high in iron, vitamin C, and calcium which help prevent young bodies from absorbing lead.
PAINT Paint used before 1978 could contain lead. If the paint is chipping, peeling or chalking it may be a problem. Windows, doors, steps and porches are areas where surfaces rub together and make lead dust.
DUST Lead dust is the main source of lead poisoning. Lead dust mixes with household dust and can gather on surfaces, in carpets and on toys. Home repairs and remodeling can create large amounts of lead dust if not done correctly.
SOIL & DIRT Soil around homes and apartment buildings may contain lead. Children may come into contact with lead by playing in bare dirt. Lead in the soil may enter vegetables planted in the garden.
WATER PIPES & SOLDER Some household plumbing may contain lead solder. Lead may get into the water when water sits in pipes. If this happens, the water you use for drinking, cooking or mixing baby formula can cause lead poisoning.
POTTERY, WORKPLACES & HOBBIES Some imported pottery and ceramic cookware may have lead in the glaze. Lead can also be brought into the home from the workplace (painters, remodelers, radiator repair, etc.) and hobbies (stained glass solder, bullets, fishing sinkers, etc.) that use lead.
WHERE DO DID YOU
Children can get lead in their bodies by breathing or swallowing dust that contains lead. Even small amounts can be harmful. Young children are especially at risk for lead poisoning because lead can slow growth and development. The effects of lead poisoning can be with a child throughout life.
Lead Poisoning Is Preventable
KNOW?
WHAT ARE The Signs Of Lead Poisoning?
Children can be hurt by lead and may not look or act sick. The danger is hard to see. The only way to know if your children have lead poisoning is to have their blood tested.
IS MY
Does your child live in or regularly visit a home, child care or other building built before 1950?
During the past 6 months has your child lived in or regularly visited a home, child care or other building built before 1980 with recent or ongoing painting, repair, remodeling or damage?
Does your child have a brother, sister, other relative, housemate or playmate with lead poisoning?
Does your child spend time with an adult that has a job or hobby where they may work with lead?
Do you have pottery or ceramics made in other countries or lead crystal or pewter that are used for cooking, storing or serving food or drink?
Has your child ever used any traditional, imported or home remedies or cosmetics such as Azarcon, Alarcon, Greta, Rueda, Pay-loo-ah or Kohl?
Has your child been adopted from, lived in or visited a foreign country in the last 6 months?
Do you have concerns about your child’s development?
If you answered yes to any of these questions, please ask your health If you answered yes to any of these questions, please ask your health If you answered yes to any of these
care provider for a blood lead test.questions, please ask your health care provider for a blood lead test.questions, please ask your health
HOW CAN Lead Poisoning Affect My Child?
Reading and learning problems
Lowered intelligence
Behavior problems
Brain damage
Slowed growth
Kidney and liver damage
Lead Hazards Come From? Child at Risk For Lead Poisioning?
E L P L O M OENVENENA A LOS
?¿EstánSUS HIJOS
Averigüe en qué año se construyó su vivienda. Las viviendas construidas antes de 1978 podrían haber sido pintadas con pinturas con base de plomo.
Inspeccione su vivienda para ver si la pintura se está descascarando, pelando o deteriorando.
Tire a la basura de inmediato la pintura que se desprenda y mantenga la pintura en buen estado.
Mantenga limpios y sin polvo los lugares en que juegan los niños. Con un paño húmedo limpie regularmente los pisos, los alféizares de las ventanas y otras superficies que puedan contener polvillo de plomo
Siga las prácticas laborales seguras con respecto al plomo o contrate a un profesional en seguridad con respecto al plomo para realizar el mantenimiento, renovaciones o reparaciones en su vivienda.
Lave las manos de sus hijos a menudo, sobre todo antes de los alimentos y después de jugar al aire libre
Lave los juguetes, animales de peluche, mamaderas (mamilas) y chupones a menudo para eliminar el polvillo de plomo.
Límpiense o quítense los zapatos antes de entrar a su vivienda para evitar arrastrar tierra que pueda contener plomo
Pida a sus hijos que jueguen en el césped y no en la tierra. Proporcióneles una caja de arena con arena que no contenga plomo.
Ofrézcales alimentos con un alto contenido de hierro, vitamina C y calcio para ayudar a evitar que los organismos jóvenes absorban plomo.
Utilice solamente agua fría para beber, cocinar o preparar la fórmula para bebé. Deje correr el agua entre 15 y 30 segundos hasta que la sienta más fría.
No use remedios caseros ni cosméticos que puedan contener plomo.
No use vasijas de barro importadas, viejas o hechas a mano para cocinar, guardar o servir alimentos y bebidas.
Si emplea plomo en su trabajo o pasatiempo, cámbiese la ropa y dúchese antes de irse a su casa.
Si sus hijos están en peligro, pida que se les analice el nivel de plomo en la sangre.
NIÑOS
Spanish DHS 8151 (7/04)
Si le es difícil leer esta información y necesita la publicación en letra grande u otro formato, llame al 1-800-723-3638.
¿Cómo puedo proteger a mi hijo?
Llame a la línea de ayuda LEADLINE
1.800.368.5060
Área metropolitana de Portland
503.988.4000
en peligro
¿Está mi hijoa riesgo de envenenarse con plomo?
PINTURA La pintura utilizada antes de 1978 puede contener plomo. Si se está agrietando o descascarando puede ser un problema. Las ventanas, las puertas, los escalones y los pórticos son áreas de fricción donde se forma polvo de plomo.
POLVO El polvo de plomo es la fuente principal del envenenamiento por plomo. Éste se mezcla con el polvo del hogar y puede acumularse encima de las superficies de los muebles, alfombras y juguetes. Las reparaciones y la remodelación de la vivienda pueden producir grandes cantidades de polvo de plomo si no se realizan debidamente.
TIERRA Y SUCIEDAD La tierra que rodea a las casas y edificios de apartamentos puede contener plomo. Los niños podrían entrar en contacto con el plomo al jugar sobre el suelo. El plomo de la tierra puede contaminar las verduras en el jardín.
CAÑOS DE AGUA Y SOLDADURAS En ciertas viviendas, las tuberías podrían contener soldaduras de plomo. El plomo puede disolverse en el agua cuando se estanca en las tuberías. Si eso sucede, el agua que se usa para beber, cocinar o mezclar la fórmula para bebé puede causar envenenamiento por plomo.
ALFARERÍA, LUGARES DE TRABAJO Y PASATIEMPOSAlgunas piezas de alfarería importada y de cerámica para cocinar pueden contener plomo en el barniz. El plomo también puede llevarse del lugar de trabajo (pintores, remodeladores, reparación de radiadores, etc.) y pasatiempos (soldaduras de vitrales, balas, plomadas de pesca, etc.) que usan plomo a la vivienda.
Los niños pueden absorber plomo en su organismo al respirar o tragar polvo que contiene plomo. Hasta las cantidades pequeñas son dañinas. El peligro es mayor en los niños más pequeños porque el plomo puede retardar el crecimiento y el desarrollo. Los efectos del envenenamiento por plomo pueden estar presentes por el resto de la vida del niño.
El envenenamiento por plomo se puede prevenir.
USTED?
Los niños pueden estar afectados por el plomo sin presentar síntomas o aparecer enfermos. El peligro es difícil de ver. La única manera de saber si su hijo está envenenado por plomo es mediante un análisis de sangre
¿Vive su hijo en una vivienda o visita regularmente una guardería u otro edificio que haya sido construido antes de 1950?
Durante los últimos 6 meses, ¿ha vivido su hijo o ha visitado regularmente una guardería u otro edificio que haya sido construido antes de 1980 que se haya pintado, reparado o remodelado recientemente o que esté en vías de serlo o que haya sufrido daños?
¿Tiene su hijo un hermano o hermana u otro pariente o persona que viva o que juegue con él que padezca de envenenamiento por plomo?
¿Pasa su hijo tiempo con una persona adulta que tiene un trabajo o un pasatiempo en el que quizá se trabaje con plomo?
¿Tiene usted vasijas de barro o artefactos de cerámica de otros países o de cristal de plomo o peltre que utilice para cocinar, guardar o servir alimentos y bebidas?
¿Ha utilizado su hijo alguna vez remedios tradicionales, importados o caseros tales como azarcón, alarcón, greta, rueda, pay-loo-ah o kohl?
¿Es su hijo adoptado, o ha vivido en otro país o ha viajado al extranjero en los últimos 6 meses?
¿Le preocupa el nivel de desarrollo de su hijo?
Si usted contestó afirmativamente a cualquiera de estas preguntas, pida a su médico que haga a su niño una prueba de plomo en sangre.
Problemas para leer y aprender
Menor inteligencia
Problemas de comportamiento
Daño cerebral
Crecimiento lento
Daño renal y hepático
¿SABÍA
¿CUÁLES SONlos síntomas del envenenamiento por plomo?
¿CÓMO PUEDEafectar a mi hijo el envenenamiento con plomo?
¿DE DÓNDEvienen los peligros del plomo?
?
, . , 1978,
.
,,
.
,.
,, .
,, .
,, ,, ,
.
,.
,,
, .
,,
.
, ., .
, C, ,
,. 15-30 ,
.
,.
,
,.
- ,
.
,.
Russian DHS 8151 (7/04)
,,
1-800-723-3638.
?
1.800.368.5060
503.988.4000
A , 1978 ,
. ,,
, – ., , –
,,
.
– .
,,
.,
,.
.
..
.
,. ,
,,
.
,
.
( ,, ,
, .)( ,
, , .).
?
,.
.,
.
.
?
?
.. ,
,, -
.
?
,,
1950?
6
, 1980 ,,
?
, ,,
,?
, ,?
,
,,
?
-- ,
Azarcon, Alarcon, Greta, Rueda, Pay-loo-ah Kohl?
,
6 ?
?
, ,
.
?
NHIEÃM ÑOÄC CHAÁT CHÌ
?CON EM
CUÛA QUYÙ VÒ COÙ NGUY CÔ BÒ NHIEÃM ÑOÄC CHAÁT CHÌ KHOÂNG
Tìm hieåu nhaø cuûa quyù vò ñaõ ñöôïc xaây caát naêm naøo. Nhaø laøm tröôùc naêm 1978 coù theå ñöôïc sôn loùt vôùi sôn coù chaát chì.
Kieåm tra nhaø cuûa quyù vò ñeå tìm nhöõng daáu hieäu troùc sôn ra töøng maûnh nhoû, bò loät ra hoaëc sôn xuoáng caáp.
Haõy doïn saïch nhöõng maûnh sôn ngay töùc khaéc vaø giöõ cho sôn ôû trong tình traïng toát.
Giöõ nhöõng nôi treû em chôi ñöôïc saïch seõ vaø khoâng coù buïi. Thöôøng xuyeân lau öôùt saøn nhaø, khung cöûa soå vaø nhöõng nôi khaùc coù theå coù buïi chì.
Thöïc haønh nhöõng coâng vieäc giöõ an toaøn veà chaát chì hoaëc möôùn moät ngöôøi chuyeân moân veà chaát chì ñeå baûo trì, taân trang hoaëc söûa chöõa nhaø.
Röûa tay cho treû em thöôøng xuyeân, ñaëc bieät tröôùc böõa aên vaø sau khi chôi beân ngoaøi nhaø.
Röûa saïch ñoà chôi, thuù nhoài boâng, chai loï vaø nuùm vuù giaû thöôøng xuyeân ñeå laøm saïch buïi chì.
Laøm saïch seõ giaøy hoaëc côûi giaøy ra tröôùc khi vaøo nhaø ñeå traùnh mang ñaát coù chaát chì vaøo nhaø.
Ñeå treû em chôi treân coû thay vì chôi treân ñaát traàn. Cung caáp moät thuøng caùt khoâng coù chaát chì.
Cung caáp nhöõng böõa aên coù nhieàu chaát saét, sinh toá C, vaø calcium ñeå giuùp baûo veä cô theå coøn non bò chaát chì xaâm nhaäp.
Chæ duøng nöôùc laïnh ñeå uoáng, naáu aên hoaëc pha söõa cho em beù. Cho nöôùc chaûy töø 15 ñeán 30 giaây ñoàng hoà cho ñeán khi thaáy nöôùc laïnh hôn.
Ñöøng söû duïng nhöõng thuoác hoaëc myõ phaåm noäi ñòa coù theå coù chaát chì.
Ñöøng söû duïng nhöõng ñoà goám nhaäp caûng, cuõ hoaëc laøm baèng tay ñeå naáu aên, toàn tröõ hoaëc ñöïng thöùc aên hay thöùc uoáng.
Neáu quyù vò laøm nhöõng coâng vieäc hoaëc sôû thích rieâng coù chaát chì, haõy taém röûa vaø thay quaàn aùo tröôùc khi veà nhaø.
Neáu con em cuûa quyù vò coù nguy cô nhieãm ñoäc chaát chì, haõy cho ñi thöû möùc ñoä chì trong maùu cuûa caùc em.
TREÛ EM
Vietnamese DHS 8151 (7/04)
Neáu quyù vò coù khoù khaên trong vieäc ñoïc nhöõng ñieàu naøy vaø muoán ñöôïc in treân khoå chöõ lôùn hôn hoaëc treân moät hình thöùc khaùc, haõy goïi ñieän thoaïi soá 1-800-723-3638.
LAØM THEÁ NAØO coù theå baûo veä cho con em cuûa toâi?
Goïi ñieän thoaïi cho LEADLINE1.800.368.5060
Portland vaø Vuøng Phuï Caän503.988.4000
SÔN Sôn söû duïng tröôùc naêm 1978 coù theå coù chöùa chaát chì. Neáu sôn bò troùc ra töøng mieáng nhoû, bò loät ra hoaëc ghi veät, ñoù coù theå laø moät vaán ñeà. Cöûa soå, cöûa ra vaøo, loái caùc baäc thang vaø coång vaøo laø nhöõng khu vöïc beà maët ñuïng chaïm vôùi nhau taïo ra nhöõng buïi chì.
BUÏI Buïi chì laø nguoàn chính cuûa söï nhieãm ñoäc chaát chì. Buïi chì hoøa chung vôùi buïi trong nhaø vaø coù theå ñoïng laïi treân maët baèng, treân thaûm vaø treân ñoà chôi. Söûa vaø taân trang, söûa chöõa nhaø cöûa coù theå gaây neân moät soá löôïng lôùn buïi chì, neáu laøm khoâng ñuùng caùch.
ÑAÁT VAØ BUÏI Ñaát ôû trong nhaø vaø chung cö coù theå coù chaát chì. Treû em coù theå tieáp xuùc vôùi chaát chì baèng caùch chôi ñuøa treân buïi ñaát. Chaát chì ôû trong ñaát coù theå ñi vaøo rau coû troàng trong vöôøn.
OÁNG NÖÔÙC VAØ HAØN Moät soá oáng nöôùc trong gia ñình coù theå coù chaát chì haøn. Chaát chì coù theå ñi vaøo nöôùc khi nöôùc ôû trong oáng. Neáu xaûy ra, nöôùc quyù vò söû duïng ñeå uoáng, naáu aên hoaëc pha söõa cho con coù theå nhieãm ñoäc chaát chì.
ÑOÀ GOÁM, NÔI LAØM VIEÄC, SÔÛ THÍCH Moät soá ñoà goám vaø ñoà naáu aên baèng saønh nhaäp caûng coù theå coù chaát chì trong nöôùc men traùng. Chaát chì cuõng coù theå mang vaøo trong nhaø töø nôi laøm vieäc (thôï sôn, ngöôøi taân trang nhaø cöûa, söûa chöõa bình nöôùc xe hôi vv.) vaø sôû thích (haøn kính môø, ñaàu ñaïn, chì ôû daây caâu caù vv.) nhöõng coâng vieäc naøy coù theå coù chaát chì.
DO ÑAÂU Maø Bò Nhieãm Ñoäc Chaát Chì?
Treû em coù theå bò nhieãm ñoäc chaát chì vaøo trong cô theå baèng caùch hít thôû hoaëc nuoát phaûi buïi trong ñoù coù chaát chì. Duø chæ coù moät soá löôïng nhoû, cuõng gaây neân nguy haïi. Nhaát laø caùc em coøn nhoû gaëp nguy cô nhieãm ñoäc chaát chì vì chaát chì laøm chaäm phaùt trieån vaø taêng tröôûng. Chaát ñoäc chì coù theå naèm trong cô theå treû em suoát ñôøi.
Coù theå phoøng ngöøa nhieãm ñoäc chaát chì ñöôïc
Daáu Hieäu cuûa söï Nhieãm Ñoäc Chaát Chì LAØ GÌ?
Treû em coù theå ñaõ bò nhieãm ñoäc chaát chì nhöng khoâng nhìn thaáy hoaëc haønh ñoäng laø ngöôøi bò maéc beänh. Söï nguy hieåm raát khoù nhìn thaáy. Caùch duy nhaát ñeå bieát con em cuûa quyù vò coù bò nhieãm ñoäc chaát chì hay khoâng laø phaûi ñi thöû maùu.
CON EM cuûa chuùng toâi coù bò nhieãm ñoäc chaát chì khoâng?
Con em cuûa quyù vò coù thöôøng xuyeân soáng trong hoaëc thöôøng xuyeân thaêm vieáng moät ngoâi nhaø, nhaø giöõ treû hoaëc nhöõng toøa nhaø khaùc xaây döïng tröôùc naêm 1950 khoâng?Trong voøng 6 thaùng vöøa qua, con em cuûa quyù vò coù thöôøng xuyeân soáng trong hoaëc thöôøng xuyeân thaêm vieáng moät ngoâi nhaø, nhaø giöõ treû hoaëc nhöõng toøa nhaø khaùc xaây döïng tröôùc naêm 1980 vaø môùi vöøa sôn xong hoaëc hieän ñang sôn, söûa chöõa, taân trang hoaëc hö haïi khoâng?Con em cuûa quyù vò coù anh, chò em, thaân nhaân khaùc, ngöôøi ôû chung nhaø hoaëc baïn chôi chung, bò nhieãm ñoäc chaát chì khoâng?Con em cuûa quyù vò coù thôøi gian chôi vôùi moät ngöôøi lôùn coù coâng vieäc laøm hoaëc sôû thích maø hoï coù theå laøm vieäc vôùi chaát chì khoâng?Quyù vò coù nhöõng ñoà goám hoaëc ñoà baèng saønh cheá taïo taïi moät quoác gia khaùc hoaëc thuûy tinh coù chì hay hôïp kim thieác söû duïng ñeå naáu aên, ñöïng thöùc aên hoaëc thöùc uoáng khoâng?Con em cuûa quyù vò coù bao giôø söû duïng baát cöù thöù thuoác coå truyeàn, myõ phaåm nhaäp caûng hoaëc noäi ñòa nhö Azarcon, Alarcon, Greta, Rueda, Pay-loo-ah hay Kohl khoâng?Con em cuûa quyù vò coù ñöôïc nhaän laøm con nuoâi töø nöôùc ngoaøi, soáng taïi hoaëc thaêm vieáng moät quoác gia khaùc trong voøng 6 thaùng vöøa qua khoâng?Quyù vò coù ñieàu gì quan taâm ñeán söï taêng tröôûng cuûa con em khoâng?
Neáu quyù vò traû lôøi coù cho baát cöù caâu naøo, xin vui loøng hoûi nhöõng nôi cung caáp saên soùc y teá ñeå xin thöû nghieäm tìm chaát chì trong maùu.
AÛnh Höôûng cuûa Nhieãm Ñoäc Chaát Chì ñoái vôùi Con Em cuûa Toâi
NHÖ THEÁ NAØO?Khoù khaên trong vieäc ñoïc saùch vaø hoïc taäp Trình ñoä thoâng minh thaáp
Khoù khaên trong caùch aên ôû
Hö haïi oùc
Phaùt trieån chaäm
Hö haïi thaän vaø gan
QUYÙ VÒ COÙ BIEÁT?