Screening Kids for Lead Poisoning – Why New Hampshire Needs to do Better (Spoiler alert: only 39% of high-risk NH children are being tested)

Tom Irwin | @TomIrwinNH

In my most recent blog – the first in a series about childhood lead poisoning – I provided an overview of the challenge: that even though we know there is no safe level of lead exposure for kids and that even low levels of lead can cause irreversible, lifelong harm to our children, we are not doing a good enough job preventing what is, in fact, a very preventable problem. I also discussed the scope of the problem – that childhood lead poisoning affects communities across New Hampshire (and New England), with significant health and economic impacts.

Universal & Targeted Screening

A critical tool in addressing the problem of childhood lead poisoning is screening – testing kids to determine whether they have lead in their blood. Based on factors such as the percentage of the population under six years of age, the percentage of kids living in poverty, and the percentage of older housing stock, the NH Department of Health and Human Services – the agency that addresses lead problems through its Healthy Homes and Lead Prevention Program – has categorized each of New Hampshire’s 234 municipalities as either high-risk “universal” communities, or as “target” communities. The current approach to screening depends on the category.

More than half of New Hampshire’s cities and towns are classified as high-risk, “universal” communities, meaning all kids in these communities should be tested for lead at the age of one and two. Older children who have moved into a high-risk, “universal” community also should be tested. In the remaining cities and towns – so-called “target” communities – physicians are to use a questionnaire to determine each child’s risk and whether to conduct a blood test.

Do you live in a high-risk, “universal” testing community? To find out, take a look at Table 2 (page 9) of New Hampshire’s Screening and Management Guidelines.

So, How Are We Doing?

Some communities are doing quite well in testing their kids for lead poisoning. In Berlin – one of the state’s eight highest-risk communities – effectively all one-year-olds, and 86 percent of two-year-olds, were tested in 2013. Of those 203 kids tested, 65 (32 percent) had elevated blood lead levels.

More generally, however, New Hampshire’s screening rates are far below the state’s recommendations. Applying its guidelines, the state’s Healthy Homes and Lead Prevention program estimates that 23,554 one- and two-year-olds should have been tested in 2013. But how many actually were?

Only 10,830.

In other words, of all the kids with the highest risk of being exposed to lead, only 39 percent were tested.

Why is this a problem?

Properly screening kids – especially those at high risk – is essential for two reasons. First, it’s critical for the health of kids who have been exposed to lead. If a child is found to be poisoned, steps can and must be taken to educate the child’s parents and to eliminate lead hazards to prevent the child’s blood lead level from increasing further.

Second, by not diagnosing kids who have been poisoned, we’re working off data that understates the scale of the problem. In my prior blog, I mentioned that in 2013 alone, there were more than 1,000 new cases of lead poisoning in New Hampshire. That number derives from New Hampshire’s statewide screening data. Because that data fails to account for nearly 13,000 kids who should have been tested, but were not, it’s fair to assume that the actual number of lead-poisonings in New Hampshire is higher.

What’s the solution?
New Hampshire’s low screening rates likely stem from an inaccurate assumption – that childhood lead poisoning is no longer an issue. Whether it’s parents declining to have their children tested, or members of the medical community attending to other health issues (or a combination of both factors), we must do better. That’s why SB 135, legislation currently pending in the New Hampshire Senate is so important. The bill (see section 6 in particular) would establish a lead screening commission to ensure New Hampshire improves its screening rates and, in the process, protects more kids from the harm of lead poisoning.

In my next blog, I’ll discuss another important element of SB 135 – actions designed to prevent children from becoming poisoned by lead in the first place.

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