Poisoning the undiagnosed epidemic
By Dr. Ben Balzer, Elizabeth OBrien and Michelle Calvert.
The LEAD Group has become increasingly concerned that the extent of blood lead testing in NSW is so low. Why arent more kids being tested?
We wish it was because there are so few with high blood lead levels, but the truth is, there are more than 75,000 lead poisoned kids in Australia, and more in NSW than in any other state or territory. Children are simply not being tested. A blood test is all that is required but a doctor's request is necessary.
So why aren't doctors referring children for blood lead tests? We believe it's due to a lack of awareness of the prevalence of elevated blood lead levels and not enough discussion of the risk factors for elevated blood lead levels.
New LEAD Group Policy
Questionnaire screening on reproductive health
In order to protect reproductive health and foetuses, pregnant women should be surveyed by questionnaire to determine if their unborn baby has any risk factor for lead poisoning. People planning a pregnancy should be surveyed to determine if their eggs or sperm has any risk for lead poisoning. Risk factors will include those patients renovating pre 1970 homes (a common practice when a baby is due); those who work in a lead industry or participate in a lead hobby or those who live in a point source community. Those people with a current risk factor should be lead tested by venous blood sample. If blood lead levels are elevated then the patient should be removed from the source OR the source may be able to be moved away from the patient to prevent further poisoning.
Doctors should always consider a blood lead test for any child who is having blood tests for any other purpose.
Universal questionnaire screening of children.
Without exception, all children's parents should be surveyed by questionnaire to determine if their child has any risk factor for lead poisoning. Children with a current risk factor should be lead tested by venous blood sample. Children exposed to risk factors historically can have their baby teeth assessed for lead.
Distribution of Child Lead Risk Factor Questionnaire
The distribution of the Risk Factor Questionnaire needs to be thoroughly investigated.
One option is to include the Questionnaire in the Blue Book which the parent of every newborn receives. However, a one-page addition to the Blue Book costs $75,000, and pages can only be added when the Blue Book is being revised. The NSW Health Department has apparently decided that this is not cost effective.
An alternative is for the Questionnaire to be available for parents to fill out while waiting to see their GP or Early Childhood Centre nurse.
The LEAD Group will soon be asking for help from such groups as Rotary, in distributing bulk copies of child lead risk questionnaires to Early Childhood Centres, especially in inner Sydney.
However, clients of Early Childhood Centres are not perfectly aligned with the highest risk age group (9-48 months old), due to the drop-out rate as children get older and for second and subsequent children.
The best place to catch the highest risk age group is at the GP surgery. The LEAD Group is investigating the possibility of sponsorship for the printing of the questionnaire, which will have a message for doctors on the reverse side.
The proposed child lead risk questionnaire and the message to doctors is reproduced on the next two pages. If any of our readers have any suggestions which may assist in raising the rate of blood lead testing of "at risk" individuals, we would welcome a call on (02) 9716 0132 or 1800 626 086
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Updated 17 March 2014