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  QUESTION: Guidelines for treating children with lead poisoning. 04 May 2003, Victoria Australia

Are there any federal government guidelines for health professionals treating children with lead poisoning?

"Lead Alert" produced by the CEPA in 1994 seems out of date

Thanks
Mike

ANSWER: 29 Jul 2003

Dear Mike,

Sorry for the delay in responding to your email but we are simply understaffed and underfunded. (Update 2009: The Lead Alert Guide for Health Professionals) has never been updated although I can give you the contact details of all three authors for advice on what might have changed (eg chelating agents approved for children):

  1. Dr Garth Alperstein, Community Paediatrician, CSAHS (Central Sydney Area Health Service), ph 0295153270, alpersteing[at]email.cs.nsw.gov.au;
  2. Dr Roscoe Taylor, Director of Public Health, Tasmania, ph 0362333768, roscoe.taylor[at]dhhs.tas.gov.au; and
  3. Prof Graham Vimpani, Child And Youth Health Network, Newcastle, ph 0249246222, graham.vimpani[at]newcastle.edu.au

Update 2009: (" The Lead Alert Guide for Health Professionals" now web published by The LEAD group Inc. see above) 

Unfortunately, neither Environment Australia (new name for CEPA) nor any of the authors appears to have an electronic copy of the original booklet and EA will not web-publish it or update it because they no longer feel responsible or lead poisoning has been eliminated (by magic because they finally banned leaded petrol and this took away all the remaining lead sources and the reservoirs of lead in soil and dust from vehicle emissions), or some other lame excuse. The last time we received a request [from Greece] for an emailable or web-published treatment protocol, Dr Alperstein advised that we refer the doctor to the "Policy Statement - Treatment Guidelines for Lead Exposure in Children (RE9529)" by the AMERICAN ACADEMY OF PEDIATRICS (AAP) - Committee on Drugs, July 1995.

Update 2011: POLICY STATEMENT (Reaffirmed January 2009) Lead Exposure in Children: Prevention, Detection, and Management, Committee on Environmental Health PEDIATRICS Vol. 116 No. 4 October 2005, pp. 1036-1046 (doi:10.1542/peds.2005-1947

Following the publication of research on early death from lead poisoning, I emailed (on 7th January 2003 - see attachment) the American Academy of Pediatrics as well as the Poisons Info Line in Australia to ask whether the blood lead level at which chelation was carried out, would be lowered.

I have not received an answer that I'm aware of (there are over 1,000 unread emails in our inbox that we don't have time to read) from AAP but I did receive the following email from the federal health department:

Elizabeth, you might be interested to know that, at the request of the CMO, Dick Smallwood, the Australian paediatricians are reviewing their recommendations for treatment of lead poisoning.

Best wishes
Helen

END OF HEALTH DEPT EMAIL

Although I have emailed Helen since February, I have not received any more information on the review eg who is doing it and when it is expected to be finished.

Following the publication of "Intellectual Impairment in Children with Blood Lead Concentrations below 10 g per Deciliter" by Canfield et al in the New England Journal of Medicine Volume 348:1527-1536 April 17, 2003 Number 16, I would think that the review is even more urgent, as the study found an average of 7 IQ points lost even at a blood lead level of 10 g/dL as compared to a blood lead level of 1 g/dL.

Sorry I can't be more helpful. If you find out any more on this by your own further enquiry, I'd be very pleased to hear from you again.

Yours sincerely
Elizabeth O'Brien

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