DB1 Screening for Elevated Blood Lead Levels in Children
The Agency for Healthcare Research and Quality (AHRQ) conducted an evidence-based
study for screening for elevated blood lead levels in children which will be used by the U.S.
Preventive Services Task Force (USPSTF) to update its 2006 recommendation on screening for
elevated lead levels in children. Although there is no defined safe level of lead exposure, this
study focused on blood lead levels (BLLs) over 5 μg/dl. Elevated BLLs are known to cause a
variety of health problems that primarily effect the central nervous, hepatic, hematopoietic and
renal systems. Many of the effects of elevated BLLs are irreversible. Adverse effects in children
include behavioral and learning problems, lower IQ and hyperactivity, impaired growth, hearing
problems, and anemia (U.S. Preventative Services Task Force, 2018).
One of the focal points of this report is whether or not routine screening in asymptomatic
children under the age of five was effective for improving health outcomes. Other studies have
shown that adverse effects, such as reduced IQ and academic deficits, have been seen in BLLs
less than 10 μg/dl (Bellinger, 2017). With the neurological effects happening at such low
concentrations of lead in the blood, one would think that screening would be adventitious,
however this evidence-based report stated that no study directly compared the effectiveness of
screening versus no screening for elevated blood lead levels in children under five years of age
on health outcomes.
Residential lead hazard control techniques was another focus of this report. Young
children often put objects or their fingers in their mouth as part of their normal development.
This puts them at risk for ingesting lead-based paint chips or dust from their environment,
especially in older homes where it is likely that lead paint exists or had existed at one time.
Despite knowing that the danger exists, this report stated that there was no evidence to support
that residential lead hazard control techniques were effective in improving health outcomes in
children who were found to have elevated BLLs.
Chelation therapy is a treatment that uses medicine to remove metals, such as lead, from
the body in hopes of reducing the damaging effects they can cause. Chelation therapy for
children is recommended for moderate (levels over 45 μg/dl) to severe toxicity (levels over 70
μg/dl). Levels in that range can cause severe neurological symptoms as well encephalopathy
(U.S. Preventative Services Task Force, 2018). However, this report found no difference between
chelation therapies versus a placebo in children who suffered neuropsychological effects despite
lowering the BLL.
In reviewing this report, it was found that there is limited evidence to support screening
versus not screening in children. Targeted screening has been suggested for children who are at
high risk, however the risk assessment tool used by the Center for Disease Control (CDC) has
