Lead Exposure and Healthy Homes - Talking to Caregivers: Anticipatory Guidance

Talking to Caregivers: Anticipatory Guidance

The best way for you to help prevent or reduce lead exposure is by adequately educating pregnant women and parents/guardians. Since lead exposure is an environmental health topic about which many caregivers may not be well informed, providers like you typically become their primary resource. This means that they’ll likely rely on you for critical initial information.

You can best benefit your patients by providing regular guidance concerning childhood lead poisoning and lead exposure. The following information should be shared with pregnant woman, parents/caregivers of children and their families.

Important Note for Advising Pregnant Women:

Lead crosses the placenta and can interfere with normal development of the fetal brain.
Pregnant women can be exposed to lead through a variety of sources and are likely to pass their lead exposure to their unborn child.
CDC Guidelines for the Identification and Management of Lead Exposure in Pregnant and Lactating Women.

Important Notes for Advising Parents/Caregivers of Children:

Children are most at risk for being exposed to lead and for being lead poisoned.
Children pick up lead dust particles on their hands and eventually often ingest the lead after putting their hands in their mouths.
Floors and window sills tend to hold high amounts of lead dust. They should be cleaned regularly, using a wet cleaning method. (Learn more about wet cleaning in the chart below.)
Avoid even the smallest exposure to lead, since there is no known “safe” level of exposure.

Informing Patients Concerning Lead Exposure, Prevention, and Reduction: Guidance Chart for Medical Providers

What to Do	Why It’s Important	Timeline (for pregnant women and for children)
For Pregnant Women
Ask pregnant women if they work in or live with someone who works in the auto mechanic, pottery, battery recycling, house painting, gun, or fish hook manufacturing industry. Refer any woman who reports either of the above circumstances to the District Department of the Environment’s Lead and Healthy Housing Division.	Individuals working or living with someone who works in the auto mechanic or battery recycling industry, as a house painter or in the construction trades, with fish hooks, with fire arms or with pottery, may be exposed to lead. Its possible to ingest lead in those environments as well as bring it home from work on clothes, hands, shoes, etc.	First Trimester of pregnancy
Lead Exposure Screening for Children
Give screening questionnaire.	It is important that children are screened according to DC law and when significant environmental changes occur. This questionnaire will help you identify whether or not a child should be tested.	At each child’s annual visit and as necessary.
In cases where a child with a blood lead level ≥ 5 µg/dL has a sibling, advise that the sibling be tested for lead exposure.	Because lead exposure is an environmental issue and siblings often share environments, all children in the family could have been exposed to lead.	As necessary
In cases where a child has a blood lead level ≥ 5 µg/dL, advise that the DDOE Lead Program will be in touch with follow-up initiatives.	DC residents need to know what the appropriate next steps are, both with respect to minimizing lead exposure risks and with respect to next medical case management steps.	Immediately
Diet
Advise the consumption of foods high in calcium, iron and Vitamin C.	When the human body has high levels of calcium and iron, it is less likely to confuse lead as either. Vitamin C is helpful in the absorption of both.	Throughout pregnancy. At each child’s annual visit.
Advise frequent hand washing, if living in a home built before 1978, and if child frequently plays outdoors.	Homes built before 1978 could produce lead dust, which makes it likely that the dust ends up on human hands. Lead dust is also frequently in soil. Wash hands to avoid ingesting the lead dust while eating or drinking.	Throughout pregnancy. At each child’s annual visit.
Advise use of a water filter, if living in a home built before 1978, with no knowledge of lead status of drinking water.	Water filters reduce the risk of drinking contaminated water.	Throughout pregnancy. At each child’s annual visit.
Advise against alternative health remedies.	There are alternative health remedies (i.e., Azarcon, Alarcon, Greta, Rueda, Pay-loo-ah, or Kohl) that contain lead in them. For this reason, they should not be used.	Throughout pregnancy. At each child’s annual visit.
Advise against drinking or eating from pottery, unless known to not be lead glazed.	Some pottery contains lead, which could contaminate the food in it.	Throughout pregnancy. At each child’s annual visit.
Home
Recommend wet cleaning of horizontal surfaces.	Lead dust is best removed by wet cleaning, using a detergent solution along with disposable rags or a mop, and rinse water.	Throughout pregnancy. At each child’s annual visit.
Warn against remodeling in baby’s room without using lead-safe work practices. Warn against repainting without using lead-safe work practices. Warn against attempts to make paint repairs without using lead-safe work practices and certified professionals.	When renovations or remodeling is being done in homes built before 1978, it’s critical to use proven methods that are recommended by lead professionals, given the potential likely presence of lead in the home.	Throughout pregnancy. At each child’s annual visit.
Advise against restoring old furniture without using lead- safe work practices and certified professionals.	Old furniture may contain lead and should therefore are best placed in the hands of a licensed professional for any restoration or repairs.	Throughout pregnancy. At each child’s annual visit.
Advise against use of test kits for do-it-yourself home assessments.	Home test kits are unreliable. The best way to find out if lead exists in your home is to hire a certified risk assessor. A list of certified companies can be obtained from the District Department of the Environment.	Throughout pregnancy. At each child’s annual visit.