Questions and Answers on...CDC's New Guidance on Childhood Lead Screening

Target audience: public health personnel and other groups concerned about preventing childhood lead poisoning.

1. Why is CDC revising its guidance now?

• CDC regularly updates its guidance about childhood lead poisoning prevention, and the current revision is a timely addition to the series begun in 1975. Subsequent editions appeared in 1978, 1985, and 1991.

• Children in some places, especially large, urban inner cities, continue to be exposed to lead and many of these children who need individual follow-up are not being screened.

• There is a decline in the average blood lead levels of children in the United States as a whole.

• The new guidance will reflect the need to screen more lead-exposed children and fewer children without lead exposure.

2. When will the new guidance be available?
   The new guidance will be available for public distribution in early November, 1997.
3. What is the purpose of the guidance document?
   The new guidance contains information to assist state and local health departments determine which children in their jurisdictions are most likely to benefit from screening. CDC will:

   • Help health departments organize the process of making decisions about screening

   • Expand screening and follow-up care among children who most need these services.

   • Diminish screening of children who are not exposed to lead.
      

4. What will be new in this guidance?

   • The new guidance, entitled Screening Young Children for Lead Poisoning: Guidance for State and Local Public Health Officials will not be a comprehensive overview of childhood lead poisoning prevention, but instead will be focused on screening and follow-up of children with elevated blood lead levels.

   • It will discuss universal and targeted approaches to screening for childhood lead poisoning in order to achieve the purposes outlined in question #3 above.

5. What is the "universal approach" and the "targeted approach" to screening?

   Universal screening is the blood lead testing of all children in a given area.

   Targeted screening is blood lead testing of some but not all children in a given area. Using such an approach, children would be selected for screening on the basis of criteria provided by the health department (either state or local). These criteria are likely to include:

   • Residence in a high-risk zip-code or neighborhood.

   • Membership in a population that is at increased risk of lead exposure. National data show that poor children, minority children, children who are exposed to lead-containing home remedies, cosmetics, and ceramicware, and children of occupationally exposed adults are at increased risk of lead exposure. Risk for these children is compounded by residence in older housing.

   • Answers to a personal-risk questionnaire. Such a questionnaire should be developed by the health department and be based on local risks of lead exposure.

6. Who is the primary audience for the proposed new guidance?
   The primary audience for CDC's updated screening recommendations is composed of state and local public health officials. Secondary audiences include public health providers, pediatricians and other child health care providers and health care organizations, including managed care organizations.
7. What population is covered by the proposed new guidance?
   The guidance will focus on the screening of young children. It will include a discussion of anticipatory guidance for pregnant women, as well as lead screening for older children who are at risk.
8. How was the document prepared?
   The new guidance was prepared by CDC staff with advice from CDC's Advisory Committee on Childhood Lead Poisoning Prevention, a group of non-Federal experts on childhood lead poisoning prevention. The guidance also reflects the comments of many other persons involved in scientific and programmatic aspects of childhood lead poisoning prevention and child health. The guidance takes into account new scientific information and practical concerns about how best and most efficiently to prevent and control childhood lead poisoning.
9. What sort of assistance will CDC give to states and locales to help in the implementation of the new guidance?
   CDC will provide support for development and communication of appropriate screening strategies. CDC will also continue to conduct and promote research to improve screening.
10. Will the new guidance replace the 1991 document?
    The new guidance does not contain information on all the subjects included in the 1991 guidelines. Rather, it focuses on decision-making processes, screening and follow-up for children with lead exposure. Sources of updated information on childhood lead poisoning and its prevention include the following:

    • Measuring Lead Exposure in Infants, Children and Other Sensitive Populations. National Research Council. Washington, D.C. National Academy Press. 1993. -- National Academy of Sciences' review of the adverse health effects of lead exposure, and the sources and pathways of lead exposure.

    • Treatment Guidelines for Lead Exposure in Children. American Academy of Pediatrics Committee on Drugs. Pediatrics 1995;96: 155-60.C American Academy of Pediatrics' review of chelation therapy.

    • Guidelines for the Evaluation and Control of Lead-based Paint Hazards in Housing. U.S. Department of Housing and Urban Development. 1995. --  U.S. Department of Housing and Urban Development discusses the management of lead hazards in the child's home environment.

    • Putting the Pieces Together: Controlling Lead Hazards in the Nation's Housing. Lead-Based Paint Hazard Reduction and Financing Task Force. 1995.CLead-Based Paint Hazard Reduction and Financing Task Force's review of their experience and recommendations on reducing lead hazards in housing.

    • the new guidance, "Screening Young Children for Lead Poisoning: Guidance for State and Local Public Health Officials."

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