Published online June 1, 2006
PEDIATRICS Vol. 117 No. 6 June 2006, pp. 2329-2330 (doi:10.1542/peds.2006-0848)
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Home Visiting and Childhood Lead Poisoning Prevention: In Reply

Pat McLaine, RN, MPH
Johns Hopkins School of Nursing
Baltimore, MD, 21205

Mary Jean Brown, ScD, RN
Lead Poisoning Prevention Branch,
Centers for Disease Control and Prevention
Atlanta, GA 30341

Peter Simon, MD, MPH
Department of Family Health
Rhode Island Department of Health
Providence, RI 02908

In Reply.—

Dr Woolf's letter raises some excellent points, and we appreciate the opportunity to clarify some of the findings from our randomized community trial1 of educational interventions provided by nurses to families of children with moderate-level lead poisoning.

As recommended by the American Academy of Pediatrics,2 parents of children in both the intervention and comparison groups were encouraged to wash the children's hands carefully and frequently. However, by design, the children in the intervention group received more frequent reminders over a longer time. In effect, those in the intervention group received a larger dose of the importance of hand-washing.

We also found the results of the Nurse Child Assessment Satellite Teaching Scale (NCATS) intriguing. Because of the study logistics, we would have had difficulty using only individuals who were blinded to the children's group assignment to perform the NCATS testing in the home. We agree that because the nurses were not blind to group assignment, the results could have been biased. Thus, we have suggested that additional research in this area is needed. Because higher NCATS scores have been linked with improved measurements of children's cognitive abilities,3 our preliminary findings suggest that simple interventions such as those used in this trial that focus on parenting of young children may benefit lead-exposed children.

Dr Woolf points out that the mean blood lead levels (BLLs) declined in both groups. Because the State of Rhode Island had begun offering case management services to children with BLLs in the 15 to 19 µg/dL range before our community trial was initiated, we were unable to conduct this research with a comparison group that did not receive services. Had we had a comparison group that was not receiving services, we might have seen greater differences in BLLs between the 2 groups. However, of the 153 children tested for blood lead 1 year after enrollment, 80 (52%) still had BLLs ≥10 µg/dL. These children were evenly distributed between groups, with 39 (51%) in the comparison group and 41 (54%) in the intervention group. In addition, during the 1-year enrollment period, 12 (16%) of the children in the comparison group and 16 (21%) of those in the intervention group had at least 1 BLL test result that was higher than their BLL test result when they enrolled in the trial.

The findings of this study underscore the need for primary prevention of lead exposure through the control and elimination of lead sources in children's environments before they are poisoned.

REFERENCES

  1. Brown MJ, McLaine P, Dixon S, Simon P. A randomized, community-based trial of home visiting to reduce blood lead levels in children. Pediatrics. 2005;117 :147 –153
  2. American Academy of Pediatrics, Committee on Environmental Health. Lead exposure in children: prevention, detection, and management. Pediatrics. 2005;116 :1036 –1046[Abstract/Free Full Text]
  3. Barnard KE, Hammon MA, Booth CL, Bee HL, Mitchell SK, Spieker SJ. Measurement and meaning of parent-child interaction. In: Morrison FJ, Lord CE, Keating DP, eds. Applied Developmental Psychology. Vol 3. New York, NY: Academic Press; 1984;39–80
PEDIATRICS (ISSN 1098-4275). ©2006 by the American Academy of Pediatrics

Related articles in Pediatrics:

Home Visiting and Childhood Lead Poisoning Prevention
Alan D. Woolf
Pediatrics 2006 117: 2328-2329. [Extract] [Full Text]  




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