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ELECTRONIC ARTICLE: Rachel B. Kaufmann, Timothy L. Clouse, David R. Olson, and Thomas D. Matte Elevated Blood Lead Levels and Blood Lead Screening Among US Children Aged One to Five Years: 1988-1994 Pediatrics 2000; 106: e79 [Abstract] [Full text] [PDF]

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Pb exposure in child (day) care should be considered

Susan S Aronson   (5 December 2000)

Pb exposure in child (day) care should be considered: the authors reply

Rachel Kaufmann   (15 December 2000)

Pb exposure in child (day) care should be considered 5 December 2000
Susan S Aronson, pediatrician and child care health consultant The Childrens' Hospital of Philadelphia Send letter to journal: Re: Pb exposure in child (day) care should be considered saronson{at}bellatlantic.net Susan S Aronson	In the survey, as in many pediatric practices, the history of risk factors did not include the participation of the child in out-of-home child (day)care. Many children spend some part of the day, some part of the week in such facilities. Whether out-of-home child care takes place in someone else's home or in a child care center, parents rarely know the status of that facility with regard to lead hazards. Assuming that a parent history will reveal risk factors for lead exposure has failed to identify children whose lead poisoning occurred. In one upscale child care facilities old leaded paint was converted to lead dust and distributed in the facility after window airconditioning units were installed. In the next NHANES and in every lead exposure history taken by primary pediatric clinicians, the use of child care by the child now and in the past should be probed. Since out-of-home child care often takes place in older buildings, all children who are or have been in out-of-home child care in an older building should have blood lead screening.
Pb exposure in child (day) care should be considered: the authors reply 15 December 2000
Rachel Kaufmann Centers for Disease Control and Prevention Send letter to journal: Re: Pb exposure in child (day) care should be considered: the authors reply rkaufmann{at}cdc.gov Rachel Kaufmann	We thank Dr. Aronson for her thoughtful letter. She is correct that lead exposure can occur wherever a child spends time, including the home, outdoor play areas, day care centers and preschools, and "second homes" (i.e. for those with separated parents sharing custody). We agree that physicians should ask about these possible sites of exposure when performing risk assessments for individual children. Physicians should also ask about other homes a child may have lived in recently. The number of cases of pediatric lead poisoning that are attributable to "outside-the-home" exposures is not known, but such cases surely occur. Unfortunately, the NHANES III dataset does not allow a full analysis of this question. One could use the dataset to examine the prevalence of elevated blood lead levels by whether children attend day care or preschool, but no information on the year of construction of those sites is included, and it would be impossible to ascertain where any lead exposure had actually occurred. NHANES 99+, which is currently being fielded, also has this constraint. However, NHANES 99+ does include limited measurements of dust lead loadings in homes of small children. Thus, it will be possible to estimate the number of children with elevated blood lead levels and small quantities of dust lead measured within the home, but it will not be possible to definitively conclude whether the lead exposure occurred outside the home or at what site it occurred. Rachel B. Kaufmann Thomas D. Matte David R. Olson

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