Suggested Clinical Evaluation for Lead Exposure

Medical history
    Ask about
        Developmental history
        Mouthing activities
        Previous blood lead concentration measurements
        Family history of lead poisoning
    Environmental history
    Paint and soil exposure
        What is the age and general condition of the residence or other structure in which the child spends time?
        Is there evidence of chewed or peeling paint on woodwork, furniture, or toys?
        How long has the family lived at that residence?
        Have there been recent renovations or repairs to the house?
        Are the windows new?
        Are there other sites at which the child spends significant amounts of time?
        What is the condition/make-up of indoor play areas?
        Do outdoor play areas contain bare soil that may be contaminated?
        How does the family attempt to control dust and dirt?
    Relevant behavioral characteristics of the child
        To what degree does the child exhibit hand-to-mouth activity?
        Does the child exhibit pica?
        Are the child's hands washed before meals and snacks?
    Exposures to and behaviors of household members
        What are the occupations of adult household members?
        What are the hobbies of household members? (Fishing, working with ceramics or stained glass, and hunting are examples of hobbies that involve risk for lead exposure.)
        Are painted materials or unusual materials burned in household fireplaces?
        Does the home contain vinyl miniblinds made overseas and purchased before 1997?
        Does the child receive or have access to imported food, cosmetics, or folk remedies?
        Is food prepared or stored in imported pottery or metal vessels?
        Does the family use imported foods in soldered cans?
Nutritional history
    Take a dietary history
    Evaluate the child's iron status by using the appropriate laboratory tests
    Ask about history of food stamps or participation in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC)
Physical examination
    Pay particular attention to the neurologic examination and the child's psychosocial and language development