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CDC Issues Recommendations for Lead Poisoning Prevention in Newly Arrived Refugee Children

Last updated March 19, 2020

Approved by: Krish Tangella MD, MBA, FCAP

ATLANTA – Although blood lead levels (BLLs) in children aged 1 to 5 years are decreasing in the United States, the prevalence of elevated BLLs among newly resettled refugee children is substantially higher than children born in the United States. The Centers for Disease Control and Prevention (CDC) and the U.S. Department of State, Bureau of Population, Refugees and Migration have developed recommendations to address lead exposure among refugee children.


CDC Issues Recommendations for Lead Poisoning Prevention in Newly Arrived Refugee Children

ATLANTA – Although blood lead levels (BLLs) in children aged 1 to 5 years are decreasing in the United States, the prevalence of elevated BLLs among newly resettled refugee children is substantially higher than children born in the United States. The Centers for Disease Control and Prevention (CDC) and the U.S. Department of State, Bureau of Population, Refugees and Migration have developed recommendations to address lead exposure among refugee children.

"By being proactive in identifying at-risk refugee children, we can control or eliminate lead sources in the children’s environment whether they are products the families brought with them or lead paint, dust and soil hazards in homes in the US," said Mary Jean Brown, chief of the lead poisoning prevention branch at CDC.

The complete Recommendations for Lead Poisoning Prevention in Newly Arrived Refugee Children are available online at www.cdc.gov/nceh/lead. The following recommendations were developed for use by state and local health departments and state refugee health coordinators:

Identify Children with Elevated Blood Lead Levels

Conduct BLL testing for all refugee children ages six months to 16 years upon entering the US.

Repeat BLL testing for all refugee children ages six months to six years, three to six months after refugee children are placed in permanent residences. BLL testing should be repeated in older children if a child has a sibling with elevated BLL, regardless of his/her initial test results.

Early Post-arrival Evaluation and Therapy

Perform nutritional evaluations for all refugee children upon arrival in the US. In addition, provide each child with appropriate nutritional and vitamin supplements as indicated.

Evaluate the value of iron supplementation for refugee children.

Health Education/Outreach

CDC and its state and local partners will develop health education materials and outreach activities that are culturally appropriate and sensitive to the target population.

CDC and its state and local partners will develop training and education modules for health care providers, refugee and resettlement case workers, and partner agencies on the following:

Effects of lead poisoning among children.

Lead sources in children’s environments and ways to reduce the risk of exposure.

Nutritional and developmental interventions that can mitigate the effects of lead exposure.

Ways to provide comprehensive services to children with elevated BLLs.

The recommendations are based partially on Elevated Blood Lead Levels in Refugee Children – New Hampshire, 2003-2004, which was released earlier this year. The report documents the occurrence of elevated BLLs in refugee children, primarily from Africa, who resettled in New Hampshire. For more information about the report, visit www.cdc.gov/mmwr/preview/mmwrhtml/mm5402a4.htm

Lead can damage a child’s central nervous system, kidneys and reproductive system, and at higher levels can cause coma, convulsions and death. Lead poisoning is entirely preventable. However, nearly half a million children living in the United States have lead levels in their blood that are high enough to cause irreversible damage to their health.

"These comprehensive recommendations will bring us closer to the Healthy People 2010 goal of eliminating lead poisoning in America’s children," Dr. Brown added.

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Reviewed and Approved by a member of the DoveMed Editorial Board
First uploaded: March 19, 2020
Last updated: March 19, 2020