Abstract
Keywords
Flint, Michigan, is one of thousands of cities across the United States with elevated child blood lead levels (BLLs; Pell & Schneyer, 2016). Although many sources of lead exposure have been eliminated, such as in paint and gasoline, there are still many everyday sources of lead including baby food (Gardener et al., 2019), older apartments/homes with residual lead paint, and from parents who are occupationally exposed (Centers for Disease Control and Prevention [CDC], 2022).
Over time, researchers have concluded that there is no safe level of lead in children. Still, clinical guidelines for childhood lead exposure can be confusing for practitioners. The CDC recommends a reference value of 3.5 mcg/dl for childhood BLLs (Ruckart et al., 2021). This value is not meant to indicate safety, but instead represents the 97.5th percentile value of children’s BLLs in the United States. Importantly, adverse health, neurocognitive, and behavioral outcomes have been evidenced at all levels of exposure.
Children in underserved populations bear the brunt of day-to-day lead exposure, including children living in Flint. Even before the water crisis, Flint children had significantly greater BLLs relative to children living outside of Flint. Children on Medicaid continually have greater BLLs than children not on Medicaid. These inequities stem from long-lasting, historical roots of concentrated disadvantage. Low-income and predominantly minority families are more likely to live in older homes with residual lead paint, work in jobs with high risk for exposure, and live in closer proximity to industrial plants making them more likely to be exposed to current and historical lead pollution (Muller et al., 2018).
Occupational health nurses (OHNs) can help workers understand their risk for lead exposure and advocate for adult BLL testing to monitor exposure levels and potential health risks. To reduce childhood lead exposure, OHNs should educate workers on best practices to prevent transmission of lead from work to home, such as washing hands frequently at work and changing work clothes and shoes prior to entering their home (Occupational Safety and Health Administration [OSHA], 2014). Finally, OHNs can help workers advocate for their children by ensuring that BLL screening tests (i.e., capillary) are performed at well child visits to monitor for exposure. BLL testing, performed via a venous draw and more accurate than capillary screening, should be conducted at 1 and 2 years, and potentially annually until 6 years if living in a high-risk area per state health department guidelines. OHNs can help parents understand the differences between screening and testing, making them better equipped to monitor their children’s health. This is especially important for those who are at greatest risk, such as children on Medicaid or those living in high-risk areas, who are meant to undergo mandated lead testing up to 2 years old (6 years for high-risk residential areas). As required guidelines for testing do not extend beyond 6 years, OHNs can educate parents on risks for exposure and if they should request additional testing for their child. Childhood BLL testing has been substantially curtailed in the wake of COVID-19 and should be a priority for OHNs working in communities at greatest risk for exposure (Loza & Doolittle, 2022). OHN education and advocacy can help better monitor childhood lead exposure, mitigate sources of exposure, and reduce disparities in health outcomes.
