Childhood Lead Poisoning Research Articles

Lead poisoning as a differential diagnosis in pediatric patients with chronic abdominal pain: a case–control study in Tehran-Iran

BackgroundChronic abdominal pain is a potential symptom of lead poisoning, which is often challenging to diagnose. This case–control study aimed to evaluate blood lead levels in pediatric patients with chronic abdominal pain.MethodsThe case–control study was conducted on 190 pediatrics who presented to the Children's Medical Center Hospital clinics, Tehran between April 2021- 2023. The children were divided into two groups: the case group, consisting of 81 patients with chronic abdominal pain, and the matched control group; 109 children without any gastrointestinal symptoms. The statistical analysis of the data was performed using STATA 16. A multiple logistic regression model was used to assess the association of different independent variables with chronic abdominal pain.ResultsThere was no significant difference between mean (± standard deviation [SD]) of age (8.80(2.7) years vs. control group: 9.23(3.9) years), sex, and BMI (16.55(4.6) vs. 17.32(4.7)) of the patients with chronic abdominal pain (case group) and the control group, whereas the mean weight was remarkably low in patients with chronic abdominal pain: 27.25(± 12.1) kg vs. 31.70(± 14.7) kg (P value = 0.028). Fifty-nine percent of children with chronic abdominal pain had serum lead levels ≥ 10 µg/dL. The mean (SD) of blood lead levels was statistically high in the case group: 11.09 (± 5.35) µg/dL vs. control group: 8.26 (± 5.01) µg/dL) (P value ≤ 0.05). The appetite level was significantly low in the case group: 3.8 (± 2.5) vs. control group 5.4 (± 1.3).ConclusionsLead poisoning could be a possible cause of children's chronic abdominal pain. Regarding the high rate of lead poisoning in children exerting appropriate measures to reduce their exposure to lead is necessary.

Implementation of a Childhood Lead Poisoning Prevention Program Data and Outcomes Management System Based on the Omaha System: A Pre-Post Evaluation.

Implementation of a Childhood Lead Poisoning Prevention Program Data and Outcomes Management System Based on the Omaha System: A Pre-Post Evaluation.

Applied Informatics Innovation Within a Childhood Blood Lead Poisoning Prevention Program Resulted in Improved Data Management and Demonstrated Client Outcomes.

This poster presentation describes innovative use of the Omaha System, a standardized terminology, into public health nurses' (PHNs) workflow and electronic records within a local health department's Childhood Lead Poisoning Prevention Program. The Omaha System facilitated the tracking of evidence-based interventions and client outcomes, showing a significant improvement in record completeness (from 33% pre-implementation to 84% post-implementation) and client outcomes in health care supervision, growth and development, and nutrition. Outcome data analysis revealed improvement across all post-implementation records from initial assessments to interim assessments for Health care supervision (p<.001), Growth and development (p<.001), and Nutrition (p = .025). This achievement has given program leaders and employees the ability to clearly present their services and results to policymakers, facilitating better assessment of the program's effectiveness. The successful implementation illustrates its potential applicability to other public health projects and areas.

On the performance of Sargassum-derived calcium alginate ion exchange resins for Pb2+ adsorption: batch and packed bed applications

Driven by climate change and human activity, Sargassum blooming rates have intensified, producing copious amount of the invasive, pelagic seaweed across the Caribbean and Latin America. Battery recycling and lead-smelter wastes have heavily polluted the environment and resulted in acute lead poisoning in children through widespread heavy metal contamination particular in East Trinidad. Our study details a comprehensive investigation into the use of Sargassum (S. natans), as a potential resource-circular feedstock for the synthesis of calcium alginate beads utilized in heavy metal adsorption, both in batch and column experiments. Here, ionic cross-linking of extracted sodium alginate with calcium chloride was utilized to create functional ion-exchange beads. Given the low quality of alginates extracted from Sargassum which produce poor morphological beads, composite beads in conjunction with graphene oxide and acrylamide were used to improve fabrication. Stand-alone calcium alginate beads exhibited superior Pb2+ adsorption, with a capacity of 213 mg g−1 at 20 °C and pH 3.5, surpassing composite and commercial resins. Additives like acrylamide and graphene oxide in composite alginate resins led to a 21–40% decrease in Pb2+ adsorption due to reduced active sites. Column operations confirmed Alginate systems’ practicality, with 20–24% longer operating times, 15 times lower adsorbent mass on scale-up and 206% smaller column diameters compared to commercial counterparts. Ultimately, this study advocates for Sargassum-based Alginate ion-exchange beads as a bio-based alternative in Trinidad and developing nations for dealing with heavy metal ion waste, offering superior heavy metal adsorption performance and supporting resource circularity.Graphical

Effectiveness of educational interventions for the prevention of lead poisoning in children: a systematic review.

Childhood exposure to lead has severe health consequences including long-term physical, behavioral, and learning problems. Lead poisoning often occurs in the home and persists as a form of environmental injustice, disparately impacting certain children based on factors such as socioeconomic status, immigration status, and race. Because abatement is costly, many prevention programs rely on educational interventions. We conducted a systematic review to assess the effectiveness of educational interventions on reducing blood lead levels (BLL) in children. Following PRISMA-P guidelines, a librarian-guided search strategy incorporated database-specific subject headings and keywords related to lead poisoning and education, and encompassed four databases: Ovid MEDLINE, Scopus, Web of Science Core Collection and CINAHL. Two reviewers screened the results for those that met inclusion criteria (original research, study population of children under 18 years, inclusion of an educational intervention, outcome of BLL). We screened the titles of 2,062 non-duplicate studies, the abstracts of 78 studies, and full texts of 23 articles, resulting in 17 articles that met eligibility criteria. Thirteen studies used multi-pronged interventions, which precluded comprehensive assessment of the effectiveness of the educational component. Interventions that had success in lowering BLL included some notable elements: longevity of intervention, consideration of culture and ethnicity; use of a community or home-based approach; and provision of supplies or assistance with cleaning. Of the four of studies that used solely educational interventions, three were successful in reducing BLL. Among the 12 studies that used a control group, six found their interventions to be successful in reducing BLL. This review found that educational interventions, either alone or as part of a multi-pronged approach, do not consistently reduce BLL in children. However, educational interventions may decrease severity of lead poisoning in children when more robust interventions are not feasible.

Action anthropology and public policy change: Lead poisoning in Syracuse, NY

AbstractIn Syracuse, New York more than 10% of children are lead poisoned each year, a toxic exposure that lowers the children's ability to learn and increases risky behaviors in adolescence. African American children are affected at nearly twice the rate of White children. We describe a community‐university collaboration to reduce childhood lead poisoning in Syracuse, and the effects these efforts have had on public policy to date. This paper documents the effectiveness of the Community Action, Research, and Education model to deliver community‐based prevention strategies on child lead poisoning in Syracuse, New York. The community‐based strategies were successful for promoting legal and policy change, increasing the public awareness of this tragic problem, holding elected and appointed officials to their commitments in addressing this toxic injustice, and obtaining needed intervention and disability accommodations for lead‐poisoned children in the community and educational institutions.

Knowledge, Attitudes, Practices, and Prevention Barriers Related to Childhood Lead Poisoning Among Nepali-Speaking Bhutanese Parents in Northeast Ohio, United States.

The study objectives were: (i) to develop and administer a survey to assess childhood lead poisoning (CLP) knowledge, attitudes, practices and prevention barriers (KAP-B) among the Nepali-Speaking Bhutanese (NSB) community in Northeast Ohio; and (ii) to examine the association between socio-demographic characteristics of NSB parents and their understanding of CLP as measured by the constructs of knowledge and attitudes. A Nepali language KAP-B questionnaire was developed and 200 NSB parents with at least one child ≤ 7 years of age from the Akron Metropolitan Area, Ohio were interviewed. NSB parents demonstrated a low level of knowledge about CLP prevention measures. While 82% lived in pre-1978 houses, only 27.5% perceived their house/neighborhood to be potentially lead contaminated. Only 33% of the parents reported understanding lead-related information provided by their child's healthcare provider. Low-level CLP awareness among NSB community emphasizes a need for culturally tailored and linguistically appropriate community-level CLP educational intervention programs in this vulnerable community.

Identifying the Blood Lead Reference Value Based on the Advisory Committee on Childhood Lead Poisoning Prevention Guidelines and Factors Associated with Elevated Blood Lead Levels among Preschool Children in Thailand, 2019

The blood lead reference value (BLRV) is used for guiding lead prevention and control measures. It is usually defined as the 97.5th percentile of the population-based blood lead level in each country. This study aims to determine the BLRV and factors associated with elevated (≥5 µg/dL) blood lead levels among children aged 1–5 years in Thailand. A cross-sectional study was conducted using secondary data extracted from a national survey, implemented in 171 hospitals during October 2018–September 2019. Demographic characteristics and potential risk factors including lead-related industries were collected. Multilevel logistic regression was used. Of 3,184 children included in the survey, the BLRV was 6.9 µg/dL. Three significant risk factors were identified: living near a lead factory (adjusted odds ratio (AOR) 2.09, 95% CI 1.27–3.42), exposure to the manufacture of fishing tackle (AOR 4.39, 95% CI 1.54–12.50), and exposure to the manufacture of shot and ammunition (AOR 6.30, 95% CI 1.81–21.93). Despite a calculated BLRV of 6.9 µg/dL, we propose a BLRV of 5 μg/dL in Thailand based on guidelines from the United Kingdom. Surveillance of blood lead levels should be established among children at high risk of lead exposure.

Sources, blood concentrations, and approaches for reducing exposure to lead: A critical appraisal on lead poisoning

Lead, a non-essential metal, enters the body in various ways, making it a major public health issue. Painters and smelters report lead poisoning in children and staff. Mining and battery workers risk lead exposure. Traditional and cultural remedies may include dangerous quantities of lead, producing lead poisoning. These drugs must be properly understood and regulated to avoid toxicity. Lead poisoning symptoms vary by duration and severity. Lead first impairs cognition, development, and behaviour by damaging the neural system. Time degrades reproductive and haematological systems. Lead's quiet entry into the body makes it deadly. Acute lead nephropathy damages kidneys at 100mg/dL. Lead levels exceeding 150mg/dL may induce encephalopathy. Blood lead levels indicate lead poisoning severity. Lead levels over 10g/dL in children and 40g/dL in adults are hazardous. Lead toxicity affects various organs. Lead may induce hypertension and cardiovascular disease. It may also cause chronic kidney disease and renal failure. Lead exposure may impede fertility, cause miscarriages, and alter foetal development; hence the reproductive system is vulnerable. Symptoms and lead levels may be treated with different approaches. Lead chelation treatment is frequent. Other vitamins and medications may enhance organ function and treat lead poisoning. Lead poisoning prevention requires widespread awareness. Strict standards and education regarding lead-contaminated products and conventional remedies should reduce occupational lead exposure. Regular blood lead level monitoring, especially in youngsters and lead workers, may help detect and treat lead poisoning early. Lead poisoning has serious health consequences. Understanding lead exposure pathways, identifying symptoms, and preventing lead poisoning is essential to public health and organ system protection.

Neighborhood disparities and the burden of lead poisoning.

To assess the persistence of neighborhood-level lead poisoning disparities in Rhode Island. Rhode Island Department of Health blood lead levels (BLL) collected from 2006-2019 were linked to census block group rates of poverty and housing built pre-1950. We computed multivariate logistic regression models of elevated BLLs (≥5 µg/dL and ≥10 µg/dL). Of the 197,384 study children, 12.9% had BLLs ≥5 µg/dL and 2.3% had BLLs ≥10 µg/dL. The proportion of children with BLL ≥ 5 µg/dL increased across quintiles of poverty and old housing. The odds ratio for highest quintiles was 1.44 (95% CI: 1.29, 1.60) and 1.92 (95% CI: 1.70, 2.17) for poverty and pre-1950 housing, respectively. A significant temporal decline was observed for BLL ≥ 5 µg/dL (2006: 20.5%, 2019: 3.6%). Disparities narrowed over the study period across quintiles of poverty and old housing with a similar trend appearing in the proportion of children with BLL ≥ 10 µg/dL. Despite tremendous progress in reducing lead exposure, substantial neighborhood disparities in lead poisoning persist. These findings provide valuable considerations for primary childhood lead exposure prevention. Through linkage of Rhode Island Department of Health childhood lead poisoning and census data, this study captures neighborhood-level disparities in lead poisoning from 2006-2019. This study demonstrates that the odds of lead poisoning increased in a stepwise fashion for neighborhood quintiles of poverty and housing built pre-1950. While the magnitude of lead poisoning disparities narrowed across quintiles of poverty and old housing, disparities persist. Children's exposure to sources of lead contamination continues to be an important public health concern. The burden of lead poisoning is not equally distributed among all children or communities.

First lead, now no bed? The unintended impacts of lead abatement laws on eviction

Lead paint in old houses is the leading cause of lead poisoning in children under 6 today. To combat this problem, several states have passed lead abatement laws, forcing landlords to remove lead in the homes they rent if tenants have children under the age of 6. However, these laws have unintended consequences, causing landlords to evict tenants rather than abate lead. I use a difference-in-differences approach while employing various model specifications with various fixed effects and sets of controls to examine the impact of Ohio’s 2003 lead abatement law on eviction rates. Using newly collected data from the Eviction Lab at Princeton University, I find that the passage of Ohio’s lead abatement law sharply increased targeted evictions. Due to the law’s passage, the average census district in Ohio faced an increased eviction rate of roughly 0.457 points, corresponding to an additional 13.93 evictions a year. These impacts are highly statistically significant, sizeable, and economically meaningful, indicating that policy makers should incorporate distributional consequences when designing future lead abatement laws in order to avoid unintended consequences and ensure equitable outcomes.

Successful Treatment of Severe Lead Poisoning Children with Low Dosage of CaNa2EDTA -A Retrospective Study of 8 Cases from China

Background: To analyze the clinical features, treatment and prognosis of 8 Chinese children with severe lead poisoning. Methods: 8 children with blood lead levels (BLLs) over 45ug/dL hospitalized at Beijing Chaoyang Hospital of Capital Medical University from January 2015 to December 2019 were diagnosed as severe lead poisoning. Detailed medical data were retrospectively studied. All patients accepted the chelation therapy with calcium disodium ethyleneaminetetraacetate (CaNa2 EDTA). Results: The onset age ranged from 3 months to 12 years old. BLLs ranged from 46.6ug/dL to 120.2ug/dL. The sources of lead exposure were different while 3 cases had taken Chinese herbs. 3 cases had symptoms of nervous system. 3 cases had anemia. 2 cases had abnormal liver function. All patients had normal renal function. All cases accepted the repeated treatment of consecutive intravenous CaNa2 EDTA (20mg/kg/d, 5 days every month), until BLLs remained below 40ug/dL. 1 case One case got rash and one patient got transient elevated serum transaminase during the courses. All cases had BLLs under 45ug/dL on followup. Conclusion: Chinese herbs containing lead might be one of the attributing factors of lead poisoning in children. Low dosage of CaNa2 EDTA was relatively safe and effective in dealing with lead poisoning in children.

Childhood Lead Poisoning 1970-2022: Charting Progress and Needed Reforms.

Childhood lead poisoning prevention in the United States was marked by a largely failed medical approach from 1971 to 1990; an emergent (but small) healthy housing primary prevention strategy from 1991 to 2015; and implementation of large-scale proven interventions since then. Childhood Lead Poisoning Prevention & Healthy Housing. Historic and recent health and housing data from the National Health and Nutrition Examination Survey (NHANES) and the American Healthy Homes Survey (AHHS) were retrieved to analyze trends and associated policy gaps. Approximately 590 000 US children aged 1 through 5 years had elevated blood lead levels of 3.5 μg/dL and greater in 2016, and 4.3 million children resided in homes with lead paint in 2019. Despite large improvements, racial and other disparities remain stubbornly and statistically significant. The NHANES and the AHHS require larger sample sizes. The Centers for Disease Control and Prevention has not published children's blood lead surveillance and NHANES data in several years; the Department of Housing and Urban Development (HUD) has no analogous housing surveillance system; and the Environmental Protection Agency (EPA) and the Occupational Safety and Health Administration (OSHA) have not updated training, Superfund, and occupational standards in decades. The nation has been without a plan and an associated budget for more than 2 decades. Congress has not reformed the nation's main lead poisoning prevention laws in more than 30 years. Such reforms include stopping US companies from producing new residential lead paint in other countries; enabling the disclosure law to identify all residential lead hazards; closing loopholes in federally assisted housing regulations and mortgage insurance standards; harnessing tax policy to help homeowners mitigate lead hazards; streamlining training requirements; increasing the size of health and housing surveys and surveillance systems; and updating housing codes, medical guidance, dust lead standards, training, Superfund, and worker exposure limits. Congress and the president should reauthorize a cabinet-level task force (dormant since 2010) to develop a new strategic plan with an interagency budget to implement it. These reforms will scale and optimize markets, subsidies, enforcement, and other proven interventions to end ineffective, costly, harmful, and irrational cost shifting that threatens children, workers, and affordable housing.

Signs of Phenotypic Changes in Children Constantly Exposed to Elevated Environmental Levels of Chemical Pollutants in the City of Nizhny Tagil

Background: Environmental epigenetics plays an important role in developing a phenotype of diseases. Objective: To identify signs of phenotypic changes in children constantly exposed to high environmental levels of chemical pollutants in the city of Nizhny Tagil. Materials and methods: The study was conducted in a specialized kindergarten for children suffering from different allergic diseases in the city of Nizhny Tagil. To detect phenotypic signs of environmental exposure, we used data on clinical diagnoses, medical history, and pediatric physical examination, as well as the results of a parent survey on allergies. We then measured blood and urinary levels of some metals and total IgE as a marker of lead poisoning in children. Results: According to clinical diagnoses, food intolerance was noted in 97.7 % of the children, 91.2 % suffered from allergic dermatitis, and almost 20 % were allergic to house dust. Phenotypic manifestations of food intolerance testified to the predominance of its skin phenotype. Every third child had symptoms of psychological disorders. The questionnaire-based survey revealed a positive allergic status in 83.1 % of the parents, mainly with skin manifestations. High blood levels of lead, nickel, cobalt, and cadmium exceeding the safe level by 23.6–240 % were observed in the study population. The syndrome of chronic xenogeneic intoxication was established in 57.3 % of cases and the syndrome of sensitization to low doses of chemicals – in 41.6 % of them. Almost 25 % of the children were underweight, which was associated with their blood cadmium levels. Conclusions: Our findings confirm the few literature data on such health effects of heavy metals in children as asthma, eczema and food allergies, as well as low body weight and height. Studies of the signs of phenotypic changes in the group of children suffering from allergies and exposed to environmental hazards are most likely to indicate the adverse impact of heavy metals on the immune system, manifestations of epigenetic mechanisms forming the allergy phenotype, which can potentially lead to transgenerational inheritance.

A Historical Perspective on the CDC Childhood Lead Poisoning Prevention Program.

A Historical Perspective on the CDC Childhood Lead Poisoning Prevention Program.

Activities at Risk of Lead Exposure and Lead Poisoning in Children of Travellers’ Families in Charente, France

Activities at Risk of Lead Exposure and Lead Poisoning in Children of Travellers’ Families in Charente, France

Effects of lead poisoning in children- A narrative review

Objective: exposure of children to lead still poses a major health concern for public health agencies worldwide. This work aims to describe which are the symptoms most frequently associated with lead exposure in children, providing further basis to both researchers and policy makers to better guide future efforts aimed at addressing such issue. Methods: a systematized review of articles on the present topic published between June 2005 and February 2021 was carried out. Results: data described in the reviewed articles show a clear relationship between blood lead levels and hematopoietic and cognitive effects in children exposed to either low or high levels of lead. Concerning effects can be identified at blood lead levels above 4µg/dL, and the highest blood lead level reported was of 88.39 µg/dL. Conclusions: lead poisoning of children continues to be a serious public health issue worldwide, especially for those in South America, and health agencies and policy makers alike would benefit from more studies describing areas where lead exposure is high as well as describing how children have been responding to such exposure in the past years in order to better combat this issue.

Lead Poisoning: An Update.

1. Morri Markowitz, MD* 1. *Lead Poisoning Prevention and Treatment Program, Albert Einstein College of Medicine and Department of Pediatrics, Children's Hospital at Montefiore, The University Hospital for Albert Einstein College of Medicine, Bronx, NY 1. Whole blood is used to measure lead, which limits interpretation of blood lead level results. 2. The current lead poisoning intervention level is based on epidemiology, not toxicology. After completing this article, readers should be able to: 1. Describe updated knowledge about lead poisoning in children. 2. Explain why we use blood lead levels (BLLs), describe limitations in BLL interpretation, highlight the current reasons for intervening for a BLL of 5 μg/dL (0.24 µmol/L), and report the discovery of old lead sources (water and paint) in new locations (schools). 3. Discuss outcomes that support the reversibility of lead effects after treatment. Lead (Pb) poisoning can be assessed at 3 levels: the fundamental biochemical effects, subclinical organ dysfunction, and clinical disease. The presence of Pb in a child’s blood sample is an indicator that exposure and absorption have occurred. The blood Pb level (BLL) is a measure of potential toxicity because it is correlated with various health outcomes in groups of children. However, there are limitations to interpreting individual results. What is measured is not plasma Pb, the immediate and most threatening component of blood Pb, which can leave the blood compartment and enter cells. Rather, due to historical laboratory limitations, it is overwhelmingly (∼98%) red blood cell Pb content that is assessed. Thus, the BLL is a surrogate measure 2 steps removed from tissue cell Pb, the site of most toxicity. In addition, the reside time (similar to half-life, a term that is strictly defined as the time for radioactivity of an isotope to fall by 50%) of Pb atoms in blood is very different from that in the organs where it accumulates. If Pb atoms are injected into blood, half are gone in approximately 3 weeks. In contrast, those that reach and enter brain cells remain for 1 to 2 years. Most Pb …

Validation of a Machine Learning Model to Predict Childhood Lead Poisoning

Childhood lead poisoning causes irreversible neurobehavioral deficits, but current practice is secondary prevention. To validate a machine learning (random forest) prediction model of elevated blood lead levels (EBLLs) by comparison with a parsimonious logistic regression. This prognostic study for temporal validation of multivariable prediction models used data from the Women, Infants, and Children (WIC) program of the Chicago Department of Public Health. Participants included a development cohort of children born from January 1, 2007, to December 31, 2012, and a validation WIC cohort born from January 1 to December 31, 2013. Blood lead levels were measured until December 31, 2018. Data were analyzed from January 1 to October 31, 2019. Blood lead level test results; lead investigation findings; housing characteristics, permits, and violations; and demographic variables. Incident EBLL (≥6 μg/dL). Models were assessed using the area under the receiver operating characteristic curve (AUC) and confusion matrix metrics (positive predictive value, sensitivity, and specificity) at various thresholds. Among 6812 children in the WIC validation cohort, 3451 (50.7%) were female, 3057 (44.9%) were Hispanic, 2804 (41.2%) were non-Hispanic Black, 458 (6.7%) were non-Hispanic White, and 442 (6.5%) were Asian (mean [SD] age, 5.5 [0.3] years). The median year of housing construction was 1919 (interquartile range, 1903-1948). Random forest AUC was 0.69 compared with 0.64 for logistic regression (difference, 0.05; 95% CI, 0.02-0.08). When predicting the 5% of children at highest risk to have EBLLs, random forest and logistic regression models had positive predictive values of 15.5% and 7.8%, respectively (difference, 7.7%; 95% CI, 3.7%-11.3%), sensitivity of 16.2% and 8.1%, respectively (difference, 8.1%; 95% CI, 3.9%-11.7%), and specificity of 95.5% and 95.1% (difference, 0.4%; 95% CI, 0.0%-0.7%). The machine learning model outperformed regression in predicting childhood lead poisoning, especially in identifying children at highest risk. Such a model could be used to target the allocation of lead poisoning prevention resources to these children.

PIH36 TIME TO CONFIRMATORY TESTING OF CHILDREN AGE

Lead is a potent neurotoxin, with young children especially vulnerable to its toxic effects. In 2012, the CDC Advisory Committee on Childhood Lead Poisoning Prevention (ACCLPP) issued recommendations for primary prevention. Even low levels of lead exposure can cause lifelong health and behavioral problems, so ACCLPP recommends confirmatory re-testing of children with elevated blood lead (BPb) test results (≥5 μg/dL) within 3 months, with higher BPb needing quicker action. We used linked claims and laboratory test results to assess provider adherence to these testing guidelines. We accessed data from the IBM MarketScan Laboratory database for individuals with employer-sponsored insurance. We identified children age <72 months who had a BPb test result of 0-200 μg/dL from 1/1/2013 – 6/30/2017 and were continuously enrolled for 179 days after the test using BPb test LOINC codes (5671-3, 77307-7, and 10368-9). We dichotomized results into “elevated” (5-200 μg/dL) and “not-elevated” (0-4.9 μg/dL). We searched the database for subsequent BPb tests within 89 and 179 days of the initial test. 24,652 insured children age <72 months were tested during this period, of whom 235 (<1%) had an elevated initial test result and were continuously enrolled for 179 days after that test. 79/235 children (34%) had a second test within 89 days (median time-to-second test: 32 days), while 36/235 (73%) children had a second test between 90-179 days (median: 121 days). The remaining 120/235 children (51%) were not re-tested, including 31 children with BPb ≥10 μg/dL. Among children re-tested (n=115), 48 (41.7%) had a second elevated test. Prompt confirmatory testing of children with elevated BPb is important to determine the appropriate course of action. Children not re-tested may miss opportunities for secondary prevention through nutritional assessments and reduction of environmental lead hazards.