Guidelines for the Blood Lead Testing of Refugee Children and Refugee Pregnant Women

Introduction

New York State Public Health Law 1370-a and implementing regulations (10 NYCRR Subpart 67-1.2(a)(1) and (3)) establish the requirements for blood lead testing of all children at one year of age and again at two, and assessment of risk for lead exposure at each well child visit and at least annually for each child six months to six years of age. Additionally, NYS regulations (10 NYCRR Subpart 67-1.2(a)(4)) authorize the Commissioner of Health to provide recommended alternative schedules for other high risk groups.

Newly arrived refugees may have compromised nutritional status and may use imported or homemade folk remedies, spices, foods and cosmetics that contain lead. They may also lack awareness about the dangers of lead. Additionally, upon arrival to the United States, refugee children and pregnant women may be more likely to be living in older homes where the presence of lead hazards is more likely. The Centers for Disease Control (CDC) has recommended a vigilant approach to the prevention and treatment of lead poisoning for refugee children1. A similar approach should be utilized with refugee pregnant women to protect them and the developing fetus as well.

Recommendations for Testing All Refugee Children and All Refugee Pregnant Women for Lead Poisoning

  • 1. Perform blood lead testing for all refugee children birth to 16 years old and all refugee pregnant women upon entering the United States.
  • 2. Repeat blood lead testing of all refugee children less than 16 years of age and all refugee pregnant women three to six months after they obtain permanent residence, regardless of initial blood lead test results.
  • 3. Perform nutritional evaluations for all refugee children and pregnant women; offer appropriate nutrition education; and provide vitamin supplements as indicated.
  • At a minimum, the nutritional evaluation for children should include a hemoglobin/hematocrit and one or more of the following:
    • mean corpuscular volume (MCV) combined with red cell distribution (RDW);
    • ferritin;
    • transferring saturation; or,
    • reticulocyte hemoglobin content.
  • 4. In addition to the requirements for newly arrived refugees, continue to perform risk assessment for lead exposure for refugee children at each well-child visit or at least annually for each child six months to six years of age. If the child is determined to be at risk of lead exposure, a blood lead test is required to be done. Refer to http://www.nyhealth.gov/environmental/lead/exposure/childhood/risk_assessment.htm.
  • 5. A refugee woman who becomes pregnant after arrival in the US should receive lead testing as part of prenatal care. Foreign-born status and having lived or spent any extended time outside the US are considered risk factors for lead exposure and should prompt testing a pregnant woman for lead.

Protecting Refugee Children and Pregnant Women from Lead Exposure

Ideally all children and pregnant women would live in lead-safe housing, especially those whose nutritional status may be compromised. Resettlement agencies and their staff are essential in helping families identify housing free of chipped or peeling paint, promoting awareness of lead hazards and offering education about reducing lead exposure. Health care providers are required to provide anticipatory guidance on lead poisoning prevention during routine well child care and during prenatal care visits.

The Department of Health has educational materials in multiple languages available free of charge to assist with lead poisoning prevention educational efforts. Go to the Department's website for a list of the educational materials and an order form:

http://www.nyhealth.gov/forms/order_forms/lead.pdf.

1CDC Recommendations for Lead Poisoning Prevention in Newly Arrived Refugee Children
http://www.cdc.gov/nceh/lead/Publications/RefugeeToolKit/pdfs/CDCRecommendations.pdf