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Childhood lead poisoning, which is entirely preventable, is one of the most common pediatric health problems in the United States today. We know enough about the sources and pathways of lead exposure and how to prevent lead poisoning to permanently eliminate this disease. Children are particularly vulnerable to lead's toxic effects. Lead poisoning, for the most part, is silent. Most poisoned children have no symptoms and lead poisoning effects are irreversible. The vast majority of cases, therefore, go undiagnosed and untreated. Lead poisoning is widespread throughout New Hampshire. It is not solely a problem of inner city or minority children. Unfortunately, no socioeconomic group, geographic area, or racial or ethnic population is spared.

The New Hampshire Healthy Homes and Lead Poisoning Prevention Program (HHLPPP) coordinates statewide efforts to eliminate lead poisoning for all ages. This includes tracking cases of blood lead levels for children and adults, and providing outreach and education for children under the age of six years old with elevated blood lead levels above 5 micrograms per deciliter (mcg/dl). Children under the age of six with an elevated blood lead level greater than 7.5mcg/dl receive nurse case management services.

Contact LeadRN@dhhs.nh.gov for more information.

Recent Changes to NH’s Childhood Lead Poisoning Laws:
What NH Pediatric Health Care Providers Need to Know

The signing of NH Senate Bill (SB) 247 by Governor Sununu on February 8, 2018, represented a major step forward in protecting New Hampshire Children from lead poisoning. This legislation brings a number of changes to NH’s childhood lead poisoning statutes. All NH pediatric healthcare providers are impacted by these changes.

Here are the key points of the new legislation:

  • Universal Pediatric Blood Lead Level (BLL) Testing
    As of April 9, 2018, NH has become a Universal Testing state. BLL testing of all 1 and 2 year-old children is now required by law – this means every child needs at least two tests. Parents/guardians retain the right to decline BLL testing for their child, but providers must inform the parent/guardian of the requirement and associated risks of not having a child’s BLL tested, and then properly document the refusal in the patient’s medical record. A written opt-out form for parents/guardians will be developed by NH DHHS to facilitate clinician discussions. Amending child immunization record reports to include space for two BLL tests dates and results is suggested. As two BLL tests are now required by NH law, this information can be requested on health forms required by child care centers and public schools.
  • Lowers the BLL triggering of action by NH Division of Public Health Services
    The current ‘action level’ at which public health nurses and lead inspectors visit a child’s home and a child enters case management is 7.5 µg/dL as of July 1, 2019, This action level will be reduced to 5µg/dL as of July 1, 2021. This level, 5µg/dL, is the current ‘action level’ recommendation by the Centers for Disease Control and Prevention.

The new legislation also lowers the BLL at which the Division of Public Health Services (DPHS) is required to notify parents/guardians by letter to ensure they understand the consequences of lead poisoning and the steps that can be taken to avoid lead hazards. DPHS will now be sending information to parents/guardians of all children whose blood lead level tests results are >3µg/dL.

Resources Available for Pediatric Health Care Providers
Childhood Lead Poisoning Medical Management Quick Guides and On-site Education

In response to the passing of SB247, the NH Division of Public Health Services has updated the medical management quick guides that are available for pediatricians to use in exam rooms. The laminated medical management quick guides include:

Child Medical Management Provider Quick Guide POC Lead Testing With LeadCare II Analyzer Quick Guide
Child Medical Management Provider Quick Guide Adobe Acrobat Reader Symbol (revised September 2019) POC Lead Testing with LeadCare II Analyzer Quick Guide Adobe Acrobat Reader Symbol (revised September 2019)

Laminated quick guide reference sheets for exam rooms are available at no cost by request.

Short educational sessions on NH’s the new childhood blood lead level testing requirements, medical management guidelines, surveillance data and the services provided by the DPHS nurse case management staff can be scheduled at medical practice or hospital affiliate sites at no cost. Education sessions can readily be arranged before clinic hours, lunchtime, or during evening for your convenience.

For more information about any of these resources, contact Gail Gettens, MS, Child Development Specialist and Health Promotion Advisor, Division of Public Health Services, Healthy Homes and Lead Poisoning Prevention Program at gail.gettens@dhhs.nh.gov or (603) 271-1393.

Adults and Lead

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New Hampshire Department of Health and Human Services
129 Pleasant Street | Concord, NH | 03301-3852


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