AB 1316 (Quirk) would require all children to have their blood tested for lead exposure, which exceeds AAP recommendations for lead testing and could divert resources away from lead abatement, lead water testing, and other important public health efforts.
AAP Positional Letter
April 19, 2017
The Honorable Jim Wood
Chair, Assembly Health Committee
State Capitol, Room 6005
Sacramento, CA 95814
Fax: (916) 319-2102
AB 1316 (Quirk): Public health: childhood lead poisoning: prevention
AAP-CA Position: OPPOSE
Dear Chair Wood:
The American Academy of Pediatrics, California (AAP-CA), representing over 5,000 California pediatricians from all four California AAP chapters, respectfully opposes proposed legislation AB 1316 (Quirk). This bill would require that all California children be screened for blood lead levels.
We fully support efforts to reduce lead poisoning, and we appreciate both the author’s intent in crafting this legislation and his willingness to hear our concerns. However, as written, we cannot support this legislation. Neither the Centers for Disease Control (CDC) nor the national American Academy of Pediatrics recommends universal lead testing: “The recommendation is to do a risk assessment, and do a blood lead level test only if the risk assessment comes back positive. According to the AAP and CDC, universal screens or blood lead level tests are not recommended anymore except for high prevalence areas with increased risk factors as described in a 2012 CDC report, such as older housing” (“Detection of Lead Poisoning,” American Academy of Pediatrics, 2016).
Universal risk assessment for lead exposure is already the standard of care for California children, with blood testing reserved for those who are deemed at risk of lead poisoning. Screening children for lead poisoning who have one or more of risk factors is sufficient to catch the overwhelming majority of lead poisoning cases, as pediatricians are extensively trained to identify risks for lead exposure, such as living in a pre-1978 home, proximity to certain industrial sites such as battery recycling plants, and even the eating of non-food substances (pica). Given that no treatment for lead exposure has been shown to improve neurological outcomes, it is critical that we focus our limited resources on preventing lead poisoning before it occurs by removing sources of lead from the environment. As AAP policy states, “Primary prevention, reducing or eliminating the myriad sources of lead in the environment of children before exposure occurs, is the most reliable and cost-effective measure to protect children from lead toxicity” (“Prevention of Childhood Lead Toxicity,” Policy Statement, June 2016).
Since the sources of lead contamination have been known for some time, it is incumbent on us to act upon this knowledge by reducing lead-based environmental hazards. Among AAP recommendations for state governments are: to develop policies and regulations requiring the remediation of lead-contaminated housing and child care facilities; to collect, analyze, and publish blood lead test results performed in their jurisdictions and to regularly publish reports of age of housing and other risk factors for children having blood lead concentrations ≥5 µg/dL (≥50 ppb); to provide resources for environmental evaluations and case management of children who have blood lead concentrations ≥5 µg/dL (≥50 ppb), in conjunction with the child’s primary care provider; and to ensure that water fountains in schools do not exceed water lead concentrations of 1 ppb (“Prevention of Childhood Lead Toxicity,” Policy Statement, June 2016). We hope to collaborate with you and your colleagues on such projects in the future.
We sincerely appreciate the author’s efforts to improve the health and well-being of California children. However, we do not believe that universal blood lead testing is appropriate at this time, and we oppose this bill as currently written. As such, we respectfully urge a NO vote on AB 1316 (Quirk).
California pediatricians thank you for your public service and leadership, and we are grateful for this opportunity to relay our concerns about this proposed legislation.
Jacques Corriveau, M.D., Fellow of the American Academy of Pediatrics
Chair, State Government Affairs Committee, American Academy of Pediatrics, California
CC: Kris Calvin, CEO; AAP-CA Leadership; Lydia Bourne; The Honorable Bill Quirk