Lead poisoning, especially in children, hasmade headlines in recent years, for good reason. The condition,found in more than 500,000 U.S. children, can lead to lifelongdelays, including damage to the brain and nervous system; slowedgrowth and development; learning and behavior problems; and hearingand speech issues.

The most recent blast of headlines began with the crisis in Flint, Michigan. After the citystarted drawing drinking water from the Flint River in 2014, thenumber of children under six years of age with high levels of leadin their blood almost doubled. Those rates returned to normal levels after Flintwent back to its original drinking water source – Detroit's watersystem. Several officials face charges in the case.

But those headlines have only continued as further research hasuncovered high levels of lead poisoning among children across thecountry. One examination by the news agency, Reuters, discoverednearly 3,000 U.S. communities with high rates of leadpoisoning among their youngest residents.

Insurance claims involving lead contamination require aninvestigation beyond a child's medical records. (Photo:iStock)

More claims & cases

This renewed concern means more claims related to leadpoisoning, a condition the Centers for Disease Control andPrevention (CDC) calls the “most preventable environmental diseaseamong young children.”

But to truly understand the medical records and history in thosecase files and get to the bottom of the cause, insurers need toexplore more than just the patient's health information.

Everything from whether the child ever lived outside of thecountry to what products the family uses to the child's own genetichistory are critical for a fully informed review of a leadpoisoning case or claim.

Related: Get the lead out: Drinking water contaminationclaims and liability

While water is a frequently a source of lead contamination,other factors can like toys and residue from a parent's job shouldalso be considered. (Photo: Shutterstock)

Aware for decades

The public and officials have been aware of the dangers of lead for decades. In the 1950s, thefirst cities started passing laws about lead-based paint. Thefederal government didn't take action until the 1970s.

In 1978, legislators banned the residential use of lead-basedpaint. When coupled with the phase down of the use of lead ingasoline, researchers documented a big drop in the average blood lead levels inthe United States.

These days, the most common sources of lead aren't from housepaint or gasoline, but regular exposure to things such as toys,nutritional supplements, water in lead pipes, or residue from aparent's occupation and dishware, among other items.

According to the American Academy of Pediatrics, the annual cost of childhood lead exposure in the UnitedStates is $50 billion. Lead toxicity is blamed for the loss of 23million IQ points among children and is attributed to 20 percent ofcases of AD/HD.

Lead paint chips have been a frequent cause of poisoning inchiidren. (Photo: Shutterstock)

Today's goal: Prevention

Now the focus is on stopping lead exposure before it happens.According to the CDC, there is no safe blood lead level inchildren.

“Even low levels of lead in blood have been shown to affect IQ,ability to pay attention and academic achievement,” according tothe federal agency. “And effects of lead exposure cannot becorrected.”

Federal agencies and states across the United States haveenacted their own lead laws to reduce lead poisoningrates. Here are some basic facts to know about lead poisoning, howit's diagnosed and who is at risk, according to the CDC:

• A simple blood test, which is covered by Medicaid and mostprivate health insurance, can measure lead levels in a child. Forthose enrolled in Medicaid, all children are required to receivescreening tests at age 12 months and 24 months. Any child between24 and 72 months with no record of a previous test should receiveone, according to the Centers for Medicare and MedicaidServices.
• All children should be screened for lead poisoning, but thoseages six months to six years, who live in or regularly visit“deteriorated old buildings,” are the highest priority group.
• Children with unexplained seizures, neurological symptoms,abdominal pain and other symptoms, which could indicate leadpoisoning, should be tested. So should children with developmentaldelays, slow growth, hyperactivity, hearing loss, anemia andbehavioral disorders.
• A lead level of 5 micrograms per deciliter in a child indicatesa “blood lead level of concern,” according to the CDC, and requiresmedical management.
• Medical treatment is recommended when the level is greater thanor equal to 45 micrograms per deciliter of lead in the blood.

Car keys, jewelry and some toys may contain lead. (Photo:Shutterstock)

Assessing exposure

The American Academy of Pediatrics recommendspediatricians assess lead exposure risks at well-child visits untila child is six. Tests, however, are recommended only if theassessment indicates there is risk that a child could have beenexposed.

The academy's lead exposure risk assessment seeks answers to thefollowing questions:

• Does the child regularly visit or live in a house built before1978 with peeling or chipped paint?
• Has the child or family lived outside the United States?
• Does the child have a sibling or family member being followedfor lead poisoning?
• Does the child frequently put things in his mouth such as toys,jewelry or keys?
• Does the child eat nonfood items because of a disorder such aspica?
• Does the child frequently come into contact with an adult whosejob or hobby involves exposure to lead?
• Does the child live near an active lead smelter, batteryrecycling plant or other industry likely to release lead? Or, doesthe child live near a heavily traveled road where soil and dustcould possibly be contaminated with lead?

When investigating a lead claim, include a complete reviewof medical records for the child and other family members. (Photo:Shutterstock)

Full medical review required

While the results of a blood test for lead may be simple toread, for attorneys and insurance adjusters, lead poisoning casesaren't always clear cut. Many factors – not just the old buildingwhere they attend daycare or regularly visit their grandmother –must be investigated.

If you're looking over a lead poisoning claim, here is themedical information that's essential to build any case:

• Complete medical records, including infant and child growthpercentiles with height, weight and head circumferencemeasurements; labs; and documentation of well-child check ups.
• All testing and lab results for the individual.
• A full medical history of family members, including theirgenetics, that could identify any underlying medical, developmentalor cognitive issues that could account for or contribute to theallegations of lead poisoning.
• Research into the individual's geographic area, especially thetown and building in question, to uncover any other claims orpossible environmental factors such as lead in the water.

Children can pick up lead from household dust, soil, dishesor toys that have been passed down for generations. (Photo:Shutterstock)

More than medical records needed

Attorneys and adjusters also must look beyond the medicalrecords. Here are other questions you should ask about theclaimant:

• What are the parents' occupations? Could a child be picking uplead from residue left on their parents' clothes and shoes, ortracked in from their workplaces? The National Institute forOccupational Safety and Health lists nearly two dozen jobs that could lead to leadexposure.
• Does the family use Mexican folk remedies which may containlead, such as greta, azoque and azarcon? The CDC lists otherfolk medicines that may contain lead.
• Is drinking water contaminated with lead?
• How old is the claimant? Babies and toddlers are at the highestrisk because they play on the floor, picking up contaminants ontheir hands and skin and putting anything in their mouth.
• Does the child chew on toys, which possibly contain lead paint?Since 2008, the Consumer Product Safety Commission has recalledabout 50 toys because of lead.
• Are foods stored in containers high in lead such as leadedcrystal, pottery or pewter?
• Is the claimant exposed to household dust which contains leadfrom lead paint chips or contaminated soil brought in from theoutside?
• How is the child doing in school? Are there behavioral andcognitive test results to review?
• Have a developmental behavioral pediatrician, toxicologyspecialist and genetic specialist been consulted? Some geneticdisorders can cause cognitive and neurological disorders that atfirst glance may appear to be lead poisoning. These experts couldprovide critical information into the child's well being.
• Do other family members, especially children, have elevatedlevels of lead? If not, genetics may be the culprit.

After all, genetics and not lead exposure could cause learningdelays that might be attributed to lead poisoning. A favorite oldtoy, passed down from a grandparent, could be full of lead. Or,grandma's remedy for colic could be behind the high leadlevels.

In other words, a clear understanding of the clinical, genetic,cognitive and environmental presentation – and not just the medicalhistory – is critical when analyzing an alleged case of leadpoisoning. Attorneys and adjusters who don't have the full picturecould miss the details that might just make or break a case.

Kari Williamson, BS, RN, LNCC, CCM ([email protected]) is thepresident of MKC Medical Management, and works with attorneys,insurance examiners and others within the medical-legal-insurancespace to better manage and understand claim issues.

• Explore more than the patient's health information.
• Be familiar with the common sources of lead poisoning – e.g.,toys, pottery, nutritional supplements, lead pipes.
• Federal agencies and states have enacted their own laws.
• Children exhibit a number of symptoms related to lead poisoningthat require additional testing.
• A full medical review includes the family history in additionto the patient.