General Pediatrics 2

In children there is a physiologic anemia. Often it occurs - it peaks between 2 and 3 months of age. Most children will get down to a range of around 11 in about 3 months. Some people advocate screening between 9 and 12 months. It’s a peak age for iron deficiency if they have switched off iron formulas. Some people advocate 24 months. Another point is that if you do a peripheral hematocrit it could be lower than central so that if they are anemic, you should probably do a central test. Just a picture of a tiny child that can show up. Pale mucous membrane, pale skin. You see what are called red lines, concentrated dense lines at the growth centers.
Lead Poisoning. In the 1980’s the average lead level was about 12. In 1991 the average lead level in our population was 3. Leaded paint has been eliminated for the most part in this country, but even today some paint is still leaded. Leaded gasoline, industrial lead, and car batteries and then all this miscellaneous. Sometime lead-containing ceramic vessels. The point is that young children are particularly at risk for lead poisoning because of their hand-to-mouth exposure. And also through the respiratory tract. In the past we used to use the erythrocyte protoporphyrin test as a screen. It’s no longer recommended. It was only useful when sort of there were a lot of levels above 30. Venous lead level is the test to use. You do a finger first and then you do a venipuncture if it’s elevated. And the big news is, as most of you know this, is that we have
lowered our level of what’s acceptable. Any child that’s screened that has a level of 10, an environmental assessment needs to be done.
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