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Should You Test Your Children?

Old Paint, Young Victims. FIRST OF 2 PARTS.


Despite a recommendation last year by the American Academy of Pediatrics that pediatricians test all their patients under 6 years old for lead poisoning, many parents who want the test find their doctors reluctant to arrange it.

"I think if they haven't dealt with lead poisoning, it's easier to pretend it doesn't exist," said Dr. Routt Reigart, professor of pediatrics at the Charleston-based Medical University of South Carolina and chairperson of the AAP committee on environmental health, which drafted the AAP rule.

"Because it's a long-term chronic disease, it's not a short-term commitment (for the doctor). They need to work with the public health agencies to find out how the child was exposed, so it's a more than just treating an ear infection."

Reigart and others who support routine screening consider lead poisoning one of the foremost health threats faced by children nationwide. And recent studies by the Atlanta-based Centers for Disease Control say lead--even at low levels in the blood--is far more toxic to children than once believed.

But not all physicians agree with that.

Among the most vocal opponents is Dr. Edgar J. Schoen, a pediatrician with Kaiser Permanente Hospital in Oakland. Schoen says that lead poisoning is no longer a significant threat to U.S. children and that routine testing--which typically costs between $10 and $75 a test--is a waste of money.

"There's a lot of defective data out there being quoted," he said of the studies that show otherwise. ". . . and it's politically incorrect to question it."

Schoen says scientific data on the neuro-behavioral effect of low blood-lead levels are still "controversial" and "inconclusive."

He believes society would be better served by widespread education.

"What you want to do is teach parents there is a risk," he said. "If you live in an area with old homes and peeling paint then yes, your child should be tested."

Dr. Leonard Kutnik, a pediatrician with the Claremont Pediatric Medical Group in San Diego and an AAP district chairman, said he too has reservations about the AAP's recommendation.

"There's the physical pain (to the patient) of the blood being drawn and you don't want to create any pain or discomfort if you don't need to," he said. "Then there's the economic issue. We don't have enough dollars to do the things we should do . . . and we don't want to waste the dollars."

Kutnik said that of about 40 children tested for lead poisoning under a Medicaid and Medical program in San Diego, none had elevated lead levels, leading him to believe San Diego children may not benefit from universal blood lead testing.

"But until we can show that, the decision was made that the best way to protect a majority of children from something that could be harmful was to perform universal screening," said Kutnik, who voted in favor of the AAP recommendation.

Dr. Robert Adler, head of the general pediatrics and Childrens Hospital Los Angeles and president of the AAP's Los Angeles chapter agreed: "I'm not advocating that we continue a lead screening program for many years. If there is no identified danger in a community, I think it can be dropped."

Until recently, Adler said he didn't consider lead poisoning a serious problem for California children.

"But when I started doing more extensive lead screening . . . I was surprised to see the number of children that we've identified with lead toxicity."

Moreover, he said, those suffering from the disease "by far and away have not shown any clinical symptoms that would have been picked up by (a routine) examination."

But Schoen and his supporters are unswayed in their opinion that lead poisoning isn't a serious threat to children, including the urban poor, who have long been considered at greatest risk.

"The last thing in the world these kids need is their blood level tested," Schoen said. "They're not immunized, they're not getting proper nutrition, they can get shot in the street. Their threat from lead comes from a barrel of a gun."

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