updated 5/10/2005 7:49:57 PM ET 2005-05-10T23:49:57

Children who are poor often don’t get the medical follow-up they need for lead exposure, and those at highest risk for lead poisoning are the least likely to get additional testing, a study in Michigan found.

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The study involved 3,682 children in the Medicaid program whose blood tests showed levels of lead that could harm mental function. Only about half the children — 54 percent — had follow-up testing within six months, the researchers said.

Follow-up screening to see if initial blood-lead levels have changed is a key step in monitoring cases, said lead author Dr. Alex Kemper, an assistant pediatrics professor at the University of Michigan. Such testing typically precedes treatment.

Although the research focused on Michigan children, similar results likely would be found elsewhere, Kemper said.

The children in the study already are at risk for lead poisoning because they’re more likely than affluent youngsters to live in homes built before lead-based paint was outlawed, or in areas near factories and other sources of lead, Kemper said.

Medicaid children with other risk factors for lead exposure — minorities and those in urban areas — were the most likely in the study not to receive follow-up testing.

These children fall through the cracks for several reasons, Kemper said. Parents might not always be notified when their children have higher lead levels or they may not know they should seek additional screening. Some doctors might not pursue follow-up testing for low-income patients, figuring that remedies including paint removal might be impossible for patients with few resources.

Even in more affluent areas, public health officials lack resources or legal muscle for lead abatement, said Dr. Bruce Lanphear, a researcher at Cincinnati Children’s Hospital.

“There’s probably enough blame to go around,” said Lanphear, who wrote an editorial accompanying the study in Wednesday’s Journal of the American Medical Association.

Lead can interfere with development of the central nervous system and severe lead poisoning can cause seizures and even death. Lead-linked declines in mental functioning may be permanent, Lanphear said.

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