Expanding the physician's role in pediatric environmental health

In rural Georgia, a nurse and an environmental health specialist from the local health department visit the home of a young nursing mother to evaluate her home for the presence of lead hazards. The mother's older child, a 3-year old girl, has a blood lead level of 22 micrograms per deciliter, which was discovered through routine (EPSTD) health department screening. In examining the home, the specialist finds classic environmental risks; peeling and chipping lead-based paint on windows and door frames, lead dust on window wells and floors, and a backyard that serves as a burial ground for defunct car parts and dead batteries. In the course of talking with the mother about the lead hazards he has found, he notices that she and her 8-week-old infant seem quite listless, so he asks the mother how she's coping with her new baby. Eventually, the mother discloses that during her pregnancy she craved dirt and that she had eaten bowels of it scooped from her backyard. Once she had the baby, she says, she lost her craving. The nurse immediately contacts the physician involved in this case, who arranges for the mother and infant to be admitted to a nearby medical center for chelation therapy. Testing reveals the mother's lead level at 90 micrograms per deciliter; the infant's level is staggering 85 micrograms per deciliter. Once lead levels are reduced,the physician and public health nurse arrange for a host of social services, including psychological and nutritional counseling for the mother and periodic retesting of the children. The family moves from the dilapidated rental home. However, the mother misses her appointments, and despite repeated attempts to locate her, the family is lost to follow-up.