I created my “Pediatric Lead Poisoning Case Management Program” for Hudson Health Plan (HHP) in 1996 but lead poisoning is an age-old story that dates back thousands of years. In fact, historians believe that much of ancient Rome’s affluent class suffered from lead-induced gout. Later in history Ludwig van Beethoven suffered from lead poisoning. With the recent recall of millions of children’s lead contaminated toys, new attention is being paid to the astonishing fact that lead poisoning is still hurting thousands of children across our county. The primary source of lead poisoning is lead-based paint, and normal hand-to-mouth behavior of toddlers put children at a risk. Their growth and development can be affected by small amounts of exposure, and with greater exposure the kidneys and central nervous system can be damaged.
I have case managed 160 lead-poisoned children over the years, but it is one particular case of a 2-year-old boy that I am especially proud of. Abner was a beautiful child who had just moved to our area from Mexico. I was quickly introduced to him through the review of our daily hospital census. There he was, a new admission to the hospital with an incredible blood lead level of 60 micrograms per deciliter. Normal acceptable levels are below 10 micrograms per deciliter. My immediate goal was to reduce the blood lead level as quickly as possible, remove the source of the poisoning, and ensure a safe environment to prevent neurological damage. Abner’s story begins.
As the leader of the case management program, I immediately called upon the interdisciplinary team, which included the local Department of Health, physicians, the hospital case manager, a specially trained home care agency, and my very valuable Spanish-speaking case manager assistant.
Thankfully, Abner’s hospital stay went well. He responded well to his oral chelation therapy, succimer, but psychosocial problems were about to begin. The environmental inspection revealed that the family’s current housing was a “lead hazard” and Abner could not return home. Without local family, his frightened mother did not know where to turn. She and I established a comfortable relationship, and she was grateful when I assisted with the coordination of a temporary stay in the local “safe house.” Unfortunately, transition of care often does not go smoothly. At the time of Abner’s discharge, the hospital staff provided a prescription for succimer, not realizing that it could not be obtained at the local pharmacy. Through my case management resources, I was able to have the medication delivered to my office and transferred to the safe house. With proper medical treatment, individualized family education, home care visits and participation in HHP’s culturally sensitive “Pediatric Lead Poisoning Case Management Program,” Abner did remarkably well. He is now an active normal 8 year old.
It is said that “our children are our future.” One of my proudest moments as a nurse case manager is when I saved the future of one child. He was not affluent or famous, but he was loved by his family.
