Make long term developmental surveillance a component of the management plan for any child with a blood lead level (BLL) $ 20 Fg/dL, while recognizing that this will not necessarily result in referral for diagnostic assessment or intervention. Also consider developmental surveillance for a child who has a BLL that does not exceed 20 Fg/dL but who has other significant developmental risk factors. Do not base decisions regarding developmental assessment or intervention on a child’s age at the time the child is found to have an elevated blood lead level (EBLL). If you wish to refer a child with an EBLL for intervention services, consider referring that child to early intervention/stimulation programs. Include a history of a child’s EBLL in the problem list maintained in the child’s medical record. • Do not stop developmental surveillance when a child with an EBLL reaches age 6 or when the child’s blood lead level is reduced. A responsible party (e.g., the child’s PCP) should provide ongoing developmental surveillance of that child after the EBLL case is closed. In the developmental surveillance of children with EBLLs: — Watch for emerging difficulties at critical transition points in childhood: first, fourth, and sixth/seventh grades. — Watch for behaviors that interfere with learning, such as inattention and distractibility. Refer children experiencing neurodevelopmental problems for a thorough diagnostic evaluation. Be advocates for the child
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