Lead Poisoning in Wisconsin for Parents

1. Good (morning, afternoon, evening) Introduce yourself I have been working with the Wisconsin Childhood Lead Poisoning Prevention Program (WCLPPP) and the Wisconsin Adult Blood Lead Surveillance Epidemiology (ABLES) Program so that I could present information about lead exposure and lead poisoning to you. While lead was taken out of paint in 1978 and out of gasoline in the early 1980�s, you will see that children and adults in Wisconsin are still being poisoned with devastating results to their health. Good (morning, afternoon, evening) Introduce yourself I have been working with the Wisconsin Childhood Lead Poisoning Prevention Program (WCLPPP) and the Wisconsin Adult Blood Lead Surveillance Epidemiology (ABLES) Program so that I could present information about lead exposure and lead poisoning to you. While lead was taken out of paint in 1978 and out of gasoline in the early 1980�s, you will see that children and adults in Wisconsin are still being poisoned with devastating results to their health.

2. Lead Poisoning in Wisconsin Wisconsin specific data Cause and effects of childhood, youth & adult lead poisoning Sources of lead exposure for children, youth and adults What should you do if you are lead poisoned How to prevent lead poisoning Resources for information Today I will talk with you about : Lead Poisoning in Wisconsin The cause and effects of lead on children, youth and adults Sources of lead exposure What you should do if you or your child is lead poisoned How you can prevent lead poisoning Provide Resources for informationToday I will talk with you about : Lead Poisoning in Wisconsin The cause and effects of lead on children, youth and adults Sources of lead exposure What you should do if you or your child is lead poisoned How you can prevent lead poisoning Provide Resources for information

3. Introduction Lead poisoning is the most serious environmental health threat facing young children in the U.S. Lead poisoning interferes with the normal development of a child�s brain causing learning difficulties and a greater likelihood of behavior problems. Read Slide-Read Slide-

4. Introduction Lead poisoning can be prevented by: Controlling lead hazards Decreasing lead exposure Many people believe that children are poisoned by eating paint chips that contain lead, which is sometimes the case. However, most children in Wisconsin are poisoned by lead dust that is created by chipping and peeling paint. Lead dust can be so fine that it isn�t always clearly visible. If old paint is on the floors and the floors get scuffed by the impact of shoes on the floor it creates dust that contains lead. If old paint is on the windows, then the friction of the window being raised and lowered creates dust that contains lead and it falls into the window well. (A place where children love to play!) Then this lead tainted dust gets on the child�s hands and into their mouths. The critical areas where lead dust is found are windows, floors and porches. I will show you later how youth and adults are often poisoned.Many people believe that children are poisoned by eating paint chips that contain lead, which is sometimes the case. However, most children in Wisconsin are poisoned by lead dust that is created by chipping and peeling paint. Lead dust can be so fine that it isn�t always clearly visible. If old paint is on the floors and the floors get scuffed by the impact of shoes on the floor it creates dust that contains lead. If old paint is on the windows, then the friction of the window being raised and lowered creates dust that contains lead and it falls into the window well. (A place where children love to play!) Then this lead tainted dust gets on the child�s hands and into their mouths. The critical areas where lead dust is found are windows, floors and porches. I will show you later how youth and adults are often poisoned.

5. Wisconsin-Specific Data Where are the problems in Wisconsin?Where are the problems in Wisconsin?

6. Each red dot on this map represents an address associated with a lead-poisoned child from 1996-2010. More than 46,000 children in Wisconsin have been lead poisoned. (This number would fill the Miller Park where the Milwaukee Brewer�s hold their baseball games.) You see that children have been found to be lead poisoned in every county in the state. That�s because old homes with chipping and peeling lead-based paint are found in every county in the state. .Each red dot on this map represents an address associated with a lead-poisoned child from 1996-2010. More than 46,000 children in Wisconsin have been lead poisoned. (This number would fill the Miller Park where the Milwaukee Brewer�s hold their baseball games.) You see that children have been found to be lead poisoned in every county in the state. That�s because old homes with chipping and peeling lead-based paint are found in every county in the state. .

7. Wisconsin vs. U.S. The rate of lead poisoning in Wisconsin in 2006 was more than double the national average: 2.5% of Wisconsin children that were tested were found to be poisoned Versus 1.2% of all other children in the U.S. Wisconsin has consistently ranked in the top ten in the nation for the number of children found to be lead poisoned. Wisconsin has consistently ranked in the top ten in the nation for the number of children found to be lead poisoned.

8. 2nd in Midwest States And only second in the Midwest to Illinois.And only second in the Midwest to Illinois.

9. Effects of Lead on Children, Youth and Adults What are the effects of lead?What are the effects of lead?

10. A child is at risk of lead exposure if the child is under the age of 6 and� lives in home or regularly visits a daycare built before 1950 lives in home or regularly visits a daycare built before 1978 with recent renovation/remodeling has a sibling who is lead-poisoned is eligible for Medicaid or WIC services How Lead Affects Children Read the information on the slide� If any of this information describes your family, children under age 6 should be tested for lead. If your child in this age group visits grandparents or friends in an older home, the child may also be at risk. Why do we make a distinction between 1950 and 1978 with recent renovation? Lead was finally banned from paint in 1978. In the period from 1950 to 1978, the paint contained much less lead than it did before 1950. However, if this paint is disturbed it can create a lead dust hazard. That is why we caution about lead poisoning during that time frame if the paint is being disturbed during remodeling activities. Prior to 1950, paint had a much higher concentration of lead. In fact, in Wisconsin 90% of the children that have been found to be lead poisoned lived in a home built before 1950.Read the information on the slide� If any of this information describes your family, children under age 6 should be tested for lead. If your child in this age group visits grandparents or friends in an older home, the child may also be at risk. Why do we make a distinction between 1950 and 1978 with recent renovation? Lead was finally banned from paint in 1978. In the period from 1950 to 1978, the paint contained much less lead than it did before 1950. However, if this paint is disturbed it can create a lead dust hazard. That is why we caution about lead poisoning during that time frame if the paint is being disturbed during remodeling activities. Prior to 1950, paint had a much higher concentration of lead. In fact, in Wisconsin 90% of the children that have been found to be lead poisoned lived in a home built before 1950.

11. Why are young children at greater risk? Normal hand-to-mouth behavior Rapidly developing nervous system - vulnerable to the effects of lead Higher rate of absorption I mentioned previously that children under the age of 6 are susceptible to lead poisoning if they are in a home with lead dust. Why is that? Well, children under 6 are at greater risk due to their behavior and their stage of development. They put everything in their mouths � nuks, toys, hands, fingers, toes�This is the way they explore their world, learn about language, movement, spatial concepts, proximity, etc. The nervous system is going through changes incredibly fast. These are complex and extensive changes which are highly susceptible to the toxic effects of lead as you will see on the next slide. Young children have a much higher absorption rate than adults, approximately 6 times faster, so lead in their system is absorbed more quickly than in older children or adults, who may be poisoned in other ways.I mentioned previously that children under the age of 6 are susceptible to lead poisoning if they are in a home with lead dust. Why is that? Well, children under 6 are at greater risk due to their behavior and their stage of development. They put everything in their mouths � nuks, toys, hands, fingers, toes�This is the way they explore their world, learn about language, movement, spatial concepts, proximity, etc. The nervous system is going through changes incredibly fast. These are complex and extensive changes which are highly susceptible to the toxic effects of lead as you will see on the next slide. Young children have a much higher absorption rate than adults, approximately 6 times faster, so lead in their system is absorbed more quickly than in older children or adults, who may be poisoned in other ways.

12. Brain cells or neurons do not directly touch each other so they communicate across a tiny space about one one-millionth of an inch in size called a synapse. This graph demonstrates the synapse development in the brain of a young child, indicating the most sensitive phase begins just before 12 months (Point there). This sensitive phase continues up to around 6 years of age. Notice that the number of synapses on the left of the graph are in �trillions�. (Point to the LEFT side of the graph). The nerve impulse travels down the neuron and across the synapse to the next neuron. A nerve impulse (like the pain we feel when we stub our toe) can travel the length of a six-foot adult body in two-tenths of one second. A single nerve cell, or neuron, can send 250 to 2500 nerve impulses each second! As this graph shows, many synapses are eliminated as a child ages. Synapses are not efficient at birth and must be used repeatedly to become part of the child�s brain�s permanent circuitry, otherwise that pathway is eliminated for the remainder of the child�s life. Brain cells or neurons do not directly touch each other so they communicate across a tiny space about one one-millionth of an inch in size called a synapse. This graph demonstrates the synapse development in the brain of a young child, indicating the most sensitive phase begins just before 12 months (Point there). This sensitive phase continues up to around 6 years of age. Notice that the number of synapses on the left of the graph are in �trillions�. (Point to the LEFT side of the graph). The nerve impulse travels down the neuron and across the synapse to the next neuron. A nerve impulse (like the pain we feel when we stub our toe) can travel the length of a six-foot adult body in two-tenths of one second. A single nerve cell, or neuron, can send 250 to 2500 nerve impulses each second! As this graph shows, many synapses are eliminated as a child ages. Synapses are not efficient at birth and must be used repeatedly to become part of the child�s brain�s permanent circuitry, otherwise that pathway is eliminated for the remainder of the child�s life.

13. How does lead get into the body? Ingested - mouth (most common source of exposure for children) Inhaled - nose (occupational exposure) Lead dust is not absorbed through the skin. Read slideRead slide

14. The toxic effects of lead on the brain disrupt normal brain development and can affect school performance: Lower IQ Memory problems Learning disabilities Speech and Language delays Hearing loss Low self esteem How Lead Affects Children Lead poisoning is a silent disease, so often there are no symptoms that demonstrate lead poisoning at the time a young child is exposed. Later there may be obvious effects that are seen--usually in first, fourth or seventh grades. (because the style of learning changes and requires more abstract thinking) Read slide. In fact, research published in 2008 explains there is a physical difference in the brain between a child who was lead poisoned versus a child who was not lead poisoned. The lead poisoned child may show lower reading and math scores. Speech and language delays may affect the child so he/she has difficulty understanding what words mean and/or difficulty expressing him or herself. Hearing loss can also occur as a result of lead poisoningLead poisoning is a silent disease, so often there are no symptoms that demonstrate lead poisoning at the time a young child is exposed. Later there may be obvious effects that are seen--usually in first, fourth or seventh grades. (because the style of learning changes and requires more abstract thinking) Read slide. In fact, research published in 2008 explains there is a physical difference in the brain between a child who was lead poisoned versus a child who was not lead poisoned. The lead poisoned child may show lower reading and math scores. Speech and language delays may affect the child so he/she has difficulty understanding what words mean and/or difficulty expressing him or herself. Hearing loss can also occur as a result of lead poisoning

15. The behavioral effects of lead poisoning can result in: Aggression and hostility Hyperactivity and distractibility Classroom disruptions How Lead Affects Children One study demonstrated that adults who had higher blood lead levels as children show a significant reduction in brain volume in the frontal cortex. This is the region of the brain that reasons, judges, solves problems and controls impulses and emotional responses. Read SlideOne study demonstrated that adults who had higher blood lead levels as children show a significant reduction in brain volume in the frontal cortex. This is the region of the brain that reasons, judges, solves problems and controls impulses and emotional responses. Read Slide

16. A young person or adult is at risk of lead exposure if they� Work in an occupation that uses lead Renovate a home that was built before 1978 Have a hobby that uses lead, such as: Reloading bullets or target shooting Casting fishing weights Stained glass or ceramics How Lead Affects Youth and Adults How does lead affect youth and adults? (Read Slide) and return to the paragraph below. Examples of other items that can cause lead poisoning (LP) include: eating from leaded cookware; eating food containing lead (e.g. imported candy); drinking liquids stored in leaded crystal or liquids that contain lead (i.e. moonshine), taking some alternative medicines such as �Ayurvedic� medications) Youth and adults should be tested if they do any of the above. (If there are questions about reloading bullets: in Wisconsin we have had several individuals poisoned from reloading lead bullets and also individuals LP from lead dust at the target shooting ranges if the range isn�t cleaned properly) If there are questions about lead in venison: Leaded bullets shatter and the fragments can spread over a large area. While much of the wound site meat is cut away before processing, fragments can remain so lead can be ingested. How does lead affect youth and adults? (Read Slide) and return to the paragraph below. Examples of other items that can cause lead poisoning (LP) include: eating from leaded cookware; eating food containing lead (e.g. imported candy); drinking liquids stored in leaded crystal or liquids that contain lead (i.e. moonshine), taking some alternative medicines such as �Ayurvedic� medications) Youth and adults should be tested if they do any of the above. (If there are questions about reloading bullets: in Wisconsin we have had several individuals poisoned from reloading lead bullets and also individuals LP from lead dust at the target shooting ranges if the range isn�t cleaned properly) If there are questions about lead in venison: Leaded bullets shatter and the fragments can spread over a large area. While much of the wound site meat is cut away before processing, fragments can remain so lead can be ingested.

17. Symptoms that can be related to lead include: Headaches Dizziness Sleep disturbances Memory problems Muscle/joint aches and pains Irritability Fatigue Nausea, loss of appetite, weight loss Infertility problems, miscarriages How Lead Affects Youth and Adults Adults and youth who are lead poisoned often will not show any symptoms. If they do, they could include any of these: ..Read symptoms on the slide. The CDC Morbidity and Mortality Weekly Report (MMWR) reported many of these symptoms for high school target shooters. Adults and youth who are lead poisoned often will not show any symptoms. If they do, they could include any of these: ..Read symptoms on the slide. The CDC Morbidity and Mortality Weekly Report (MMWR) reported many of these symptoms for high school target shooters.

18. The behavioral effects of teenagers exposed to lead as a child can result in: Increased high school dropout rate Juvenile delinquency Teenage pregnancy 5x more likely to smoke tobacco Committing the most violent crimes as youth and adults. How Lead Affects Youth Not surprisingly then, when children are lead poisoned, the consequences of the decreased volume of the frontal cortex which governs judgment would lead to these outcomes. Read Slide Lead is measured in the blood by laboratories as �micrograms per deciliter�. In a prospective study published in 2008, it showed that for every increase of 5 micrograms per deciliter of lead in the blood of a child 6 years of age, that child went on to have a 50 percent greater chance of being arrested for committing a violent crime as a young adult. Not surprisingly then, when children are lead poisoned, the consequences of the decreased volume of the frontal cortex which governs judgment would lead to these outcomes. Read Slide Lead is measured in the blood by laboratories as �micrograms per deciliter�. In a prospective study published in 2008, it showed that for every increase of 5 micrograms per deciliter of lead in the blood of a child 6 years of age, that child went on to have a 50 percent greater chance of being arrested for committing a violent crime as a young adult.

19. A recent study showed that youth who have been lead poisoned may feel: Panic Depression How Lead Affects Youth By preventing lead poisoning we can prevent health problems that youth may suffer from such as panic and/or depression.By preventing lead poisoning we can prevent health problems that youth may suffer from such as panic and/or depression.

20. Long term effects related to childhood lead exposure as well as adult exposure can include such things as: High blood pressure, heart attack, stroke Premature death because of the above Neurological problems Kidney disease Mood disorders such as hostility or depression Memory loss and Alzheimer�s disease How Lead Affects Adults Long term effects of lead in adults can include such things as �Read Slide. Long term effects of lead in adults can include such things as �Read Slide.

21. �How do I know if anyone in my family is lead poisoned?� 

22. Blood Lead Testing A person who is lead poisoned usually does not show any signs or symptoms unless their levels are very highly elevated, and even then, individuals do not always have symptoms. The only way to know if someone is lead poisoned is by having a simple blood lead test. Children should be tested according to the questions presented in slide 10. Youth and adults exposed to lead should be tested as soon as possible to determine their blood lead level. Either a simple fingerstick blood draw (capillary blood test) Or Drawing blood from the vein (venous blood test) usually a capillary test is done on a child under age 6, and if it is equal to or greater than 10 micrograms per deciliter (mcg/dL), then it should be followed up with a venous confirmation test. (Capillary blood samples can be easily contaminated) A venous blood draw is recommended for youth and adults. All ages are considered to be lead poisoned when they have a blood lead level result of 10 mcg/dL or higher. A person who is lead poisoned usually does not show any signs or symptoms unless their levels are very highly elevated, and even then, individuals do not always have symptoms. The only way to know if someone is lead poisoned is by having a simple blood lead test. Children should be tested according to the questions presented in slide 10. Youth and adults exposed to lead should be tested as soon as possible to determine their blood lead level. Either a simple fingerstick blood draw (capillary blood test) Or Drawing blood from the vein (venous blood test) usually a capillary test is done on a child under age 6, and if it is equal to or greater than 10 micrograms per deciliter (mcg/dL), then it should be followed up with a venous confirmation test. (Capillary blood samples can be easily contaminated) A venous blood draw is recommended for youth and adults. All ages are considered to be lead poisoned when they have a blood lead level result of 10 mcg/dL or higher.

23. Blood Lead Testing Read Slide Read Slide

24. Blood Lead Testing (Read slide) Why isn�t it recommended that everyone be tested? Because if a child isn�t living in or visiting an older home, isn�t from a low income family (e.g., Medicaid or WIC eligible) and doesn�t have a sibling that was lead poisoned, they have a very low chance of being lead poisoned. (Read slide) Why isn�t it recommended that everyone be tested? Because if a child isn�t living in or visiting an older home, isn�t from a low income family (e.g., Medicaid or WIC eligible) and doesn�t have a sibling that was lead poisoned, they have a very low chance of being lead poisoned.

25. Nutrition is Important! Read Slide So, a diet rich in calcium, iron, vitamin C and zinc, Thiamin and Vitamin E help reduce the toxic effects of lead. Sources of these vitamins and minerals include: Calcium: Milk, cheese, yogurt, kale, collards or turnip greens, canned salmon or sardines with the bones Iron: Lean meats and poultry, seafood, cereals and breads fortified with iron, peanut butter, nuts, dried beans and peas, raisins, prunes, prune juice, greens such as broccoli and spinach Vitamin C: Tomatoes, oranges and grapefruits, juices fortified with vitamin C, strawberries, kiwi, green peppers, watermelon, cantaloupe, potatoes Zinc: Lean red meats, eggs, fish and seafood; nuts, milk and cheese Thiamine: Whole grain foods, organ meats, lean pork, legumes Vitamin E: Vegetable oils, Wheat germ Read Slide So, a diet rich in calcium, iron, vitamin C and zinc, Thiamin and Vitamin E help reduce the toxic effects of lead. Sources of these vitamins and minerals include: Calcium: Milk, cheese, yogurt, kale, collards or turnip greens, canned salmon or sardines with the bones Iron: Lean meats and poultry, seafood, cereals and breads fortified with iron, peanut butter, nuts, dried beans and peas, raisins, prunes, prune juice, greens such as broccoli and spinach Vitamin C: Tomatoes, oranges and grapefruits, juices fortified with vitamin C, strawberries, kiwi, green peppers, watermelon, cantaloupe, potatoes Zinc: Lean red meats, eggs, fish and seafood; nuts, milk and cheese Thiamine: Whole grain foods, organ meats, lean pork, legumes Vitamin E: Vegetable oils, Wheat germ

26. Nutrition is Important! Read Slide High levels of fat or protein result in increased absorption of lead, while moderate dietary intake of protein and fat help prevent the absorption of lead. If one lives in an older home with lead pipes�..run tap water 2-3 minutes before drinking the water or before using it to mix formula. This is to make sure standing water has been flushed through the pipes and fresh water is used. Also, warm water is more likely to have a higher lead content if there is lead in the pipes.. Read Slide High levels of fat or protein result in increased absorption of lead, while moderate dietary intake of protein and fat help prevent the absorption of lead. If one lives in an older home with lead pipes�..run tap water 2-3 minutes before drinking the water or before using it to mix formula. This is to make sure standing water has been flushed through the pipes and fresh water is used. Also, warm water is more likely to have a higher lead content if there is lead in the pipes..

27. �What happens if someone in my family is lead poisoned?� Read Slide Read Slide

28. Read slide. If you have questions about lead poisoning feel free to contact your local health department, the Wisconsin Childhood Lead Poisoning Prevention Program or the Wisconsin Adult Blood Lead (ABLES) Program. (Nurse, you might want to look up the Local Health Department phone number and tell them what it is ( or add it to the presentation on the resources available slide at the end of this presentation) The contact information will be provided at the end of this presentation. Read slide. If you have questions about lead poisoning feel free to contact your local health department, the Wisconsin Childhood Lead Poisoning Prevention Program or the Wisconsin Adult Blood Lead (ABLES) Program. (Nurse, you might want to look up the Local Health Department phone number and tell them what it is ( or add it to the presentation on the resources available slide at the end of this presentation) The contact information will be provided at the end of this presentation.

29. Preventing Lead Poisoning While some children have an acute poisoning or lead poisoning is diagnosed in it�s early stages, many children are exposed over a long period of time before the exposure is detected. Read SlideWhile some children have an acute poisoning or lead poisoning is diagnosed in it�s early stages, many children are exposed over a long period of time before the exposure is detected. Read Slide

30. Prevention means Eliminating Risk Factors in the Home RISK FACTORS COULD INCLUDE �.READ THE ABOVE! Varnish also contains lead! (If there are questions about lead in toys: Many have been recalled and pictures of those that were may be seen on the WCLPPP website. The web address will be at the end of this presentation. We have not had any reports of children in WI poisoned from the toys. Several years ago a 4-year old in MN died from swallowing a charm that came with Reebok shoes and was treated for flu symptoms before it was realized that she was lead poisoned. Her blood lead level was over 300 mcg/dL.RISK FACTORS COULD INCLUDE �.READ THE ABOVE! Varnish also contains lead! (If there are questions about lead in toys: Many have been recalled and pictures of those that were may be seen on the WCLPPP website. The web address will be at the end of this presentation. We have not had any reports of children in WI poisoned from the toys. Several years ago a 4-year old in MN died from swallowing a charm that came with Reebok shoes and was treated for flu symptoms before it was realized that she was lead poisoned. Her blood lead level was over 300 mcg/dL.

31. What Chipping and Peeling Paint Looks Like What does chipping and Peeling paint look like? (Note to School Nurse: You can go quickly through the next group of slides showing what the paint looks like) What does chipping and Peeling paint look like? (Note to School Nurse: You can go quickly through the next group of slides showing what the paint looks like)

32. Obvious Hazards alligatoring/checking paint Alligatoring paint creates lead dustAlligatoring paint creates lead dust

33. Windows Cracked and chipping paint in windows create dust and are a typical source of lead poisoning in small childrenCracked and chipping paint in windows create dust and are a typical source of lead poisoning in small children

34. Another view of deteriorated paint in window Another view of deteriorated paint in window

35. Exterior Hazards Exterior Lead Paint HazardsExterior Lead Paint Hazards

36. Porches Children are also often poisoned because they play on porches and on porch railings with chipping and peeling paint. Children are also often poisoned because they play on porches and on porch railings with chipping and peeling paint.

37. A porch railingA porch railing

38. Preventing Lead Poisoning in Children  Childhood Lead poisoning is an environmental health problem that is primarily related to the condition of the housing. Check with your local health department to see if there are any resources available for fixing older houses with lead paint hazards.Childhood Lead poisoning is an environmental health problem that is primarily related to the condition of the housing. Check with your local health department to see if there are any resources available for fixing older houses with lead paint hazards.

39. The Wisconsin Childhood Lead Poisoning Prevention Program has free information that can be helpful if you live in or are moving to an older home or if you are remodeling your home. This Renovate Right booklet provides guidance to safely work with lead paint when you are renovating an older home.The Wisconsin Childhood Lead Poisoning Prevention Program has free information that can be helpful if you live in or are moving to an older home or if you are remodeling your home. This Renovate Right booklet provides guidance to safely work with lead paint when you are renovating an older home.

40. Additional free materials that you may request include: �Protect Your Family From Lead in Your Home�-pamphlet �Lead Paint Safety�-booklet �Look Out for Lead�-brochureAdditional free materials that you may request include: �Protect Your Family From Lead in Your Home�-pamphlet �Lead Paint Safety�-booklet �Look Out for Lead�-brochure

41. SUMMARY Lead poisoning occurs in every county in WI Lead poisoning effects all ages: affects brain development in children; can cause future health problems for all ages. Sources of lead for various ages differ A blood lead test is the only way to know if a child, youth or adult is lead poisoned Prevent lead poisoning by being aware of hazards and taking steps to eliminate them correctly Contact your local health department or WCLPPP for information

42. Resources: 1. Your Local Health Department 2. WCLPPP website: dhs.wi.gov/lead 3. WCLPPP and ABLES Phone Number: 608/266-5817 Here are resources that you can contact if you desire further information. Thank you for your time. (If they have any questions that you are unsure about, ask them to contact your local health department (YOU MAY WISH TO LOOK UP THE TELEPHONE NUMBER AND HAVE IT READY FOR THEM) OR REFER THEM TO the WCLPPP or ABLES programs. (Thank you to you, School Nurse, for making families aware of lead poisoning)!Here are resources that you can contact if you desire further information. Thank you for your time. (If they have any questions that you are unsure about, ask them to contact your local health department (YOU MAY WISH TO LOOK UP THE TELEPHONE NUMBER AND HAVE IT READY FOR THEM) OR REFER THEM TO the WCLPPP or ABLES programs. (Thank you to you, School Nurse, for making families aware of lead poisoning)!