Parental Questionaire

Does your child live in or regularly visit a house that was built before 1950? This question could apply to a facility such as a home day-care center or the home of a babysitter or relative. Does your child live in or regularly visit a house built before 1978 with recent or ongoing renovations or remodeling (within the last 6 months)? Does your child have a sibling or playmate who has or did have lead poisoning?

Personal or family history.

• Have you ever been told that your child has lead poisoning?
• Is there an occupational, industrial, or hobby-related exposure with someone in your household?
• Does your child live with an adult whose job or hobby involves exposure to lead?
• Does your child live near an active lead smelter, battery recycling plant, or other industry likely to release lead into the environment?

Other sources.

• Does your child live within one block of a major highway or busy street?
• Do you use hot tap water for cooking or drinking?

Cultural exposures.

• Has your child ever been given home remedies (e.g., azarcon, greta, pay looah)?
• Has your child been to Latin America?
• Has your child ever lived outside the U.S.?
• Does your family use pottery or ceramicware for cooking, eating, or drinking?

Poverty.

• Does your family receive medical assistance?
• Do you rent your home?
• Do you or the child's parents perform migrant farm work?
• Have you recently moved?

Behavior.

• Have you seen your child eating paint chips?\
• Have you seen your child eat soil or dirt?

Associated medical problems.

• Have you been told that your child has low iron?

Lead Levels / Symptoms / Risk Factors / What Now? / Treatment / Source? / Liability / Illinois Cases

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