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October 24, 2013 President Barack Obama The White House Washington, DC Dear. President Obama: As pediatricians, we are writing to urge your support for the restoration of $29 million in funding for the Centers for Disease Control and Prevention (CDC) Healthy Homes/Lead Poisoning Prevention Program. Due to the importance of public health support for pediatricians in our efforts to protect children from exposures to toxic agents like lead, we are deeply concerned by recent trends in funding of the CDC’s Healthy Homes/Lead Poisoning Prevention Program. Funding for the program went from $29,257,000 in fiscal year 2011 to $1,995,000 in fiscal year 2012, a more than 90 percent funding reduction. These cuts are devastating to pediatric prevention efforts and we urge you to support a restoration of the funding needed for this critical program. Lead toxicity and elevated blood lead levels are preventable, and no children should have to suffer the deleterious effects that lead exposure has on their intelligence, development, other neurologic functions, and ultimately, their academic and career paths. The American Academy of Pediatrics has long emphasized that there is no safe level of lead exposure, which has pernicious effects on children’s health and is associated with low birth weight, delayed puberty, decreased hearing and stunted growth. At higher blood lead levels, exposure can lead to anemia, lead encephalopathy and even death. Research continues to conclusively demonstrate adverse health effects of lead exposure on children at increasingly lower blood lead levels (BLLs; including those below 5 µg/dL), to include: effects on children’s intellectual abilities, development and academic achievement; attention deficit hyperactivity disorder (ADHD); conduct disorder; and antisocial behavior. For decades, the Lead Poisoning Prevention Branch at CDC has provided funding grants and federal leadership to state and local health departments around lead poisoning education, surveillance, environmental inspection and remediation, lead screening, case management, data management and laboratory issues. With current limited funding, most of the activities which provided federal leadership and oversight and a public health framework for lead poisoning prevention and healthy housing work, as well as funding to approximately 35 state and local grantees for lead poisoning, cannot be carried out at this time. This represents a tremendous loss of knowledge and resources that will cripple both state and local public health departments and pediatricians looking to them for guidance, in their work preventing lead exposure. Individual pediatricians can undertake some activities to prevent and manage elevated blood lead levels through giving anticipatory guidance, performing lead screening, monitoring serial BLLs in the office, and providing medical therapy, such as with chelation therapy, when indicated. Outside of the office, pediatricians have long relied on our local and state health department colleagues to ensure that there is proper assessment of the source or sources of lead exposure for patients and that work for elimination or remediation of lead sources is carried out by qualified

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professionals. This partnership has been premised on the availability of lead poisoning prevention professionals at the local and state level, without whom proper environmental management cannot take place. Current Healthy Homes/Lead Poisoning Prevention Program funding does not support this need and undermines previous advances and longstanding partnerships in lead poisoning prevention. Adverse health effects occur at even very low blood lead levels in children, and high numbers of U.S. children are expected to continue to be exposed to lead in their homes and environments. The CDC has revised its reference level for blood lead levels of concern from ≥ 10 µg/dL to ≥ 5 µg/dL. This change reflects evidence that lead exposure has significant negative health effects at levels lower than previously estimated, but it also means that a larger-than-anticipated number of children will need services under this program. Recently, the Senate Committee on Appropriations approved its fiscal year 2014 budget, which included $10 million in funding for this program. While this increased funding is a welcome improvement from current levels, it still falls short of the program’s needs. Therefore, we respectfully request the administration’s support to reinstate funding for the CDC Healthy Homes/Lead Poisoning Prevention Program to at least the fiscal year 2011 level of $29 million. Again, we urge your support to restore full funding for lead poisoning prevention efforts. For further assistance, please do not hesitate to contact Sonya Clay, Assistant Director, Department of Federal Affairs, 202-347-8600 or sclay@aap.org. Cc: The Honorable Kathleen Sebelius, Department of Health and Human Services Thomas R. Frieden, MD, MPH Director, Centers for Disease Control and Prevention Sincerely, Jaclyn Albin, MD Chief Resident Baylor College of Medicine Houston, TX Maude Aldridge, MD Baystate Medical Center Springfield, MA

D. Adam Algren, MD Assistant Professor of Pediatrics and Emergency Medicine University of Missouri-Kansas City Kansas City, MO Carole Allen, MD, FAAP District I Chair American Academy of Pediatrics Arlington, MA

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Erin Allen, MD, FAAP Assistant Professor of Pediatrics Baylor College of Medicine Pasadena, TX Joel J. Alpert, MD, FAAP Past President American Academy of Pediatrics Professor and Chair Emeritus of Pediatrics Boston University School of Medicine Boston, MA Mercedes Amado, MD, FAAP Associate Professor of Pediatrics Children’s Mercy Hospital University of Missouri- Kansas City School of Medicine Parag Amin, MD, FAAP Centre Pediatric Associates, PC Brookline, MA Deborah Archer, MD, FAAP Community Health Center Fort Collins, CO Daniel Arnold, MD, FAAP Children’s Mercy Hospital Kansas City, MO Michael Artman, MD, FAAP Pediatrician-In-Chief Children’s Mercy Hospital Kansas City, MO Ghufran Babar, MD Children’s Mercy Hospital Kansas City, MO Sami Bahna, MD, DrPH, FAAP Professor of Pediatrics Louisiana State University Health Sciences Center Shreveport, LA

Charles Barnes, PhD Children’s Mercy Hospital Kansas City, MO Valerie Barnes, MD Medical Director Archer Child Advocacy Center Associate Professor in Family Medicine UCSF Natividad Medical Center Salinas, CA Erich Batra, MD, FAAP Lebanon, PA Carl Baum, MD, FAAP Associate Professor of Pediatrics Yale University School of Medicine New Haven, CT Thomas Bender, MD, FAAP SSM Cardinal Glennon Children’s Medical Center St. Louis, MO Jay Berkelhamer, MD, FAAP Past President American Academy of Pediatrics Atlanta, GA Carol Berkowitz, MD, FAAP Past President American Academy of Pediatrics Professor and Executive Vice Chair David Geffen School of Medicine UCLA Torrance, CA Philip Black, MD, FAAP Kansas City, MO Gordon Bloomberg, MD, FAAP Professor of Pediatrics Washington University School of Medicine St. Louis, MO

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Aparna Bole, MD, FAAP UH Rainbow Babies and Children’s Hospital Cleveland, OH Hilary Branch, MD, FAAP Baystate Medical Center Springfield, MA Anne Brayer, MD, FAAP Professor, Emergency Medicine Pediatrics and Center for Community Health University of Rochester Rochester, NY Lorraine Brewer, DO, FAAP Kansas City, KS Patrick Brown, MD Baystate Health Springfield, MA Marilyn Bull, MD, FAAP District V Chair Member of Board of Directors American Academy of Pediatrics Morris Green Professor of Pediatrics Riley Hospital for Children Indianapolis, IN Michele Burns, MD, MPH, FAAP Staff Physician Boston Children’s Hospital Harvard Medical School Boston, MA Marion Burton, MD, FAAP Past President American Academy of Pediatrics Director of Community of Affairs University of South Carolina School of Medicine Columbia, SC

Carla Campbell, MD, MS, FAAP Associate Teaching Professor Drexel University of Public Health Philadelphia, PA Lisa Carney, MD, FAAP Kansas City, MO Beth Carter, MD Baystate Medical Center Springfield, MA Brian Carter, MD, FAAP Professor of Pediatrics and Bioethics University of Missouri- Kansas City Kansas City, MO Fernando Catalina, MD, PhD, FAAP Medical Associate Pediatrics Leominster, MA Ruby Chang, MD, FAAP Berkshire Health Systems Great Barrington, MA Victoria Chen, MD Developmental Behavioral Pediatrician NYUMC New York, NY Christina Ciaccio, MD Assistant Professor Children’s Mercy Hospital Kansas City, MO William Cochran, MD, FAAP Vice Chairman Department of Pediatrics Geisinger Clinic Danville, PA George Cohen, MD, FAAP Children’s National Medical Center Washington, DC

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Mark Corkins, MD, CNSC, FAAP Professor of Pediatrics University of Tennessee Health Science Center Memphis, TN Deborah Cory-Slechta, PhD Professor of Environmental Medicine and Pediatrics University of Rochester Rochester, NY Stephen Daniels, MD, PhD, FAAP Professor and Chairman Department of Pediatrics University of Colorado School of Medicine Aurora, CO Manuel Datiles, MD Baystate Tufts Pediatrics Department Springfield, MA Caroline de Roode-Wentz, MD Kansas City, MO Teresa Del Moral, MD, FAAP University of Miami Miami, FL Chitra Dinakar, MD, FAAP Kansas City, MO Molly Droge, MD, FAAP Chair Subcommittee on Access to Care Committee on Federal Government Affairs American Academy of Pediatrics Parkville, MO April R. Dworetz, MD, MPH, FAAP Assistant Professor of Pediatrics Emory University School of Medicine Atlanta, GA

Antoinette Eaton, MD, FAAP Past President American Academy of Pediatrics Columbus, OH Kathleen Farrell, MD, FAAP Children’s Mercy Hospital Kansas City, KS Mary Beth Fasano, MD, MSPH, FAAP Iowa City, IA Chris Feudtner, MD, PhD, MPH, FAAP Philadelphia, PA Clara Filice, MD, MPH, MHS, FAAP Pediatric Environmental Health and Food Policy Fellow AAP Department of Federal Affairs Washington, DC Gilbert Fisch, MD, FAAP Jupiter, FL Donna Fisher, MD, FAAP Chief, Pediatric Infectious Diseases Baystate Children’s Hospital Springfield, MA Eric Fleegler, MD, MPH, FAAP Attending, Pediatric Emergency Medicine Boston Children’s Hospital Harvard Medical School Boston, MA Allen Friedland, MD, FAAP Newark, DE Lorne Garrettson, MD, FAAP Professor Emeritus Emory University Sandy Spring, MD Mary Gealow, MD, FAAP Greater Lowell Pediatrics Lowell, MA

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Robert Geller, MD, FAAP Chair Committee on Injury, Violence and Poison Prevention AAP Georgia Chapter Atlanta, GA Emily Gertsch, MD, MPH Memphis, TN Michele Ghim, MD, FAAP Frederick Memorial Hospital Frederick, MD Philip Gioia, MD, MPH, FAAP, FACPM President Children’s Health Specialists Auburn, NY Mike Gittelman, MD, FAAP Professor, Clinical Pediatrics Division of Emergency Medicine Cincinnati Children’s Hospital Cincinnati, OH Carolyn Goldstein, MD, FAAP Baystate Medical Center Springfield, MA Zachary Goode, DO, FAAP Springfield, MA Aimee Grace, MD, MPH, FAAP Fellow, Academic General Pediatics Children’s National Medical Center Washington, DC Kathryn Green, MD Tarboro, NC Tara Greendyk, MD, FAAP General Pediatrician Dell Children’s Medical Center UTSW Austin Residency Program Austin, TX

Marc Grella, MD, FAAP Massachusetts General Hospital Boston, MA Gregory Hagan, MD, FAAP Interim Chief of Pediatrics The Cambridge Health Alliance Cambridge, MA Ara Hall, MD Pediatric Neurologist Kansas City, KS Sarah Hampl, MD, FAAP Kansas City, MO Marcus Hanfling, MD, FAAP Assistant Professor Baylor College of Medicine Houston, TX Anne Hanley, DO, FAAP Baystate Children’s Hospital Springfield, MA Robert Hanneman, MD, BSChE, FAAP Visiting Professor Biomedical and Chemical Engineering and Child Psychology Purdue University, IU Health-Arnett Clinic Lafayette and West Lafayette, IN Jill Hanson, MD Kansas City, MO Rochelle Harris, PhD, ABPP Licensed Psychologist Children’s Mercy Hospitals and Clinics Kansas City, MO Leslye Heilig, MD, FAAP Great Barrington, MA Laura Heimback-Graham, MD, FAAP Tampa, FL

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Marissa Hendrickson, MD, FAAP Minneapolis, MN Karl Hess, MD, FAAP Shaker Heights, OH Harry Hoar, MD, FAAP Baystate Children’s Hospital Springfield, MA Michael Hole, MD, MBA Stanford University of Medicine Stanford, CA Patricia Holtz, MD, FAAP Philadelphia, PA Laurie Hornberger, MD, MPH, FAAP Kansas City, MO Maria Ibarra, MD, FAAP Kansas City, MO Anne-Marie Irani, MD Professor of Pediatrics and Internal Medicine Virginia Commonwealth University Richmond, VA Xochitl Jackson, MD, FAAP Los Angeles, CA Madhangi Jayaraman, MD, FAAP Bellflower, CA Karen Judy, MD, FAAP Cadence Health Glen Ellyn, IL Nandita Kapa-Kalahasty, MD, FAAP Clinical Associate Johns Hopkins Bayview Baltimore, MD

Catherine Karr, MD, PhD, FAAP Associate Professor University of Washington Seattle, WA Mateusz Karwowski, MD, MPH Boston Children’s Hospital and Harvard School of Public Health Boston, MA Erica Kates, MD, FAAP Ludlow Pediatrics Ludlow, MA Ana Kato, MD Los Angeles, CA Aviva Katz, MD, MA, FAAP Pediatric Surgeon Children’s Hospital Pittsburgh Pittsburgh, PA David Keller, MD, FAAP President Academic Pediatrics Association Clinical Professor University of Colorado School of Medicine Aurora, CO John J. Killion, MD, FAAP Attleboro, MA Michael Klein, MD, FAAP Children’s Hospital of Michigan Detroit, MI Stephen Klem, MD Children’s Mercy Hospital Kansas City, MO Laura Koenigs, MD, FAAP Director Pediatric Residency Program Baystate Medical Center Springfield, MA

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Tracy Koogler, MD, FAAP Associate Professor of Pediatrics University of Chicago Chicago, IL Katie Krone, MD Springfield, MA Tarah Kruger, MD Developmental Pediatrician CMH Overland Park, KS Bruce Lanphear, MD, MPH, FAAP Professor of Health Sciences Simon Fraser University Vancouver, BC Jean-Baptiste Le Pichon, MD, PhD Associate Professor Children’s Mercy Hospital Kansas City, MO Lori Legano, MD, FAAP New York, NY Despina Lekakis, DO, FAAP Holyoke, MA Tamra Lemley, MD Pediatric Associate in Emergency Medicine Children’s Mercy South Overland Park, KS William Lewis MD Candidate Boston, MA Katherine Lobach, MD, FAAP Professor Emerita of Pediatrics Montefiore Medical Center Bronx, NY

Jennifer Lowry, MD, FAAP Director Mid America Pediatric Environmental Health Specialty Unit Children’s Mercy Hospital Kansas City, MO Sheela Magge, MD, MSCE, FAAP Children’s Hospital of Philadelphia Philadelphia, PA Stephanie Marton, MD Houston, TX Karen Maule, MD, FAAP East Greenwich Pediatrics East Greenwich, RI Mary McAteer, MD, FAAP Carmel, IN Valerie McDougall Kester, MD, FAAP Kansas City, MO Siobhan McNally, MD, MPH, FAAP Community Health Programs- Berkshires Great Barrington, MA Elizabeth McQuaid, MD, FAAP Taunton, MA Joan Meek, MD, FAAP Orlando, FL Marlene Melzer-Lange, MD, FAAP Milwaukee, WI Richard M. Miller, MD, FAAP Marblehead, MA Maureen Miller, MD, MPH (2014) NYU School of Medicine Harvard School of Public Health New York, NY

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Neil, Minikes, MD Allergist/Pediatrician Closter, NJ Ana Monterrey, MD Baylor College of Medicine Texas Children’s Hospital Houston, TX Emily Montgomery, MD, FAAP Kansas City, MO Dipesh Navsaria, MD, MSLIS, MPH, FAAP Assistant Professor of Pediatrics University of Wisconsin Madison, WI Elizabeth Neary, MD, MS, FAAP Madison, WI Jason Newland, MD, FAAP Kansas City, MO Nicholas Newman, DO, MS, FAAP Director Pediatric Environmental Health and Lead Clinic Cincinnati Children’s Hospital Medical Center Cincinnati, OH Susan Nondahl, MD, FAAP Associated Physicians Clinic LLP Madison, WI Sarah Nyp, MD, FAAP Kansas City, MO Abiye Okah, MD, FAAP Kansas City, MO John O’Reilly, MD, FAAP Baystate Medical Center Springfield, MA

Sean Palfrey, MD, FAAP Medical Director Boston Lead Poisoning Prevention Program Boston Medical Center MA American Academy of Pediatrics Boston, MA Emily Paprocki, DO Kansas City, MO Jerome Paulson, MD, FAAP Chair American Academy of Pediatrics Council on Environmental Health Professor of Pediatrics and Environmental and Occupational Health George Washington University Washington, DC Trina Peduzzi, MD, FAAP Pittsburgh, PA Janice Pelletier, MD, FAAP Eastern Maine Medical Center Bangor, ME Kieran Phelan, MD, MSc, FAAP Associate Professor of Pediatrics University of Cincinnati Cincinnati Children’s Hospital Medical Center Cincinnati, OH Eduardo Pino, MD, FAAP Associate Professor of Pediatrics Joan C Edwards School of Medicine Marshall University Huntington, WV Diane Plantz, MD Kansas City, MO Svetlana Pomeranets, MD, FAAP Cleveland Clinic Solon, OH

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Naomi, Priver, MD, FAAP Cambridge, MA Kyran Quinlan, MD, MPH, FAAP Associate Professor of Clinical Pediatrics Northwestern Feinberg School of Medicine Chicago, IL Angelika Rampal, MD, FAAP UCLA Reston, VA Peter Rappo, MD, FAAP Assistant Clinical Professor of Pediatrics Harvard University School of Medicine Brockton, MA Rebecca Reamy, MD Atlanta, GA Routt Reigart, MD, FAAP Professor Emeritus of Pediatrics Medical University of South Carolina Charleston, SC Ana Revilla, MD, MPH, TM Stockton, CA Moira LM Richards, MD Medical Director of Children’s Services TMC for Children Tucson, AZ Annely Richardson, MD Springfield, MA Lynn Ringenberg, MD, MSS, FAAP President Physicians for Social Responsibility/Florida Emeritus Professor USF Health Tampa, FL Jerri Rose, MD, FAAP Pediatric Emergency Physician Rainbow Babies and Children’s Hospital Cleveland, OH

Philip Rosenthal, MD, FAAP Professor of Pediatrics and Surgery UCSF San Francisco, CA Lainie Ross, MD, PhD, FAAP Carolyn and Matthew Bucksbaum Professor of Clinical Ethics University of Chicago Chicago, IL Eric Ruby, MD, FAAP Taunton, MA Grace Ryu, MD, FAAP Columbus, OH Megan Sandel, MD, MPH, FAAP Associate Professor of Pediatrics and Public Health Boston University School of Medicine Boston, MA Garima Sarda, MD, Springfield, MA Lydia Sarro, MD, FAAP Riverbend Medical Group Chicopee, MA Sheela Sathyanarayana, MD, MPH University of Washington Seattle, WA Benjamin Scheindlin, MD, FAAP Burlington Pediatrics, LLC Burlington, MA Leslie Scherl, MD, FAAP East Boston, MA

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Donald Schiff, MD, FAAP Past President American Academy of Pediatrics Professor Emeritus of Pediatrics University of Colorado School of Medicine Denver, CO Paul Schreiber, MD, FAAP Brockton, MA Robert Schremmer, MD, FAAP Pediatric Emergency Physician Children’s Mercy Hospitals and Clinics Kansas City, MO Kimberly Schwartz, MD, FAAP Shrewsbury, MA Sarah Jane Schwarzenberg, MD, FAAP Chief Pediatric Gastroenterology, Hepatology, and Nutrition University of Minnesota Amplatz Children’s Hospital Minneapolis, MN Kathleen Senn, MD, FAAP Children’s Mercy Hospital Kansas City, MO Perry Sheffield, MD New York, NY Jeffrey Shenberger, MD Chief of Neonatology Baystate Children’s Hospital Springfield, MA Kim Shubert, MD Children’s Mercy Hospital Kansas City, MO Scott Sicherer, MD, FAAP New York, NY

Benjamin Siegel, MD, FAAP Professor of Pediatrics Boston Medical Center Boston, MA Julie Silberman, MD Boston, MA Jimmy Simon, MD, FAAP Professor and Chair Emeritus Department of Pediatrics Wake Forest University Winston Salem, NC Rachana Singh, MD, MS, FAAP Baystate Children’s Hospital Springfield, MA John Snyder, MD, FAAP Tufts University School of Medicine Amherst, MA Peter Sodt, MD, FAAP Camano Island, WA Ricardo Sorensen, MD, FAAP Professor and Chairman LSU HSC- Pediatrics New Orleans, LA Robert Sprinkle, MD, PhD, FAAP University of Maryland School of Public Policy College Park, MD Janet Squires, MD, FAAP Pittsburgh, PA Amanda Stewart, MD, MPH Boston, MA E. Richard Stiehm, MD, FAAP Professor of Pediatrics David Geffen School of Medicine Los Angeles, CA

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Robert Stone, MD Associate Chair Department of Pediatrics Akron Children’s Hospital Akron, OH John Straus, MD, FAAP Massachusetts Behavioral Health Partnership Boston, MA Sharon Swindell, MD, MPD, FAAP Ypsilanti, MI David Tayloe, MD, FAAP, FAAP Past President American Academy of Pediatrics Goldsboro, NC Joseph Telch, MD, FAAP Toronto, Ontario, Canada Robert Truckner, MD, MPH Spokane, WA Angela Turpin, MD Assistant Professor of Pediatrics Kansas City, MO Eileen Tyrala, MD, FAAP Philadelphia, PA Heather Underkofler, MD Kansas City, MO Girish Vitalpur, MD, FAAP Indianapolis, IN Thomas Wadzinski, MD, PhD Baystate Medical Center Springfield, MA Jacqueline Walker, MD Pediatric Hospitalist Children’s Mercy Hospital Kansas City, MO

Jennifer Walter, MD, PhD, MS, FAAP Assistant Professor of Pediatrics Children’s Hospital of Philadelphia Philadelphia, PA Manoj Warrier, MD Saint Louis, MO Amy Whittle, MD, FAAP Assistant Clinical Professor of Pediatrics University of California San Francisco San Francisco, CA Yolanda Whyte, MD Dr. Yolanda Whyte Pediatrics Atlanta, GA Kenneth Wible, MD, FAAP Kansas City, MO Margaret Wilcots, MD, FAAP Madison, WI Nicole Wood, DO Pediatric Resident Children’s Mercy Hospital and Clinics Kansas City, MO Alan Woolf, MD, MPH, FAAP Professor Harvard Medical School Boston, MA Robert Wright, MD, FAAP Professor of Pediatrics Mount Sinai School of Medicine New York, NY Lauren Zajac, MD, MPH New York, NY Joseph Zanga, MD Chief of Pediatrics Columbus Regional Health Columbus, GA

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Jessica Zina, MD, MA Springfield, MA

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October 24, 2013 The Honorable Barbara Mikulski Chair Senate Appropriations Committee 503 Hart Senate Office Building Washington, DC 20510

The Honorable Richard Shelby Ranking Member Senate Appropriations Committee 304 Russell Senate Office Building Washington, DC 20510

The Honorable Tom Harkin Chair Senate Appropriations Subcommittee Labor, Health and Human Services, Education, and Related Agencies 731 Hart Senate Office Building Washington, DC 20510

The Honorable Jerry Moran Ranking Member Senate Appropriations Subcommittee Labor, Health and Human Services, Education, and Related Agencies 354 Russell Senate Office Building Washington, DC 20510

Dear. Chairwoman Mikulski, Ranking Member Shelby, Chairman Harkin, and Ranking Member Moran: As pediatricians, we are writing to urge your support for the restoration of $29 million in funding for the Centers for Disease Control and Prevention (CDC) Healthy Homes/Lead Poisoning Prevention Program. Due to the importance of public health support for pediatricians in our efforts to protect children from exposures to toxic agents like lead, we are deeply concerned by recent trends in funding of the CDC’s Healthy Homes/Lead Poisoning Prevention Program. Funding for the program went from $29,257,000 in fiscal year 2011 to $1,995,000 in fiscal year 2012, a more than 90 percent funding reduction. These cuts are devastating to pediatric prevention efforts and we urge you to support a restoration of the funding needed for this critical program. Lead toxicity and elevated blood lead levels are preventable, and no children should have to suffer the deleterious effects that lead exposure has on their intelligence, development, other neurologic functions, and ultimately, their academic and career paths. The American Academy of Pediatrics has long emphasized that there is no safe level of lead exposure, which has pernicious effects on children’s health and is associated with low birth weight, delayed puberty, decreased hearing and stunted growth. At higher blood lead levels, exposure can lead to anemia, lead encephalopathy and even death. Research continues to conclusively demonstrate adverse health effects of lead exposure on children at increasingly lower blood lead levels (BLLs; including those below 5 µg/dL), to include: effects on children’s intellectual abilities, development and academic achievement; attention deficit hyperactivity disorder (ADHD); conduct disorder; and antisocial behavior. For decades, the Lead Poisoning Prevention Branch at CDC has provided funding grants and federal leadership to state and local health departments around lead poisoning education, surveillance, environmental inspection and remediation, lead screening, case management, data management and laboratory issues. With current limited funding, most of the activities which

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provided federal leadership and oversight and a public health framework for lead poisoning prevention and healthy housing work, as well as funding to approximately 35 state and local grantees for lead poisoning, cannot be carried out at this time. This represents a tremendous loss of knowledge and resources that will cripple both state and local public health departments and pediatricians looking to them for guidance, in their work preventing lead exposure. Individual pediatricians can undertake some activities to prevent and manage elevated blood lead levels through giving anticipatory guidance, performing lead screening, monitoring serial BLLs in the office, and providing medical therapy, such as with chelation therapy, when indicated. Outside of the office, pediatricians have long relied on our local and state health department colleagues to ensure that there is proper assessment of the source or sources of lead exposure for patients and that work for elimination or remediation of lead sources is carried out by qualified professionals. This partnership has been premised on the availability of lead poisoning prevention professionals at the local and state level, without whom proper environmental management cannot take place. Current Healthy Homes/Lead Poisoning Prevention Program funding does not support this need and undermines previous advances and longstanding partnerships in lead poisoning prevention. Adverse health effects occur at even very low blood lead levels in children, and high numbers of U.S. children are expected to continue to be exposed to lead in their homes and environments. The CDC has revised its reference level for blood lead levels of concern from ≥ 10 µg/dL to ≥ 5 µg/dL. This change reflects evidence that lead exposure has significant negative health effects at levels lower than previously estimated, but it also means that a larger-than-anticipated number of children will need services under this program. Recently, the Senate Committee on Appropriations approved its fiscal year 2014 budget, which included $10 million in funding for this program. While this increased funding is a welcome improvement from current levels, it still falls short of the program’s needs. Therefore, we respectfully request the administration’s support to reinstate funding for the CDC Healthy Homes/Lead Poisoning Prevention Program to at least the fiscal year 2011 level of $29 million. Again, we urge your support to restore full funding for lead poisoning prevention efforts. For further assistance, please do not hesitate to contact Sonya Clay, Assistant Director, Department of Federal Affairs, 202-347-8600 or sclay@aap.org. Cc: Members of the Senate Appropriations Committee Sincerely,

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Jaclyn Albin, MD Chief Resident Baylor College of Medicine Houston, TX Maude Aldridge, MD Baystate Medical Center Springfield, MA D. Adam Algren, MD Assistant Professor of Pediatrics and Emergency Medicine University of Missouri-Kansas City Kansas City, MO Carole Allen, MD, FAAP District I Chair American Academy of Pediatrics Arlington, MA Erin Allen, MD, FAAP Assistant Professor of Pediatrics Baylor College of Medicine Pasadena, TX Joel J. Alpert, MD, FAAP Past President American Academy of Pediatrics Professor and Chair Emeritus of Pediatrics Boston University School of Medicine Boston, MA Mercedes Amado, MD, FAAP Associate Professor of Pediatrics Children’s Mercy Hospital University of Missouri- Kansas City School of Medicine Parag Amin, MD, FAAP Centre Pediatric Associates, PC Brookline, MA Deborah Archer, MD, FAAP Community Health Center Fort Collins, CO

Daniel Arnold, MD, FAAP Children’s Mercy Hospital Kansas City, MO Michael Artman, MD, FAAP Pediatrician-In-Chief Children’s Mercy Hospital Kansas City, MO Ghufran Babar, MD Children’s Mercy Hospital Kansas City, MO Sami Bahna, MD, DrPH, FAAP Professor of Pediatrics Louisiana State University Health Sciences Center Shreveport, LA Charles Barnes, PhD Children’s Mercy Hospital Kansas City, MO Valerie Barnes, MD Medical Director Archer Child Advocacy Center Associate Professor in Family Medicine UCSF Natividad Medical Center Salinas, CA Erich Batra, MD, FAAP Lebanon, PA Carl Baum, MD, FAAP Associate Professor of Pediatrics Yale University School of Medicine New Haven, CT Thomas Bender, MD, FAAP SSM Cardinal Glennon Children’s Medical Center St. Louis, MO

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Jay Berkelhamer, MD, FAAP Past President American Academy of Pediatrics Atlanta, GA Carol Berkowitz, MD, FAAP Past President American Academy of Pediatrics Professor and Executive Vice Chair David Geffen School of Medicine UCLA Torrance, CA Philip Black, MD, FAAP Kansas City, MO Gordon Bloomberg, MD, FAAP Professor of Pediatrics Washington University School of Medicine St. Louis, MO Aparna Bole, MD, FAAP UH Rainbow Babies and Children’s Hospital Cleveland, OH Hilary Branch, MD, FAAP Baystate Medical Center Springfield, MA Anne Brayer, MD, FAAP Professor, Emergency Medicine Pediatrics and Center for Community Health University of Rochester Rochester, NY Lorraine Brewer, DO, FAAP Kansas City, KS Patrick Brown, MD Baystate Health Springfield, MA

Marilyn Bull, MD, FAAP District V Chair Member of Board of Directors American Academy of Pediatrics Morris Green Professor of Pediatrics Riley Hospital for Children Indianapolis, IN Michele Burns, MD, MPH, FAAP Staff Physician Boston Children’s Hospital Harvard Medical School Boston, MA Marion Burton, MD, FAAP Past President American Academy of Pediatrics Director of Community of Affairs University of South Carolina School of Medicine Columbia, SC Carla Campbell, MD, MS, FAAP Associate Teaching Professor Drexel University of Public Health Philadelphia, PA Lisa Carney, MD, FAAP Kansas City, MO Beth Carter, MD Baystate Medical Center Springfield, MA Brian Carter, MD, FAAP Professor of Pediatrics and Bioethics University of Missouri- Kansas City Kansas City, MO Fernando Catalina, MD, PhD, FAAP Medical Associate Pediatrics Leominster, MA Ruby Chang, MD, FAAP Berkshire Health Systems Great Barrington, MA

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Victoria Chen, MD Developmental Behavioral Pediatrician NYUMC New York, NY Christina Ciaccio, MD Assistant Professor Children’s Mercy Hospital Kansas City, MO William Cochran, MD, FAAP Vice Chairman Department of Pediatrics Geisinger Clinic Danville, PA George Cohen, MD, FAAP Children’s National Medical Center Washington, DC Mark Corkins, MD, CNSC, FAAP Professor of Pediatrics University of Tennessee Health Science Center Memphis, TN Deborah Cory-Slechta, PhD Professor of Environmental Medicine and Pediatrics University of Rochester Rochester, NY Stephen Daniels, MD, PhD, FAAP Professor and Chairman Department of Pediatrics University of Colorado School of Medicine Aurora, CO Manuel Datiles, MD Baystate Tufts Pediatrics Department Springfield, MA Caroline de Roode-Wentz, MD Kansas City, MO

Teresa Del Moral, MD, FAAP University of Miami Miami, FL Chitra Dinakar, MD, FAAP Kansas City, MO Molly Droge, MD, FAAP Chair Subcommittee on Access to Care Committee on Federal Government Affairs American Academy of Pediatrics Parkville, MO April R. Dworetz, MD, MPH, FAAP Assistant Professor of Pediatrics Emory University School of Medicine Atlanta, GA Antoinette Eaton, MD, FAAP Past President American Academy of Pediatrics Columbus, OH Kathleen Farrell, MD, FAAP Children’s Mercy Hospital Kansas City, KS Mary Beth Fasano, MD, MSPH, FAAP Iowa City, IA Chris Feudtner, MD, PhD, MPH, FAAP Philadelphia, PA Clara Filice, MD, MPH, MHS, FAAP Pediatric Environmental Health and Food Policy Fellow AAP Department of Federal Affairs Washington, DC Gilbert Fisch, MD, FAAP Jupiter, FL

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Donna Fisher, MD, FAAP Chief, Pediatric Infectious Diseases Baystate Children’s Hospital Springfield, MA Eric Fleegler, MD, MPH, FAAP Attending, Pediatric Emergency Medicine Boston Children’s Hospital Harvard Medical School Boston, MA Allen Friedland, MD, FAAP Newark, DE Lorne Garrettson, MD, FAAP Professor Emeritus Emory University Sandy Spring, MD Mary Gealow, MD, FAAP Greater Lowell Pediatrics Lowell, MA Robert Geller, MD, FAAP Chair Committee on Injury, Violence and Poison Prevention AAP Georgia Chapter Atlanta, GA Emily Gertsch, MD, MPH Memphis, TN Michele Ghim, MD, FAAP Frederick Memorial Hospital Frederick, MD Philip Gioia, MD, MPH, FAAP, FACPM President Children’s Health Specialists Auburn, NY

Mike Gittelman, MD, FAAP Professor, Clinical Pediatrics Division of Emergency Medicine Cincinnati Children’s Hospital Cincinnati, OH Carolyn Goldstein, MD, FAAP Baystate Medical Center Springfield, MA Zachary Goode, DO, FAAP Springfield, MA Aimee Grace, MD, MPH, FAAP Fellow, Academic General Pediatics Children’s National Medical Center Washington, DC Kathryn Green, MD Tarboro, NC Tara Greendyk, MD, FAAP General Pediatrician Dell Children’s Medical Center UTSW Austin Residency Program Austin, TX Marc Grella, MD, FAAP Massachusetts General Hospital Boston, MA Gregory Hagan, MD, FAAP Interim Chief of Pediatrics The Cambridge Health Alliance Cambridge, MA Ara Hall, MD Pediatric Neurologist Kansas City, KS Sarah Hampl, MD, FAAP Kansas City, MO

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Marcus Hanfling, MD, FAAP Assistant Professor Baylor College of Medicine Houston, TX Anne Hanley, DO, FAAP Baystate Children’s Hospital Springfield, MA Robert Hanneman, MD, BSChE, FAAP Visiting Professor Biomedical and Chemical Engineering and Child Psychology Purdue University, IU Health-Arnett Clinic Lafayette and West Lafayette, IN Jill Hanson, MD Kansas City, MO Rochelle Harris, PhD, ABPP Licensed Psychologist Children’s Mercy Hospitals and Clinics Kansas City, MO Leslye Heilig, MD, FAAP Great Barrington, MA Laura Heimback-Graham, MD, FAAP Tampa, FL Marissa Hendrickson, MD, FAAP Minneapolis, MN Karl Hess, MD, FAAP Shaker Heights, OH Harry Hoar, MD, FAAP Baystate Children’s Hospital Springfield, MA Michael Hole, MD, MBA Stanford University of Medicine Stanford, CA Patricia Holtz, MD, FAAP Philadelphia, PA

Laurie Hornberger, MD, MPH, FAAP Kansas City, MO Maria Ibarra, MD, FAAP Kansas City, MO Anne-Marie Irani, MD Professor of Pediatrics and Internal Medicine Virginia Commonwealth University Richmond, VA Xochitl Jackson, MD, FAAP Los Angeles, CA Madhangi Jayaraman, MD, FAAP Bellflower, CA Karen Judy, MD, FAAP Cadence Health Glen Ellyn, IL Nandita Kapa-Kalahasty, MD, FAAP Clinical Associate Johns Hopkins Bayview Baltimore, MD Catherine Karr, MD, PhD, FAAP Associate Professor University of Washington Seattle, WA Mateusz Karwowski, MD, MPH Boston Children’s Hospital and Harvard School of Public Health Boston, MA Erica Kates, MD, FAAP Ludlow Pediatrics Ludlow, MA Ana Kato, MD Los Angeles, CA

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Aviva Katz, MD, MA, FAAP Pediatric Surgeon Children’s Hospital Pittsburgh Pittsburgh, PA David Keller, MD, FAAP President Academic Pediatrics Association Clinical Professor University of Colorado School of Medicine Aurora, CO John J. Killion, MD, FAAP Attleboro, MA Michael Klein, MD, FAAP Children’s Hospital of Michigan Detroit, MI Stephen Klem, MD Children’s Mercy Hospital Kansas City, MO Laura Koenigs, MD, FAAP Director Pediatric Residency Program Baystate Medical Center Springfield, MA Tracy Koogler, MD, FAAP Associate Professor of Pediatrics University of Chicago Chicago, IL Katie Krone, MD Springfield, MA Tarah Kruger, MD Developmental Pediatrician CMH Overland Park, KS Bruce Lanphear, MD, MPH, FAAP Professor of Health Sciences Simon Fraser University Vancouver, BC

Jean-Baptiste Le Pichon, MD, PhD Associate Professor Children’s Mercy Hospital Kansas City, MO Lori Legano, MD, FAAP New York, NY Despina Lekakis, DO, FAAP Holyoke, MA Tamra Lemley, MD Pediatric Associate in Emergency Medicine Children’s Mercy South Overland Park, KS William Lewis MD Candidate Boston, MA Katherine Lobach, MD, FAAP Professor Emerita of Pediatrics Montefiore Medical Center Bronx, NY Jennifer Lowry, MD, FAAP Director Mid America Pediatric Environmental Health Specialty Unit Children’s Mercy Hospital Kansas City, MO Sheela Magge, MD, MSCE, FAAP Children’s Hospital of Philadelphia Philadelphia, PA Stephanie Marton, MD Houston, TX Karen Maule, MD, FAAP East Greenwich Pediatrics East Greenwich, RI Mary McAteer, MD, FAAP Carmel, IN

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Valerie McDougall Kester, MD, FAAP Kansas City, MO Siobhan McNally, MD, MPH, FAAP Community Health Programs- Berkshires Great Barrington, MA Elizabeth McQuaid, MD, FAAP Taunton, MA Joan Meek, MD, FAAP Orlando, FL Marlene Melzer-Lange, MD, FAAP Milwaukee, WI Richard M. Miller, MD, FAAP Marblehead, MA Maureen Miller, MD, MPH (2014) NYU School of Medicine Harvard School of Public Health New York, NY Neil, Minikes, MD Allergist/Pediatrician Closter, NJ Ana Monterrey, MD Baylor College of Medicine Texas Children’s Hospital Houston, TX Emily Montgomery, MD, FAAP Kansas City, MO Dipesh Navsaria, MD, MSLIS, MPH, FAAP Assistant Professor of Pediatrics University of Wisconsin Madison, WI Elizabeth Neary, MD, MS, FAAP Madison, WI Jason Newland, MD, FAAP Kansas City, MO

Nicholas Newman, DO, MS, FAAP Director Pediatric Environmental Health and Lead Clinic Cincinnati Children’s Hospital Medical Center Cincinnati, OH Susan Nondahl, MD, FAAP Associated Physicians Clinic LLP Madison, WI Sarah Nyp, MD, FAAP Kansas City, MO Abiye Okah, MD, FAAP Kansas City, MO John O’Reilly, MD, FAAP Baystate Medical Center Springfield, MA Sean Palfrey, MD, FAAP Medical Director Boston Lead Poisoning Prevention Program Boston Medical Center MA American Academy of Pediatrics Boston, MA Emily Paprocki, DO Kansas City, MO Jerome Paulson, MD, FAAP Chair American Academy of Pediatrics Council on Environmental Health Professor of Pediatrics and Environmental and Occupational Health George Washington University Washington, DC Trina Peduzzi, MD, FAAP Pittsburgh, PA

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Janice Pelletier, MD, FAAP Eastern Maine Medical Center Bangor, ME Kieran Phelan, MD, MSc, FAAP Associate Professor of Pediatrics University of Cincinnati Cincinnati Children’s Hospital Medical Center Cincinnati, OH Eduardo Pino, MD, FAAP Associate Professor of Pediatrics Joan C Edwards School of Medicine Marshall University Huntington, WV Diane Plantz, MD Kansas City, MO Svetlana Pomeranets, MD, FAAP Cleveland Clinic Solon, OH Naomi, Priver, MD, FAAP Cambridge, MA Kyran Quinlan, MD, MPH, FAAP Associate Professor of Clinical Pediatrics Northwestern Feinberg School of Medicine Chicago, IL Angelika Rampal, MD, FAAP UCLA Reston, VA Peter Rappo, MD, FAAP Assistant Clinical Professor of Pediatrics Harvard University School of Medicine Brockton, MA Rebecca Reamy, MD Atlanta, GA

Routt Reigart, MD, FAAP Professor Emeritus of Pediatrics Medical University of South Carolina Charleston, SC Ana Revilla, MD, MPH, TM Stockton, CA Moira LM Richards, MD Medical Director of Children’s Services TMC for Children Tucson, AZ Annely Richardson, MD Springfield, MA Lynn Ringenberg, MD, MSS, FAAP President Physicians for Social Responsibility/Florida Emeritus Professor USF Health Tampa, FL Jerri Rose, MD, FAAP Pediatric Emergency Physician Rainbow Babies and Children’s Hospital Cleveland, OH Philip Rosenthal, MD, FAAP Professor of Pediatrics and Surgery UCSF San Francisco, CA Lainie Ross, MD, PhD, FAAP Carolyn and Matthew Bucksbaum Professor of Clinical Ethics University of Chicago Chicago, IL Eric Ruby, MD, FAAP Taunton, MA Grace Ryu, MD, FAAP Columbus, OH

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Megan Sandel, MD, MPH, FAAP Associate Professor of Pediatrics and Public Health Boston University School of Medicine Boston, MA Garima Sarda, MD, Springfield, MA Lydia Sarro, MD, FAAP Riverbend Medical Group Chicopee, MA Sheela Sathyanarayana, MD, MPH University of Washington Seattle, WA Benjamin Scheindlin, MD, FAAP Burlington Pediatrics, LLC Burlington, MA Leslie Scherl, MD, FAAP East Boston, MA Donald Schiff, MD, FAAP Past President American Academy of Pediatrics Professor Emeritus of Pediatrics University of Colorado School of Medicine Denver, CO Paul Schreiber, MD, FAAP Brockton, MA Robert Schremmer, MD, FAAP Pediatric Emergency Physician Children’s Mercy Hospitals and Clinics Kansas City, MO Kimberly Schwartz, MD, FAAP Shrewsbury, MA

Sarah Jane Schwarzenberg, MD, FAAP Chief Pediatric Gastroenterology, Hepatology, and Nutrition University of Minnesota Amplatz Children’s Hospital Minneapolis, MN Kathleen Senn, MD, FAAP Children’s Mercy Hospital Kansas City, MO Perry Sheffield, MD New York, NY Jeffrey Shenberger, MD Chief of Neonatology Baystate Children’s Hospital Springfield, MA Kim Shubert, MD Children’s Mercy Hospital Kansas City, MO Scott Sicherer, MD, FAAP New York, NY Benjamin Siegel, MD, FAAP Professor of Pediatrics Boston Medical Center Boston, MA Julie Silberman, MD Boston, MA Jimmy Simon, MD, FAAP Professor and Chair Emeritus Department of Pediatrics Wake Forest University Winston Salem, NC Rachana Singh, MD, MS, FAAP Baystate Children’s Hospital Springfield, MA

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John Snyder, MD, FAAP Tufts University School of Medicine Amherst, MA Peter Sodt, MD, FAAP Camano Island, WA Ricardo Sorensen, MD, FAAP Professor and Chairman LSU HSC- Pediatrics New Orleans, LA Robert Sprinkle, MD, PhD, FAAP University of Maryland School of Public Policy College Park, MD Janet Squires, MD, FAAP Pittsburgh, PA Amanda Stewart, MD, MPH Boston, MA E. Richard Stiehm, MD, FAAP Professor of Pediatrics David Geffen School of Medicine Los Angeles, CA Robert Stone, MD Associate Chair Department of Pediatrics Akron Children’s Hospital Akron, OH John Straus, MD, FAAP Massachusetts Behavioral Health Partnership Boston, MA Sharon Swindell, MD, MPD, FAAP Ypsilanti, MI David Tayloe, MD, FAAP, FAAP Past President American Academy of Pediatrics Goldsboro, NC

Joseph Telch, MD, FAAP Toronto, Ontario, Canada Robert Truckner, MD, MPH Spokane, WA Angela Turpin, MD Assistant Professor of Pediatrics Kansas City, MO Eileen Tyrala, MD, FAAP Philadelphia, PA Heather Underkofler, MD Kansas City, MO Girish Vitalpur, MD, FAAP Indianapolis, IN Thomas Wadzinski, MD, PhD Baystate Medical Center Springfield, MA Jacqueline Walker, MD Pediatric Hospitalist Children’s Mercy Hospital Kansas City, MO Jennifer Walter, MD, PhD, MS, FAAP Assistant Professor of Pediatrics Children’s Hospital of Philadelphia Philadelphia, PA Manoj Warrier, MD Saint Louis, MO Amy Whittle, MD, FAAP Assistant Clinical Professor of Pediatrics University of California San Francisco San Francisco, CA Yolanda Whyte, MD Dr. Yolanda Whyte Pediatrics Atlanta, GA

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Kenneth Wible, MD, FAAP Kansas City, MO Margaret Wilcots, MD, FAAP Madison, WI Nicole Wood, DO Pediatric Resident Children’s Mercy Hospital and Clinics Kansas City, MO Alan Woolf, MD, MPH, FAAP Professor Harvard Medical School Boston, MA

Robert Wright, MD, FAAP Professor of Pediatrics Mount Sinai School of Medicine New York, NY Lauren Zajac, MD, MPH New York, NY Joseph Zanga, MD Chief of Pediatrics Columbus Regional Health Columbus, GA Jessica Zina, MD, MA Springfield, MA

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October 24, 2013 The Honorable Harold Rogers Chair House Appropriations Committee 2406 Rayburn House Office Building Washington, DC 20515

The Honorable Nita Lowey Ranking Member House Appropriations Committee 2365 Rayburn House Office Building Washington, DC 20515

The Honorable Jack Kingston Chair House Appropriations Subcommittee Labor, Health and Human Services, Education, and Related Agencies 2372 Rayburn Office Building Washington, DC 20515

The Honorable Rosa DeLauro Ranking Member House Appropriations Subcommittee Labor, Health and Human Services, Education, and Related Agencies 2413 Rayburn Office Building Washington, DC 20515

Dear. Chairman Rogers, Ranking Member Lowey, Chairman Kingston, and Ranking Member DeLauro: As pediatricians, we are writing to urge your support for the restoration of $29 million in funding for the Centers for Disease Control and Prevention (CDC) Healthy Homes/Lead Poisoning Prevention Program. Due to the importance of public health support for pediatricians in our efforts to protect children from exposures to toxic agents like lead, we are deeply concerned by recent trends in funding of the CDC’s Healthy Homes/Lead Poisoning Prevention Program. Funding for the program went from $29,257,000 in fiscal year 2011 to $1,995,000 in fiscal year 2012, a more than 90 percent funding reduction. These cuts are devastating to pediatric prevention efforts and we urge you to support a restoration of the funding needed for this critical program. Lead toxicity and elevated blood lead levels are preventable, and no children should have to suffer the deleterious effects that lead exposure has on their intelligence, development, other neurologic functions, and ultimately, their academic and career paths. The American Academy of Pediatrics has long emphasized that there is no safe level of lead exposure, which has pernicious effects on children’s health and is associated with low birth weight, delayed puberty, decreased hearing and stunted growth. At higher blood lead levels, exposure can lead to anemia, lead encephalopathy and even death. Research continues to conclusively demonstrate adverse health effects of lead exposure on children at increasingly lower blood lead levels (BLLs; including those below 5 µg/dL), to include: effects on children’s intellectual abilities, development and academic achievement; attention deficit hyperactivity disorder (ADHD); conduct disorder; and antisocial behavior. For decades, the Lead Poisoning Prevention Branch at CDC has provided funding grants and federal leadership to state and local health departments around lead poisoning education, surveillance, environmental inspection and remediation, lead screening, case management, data management and laboratory issues. With current limited funding, most of the activities which

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provided federal leadership and oversight and a public health framework for lead poisoning prevention and healthy housing work, as well as funding to approximately 35 state and local grantees for lead poisoning, cannot be carried out at this time. This represents a tremendous loss of knowledge and resources that will cripple both state and local public health departments and pediatricians looking to them for guidance, in their work preventing lead exposure. Individual pediatricians can undertake some activities to prevent and manage elevated blood lead levels through giving anticipatory guidance, performing lead screening, monitoring serial BLLs in the office, and providing medical therapy, such as with chelation therapy, when indicated. Outside of the office, pediatricians have long relied on our local and state health department colleagues to ensure that there is proper assessment of the source or sources of lead exposure for patients and that work for elimination or remediation of lead sources is carried out by qualified professionals. This partnership has been premised on the availability of lead poisoning prevention professionals at the local and state level, without whom proper environmental management cannot take place. Current Healthy Homes/Lead Poisoning Prevention Program funding does not support this need and undermines previous advances and longstanding partnerships in lead poisoning prevention. Adverse health effects occur at even very low blood lead levels in children, and high numbers of U.S. children are expected to continue to be exposed to lead in their homes and environments. The CDC has revised its reference level for blood lead levels of concern from ≥ 10 µg/dL to ≥ 5 µg/dL. This change reflects evidence that lead exposure has significant negative health effects at levels lower than previously estimated, but it also means that a larger-than-anticipated number of children will need services under this program. Recently, the Senate Committee on Appropriations approved its fiscal year 2014 budget, which included $10 million in funding for this program. While this increased funding is a welcome improvement from current levels, it still falls short of the program’s needs. Therefore, we respectfully request the administration’s support to reinstate funding for the CDC Healthy Homes/Lead Poisoning Prevention Program to at least the fiscal year 2011 level of $29 million. Again, we urge your support to restore full funding for lead poisoning prevention efforts. For further assistance, please do not hesitate to contact Sonya Clay, Assistant Director, Department of Federal Affairs, 202-347-8600 or sclay@aap.org. Cc: Members of the Senate Appropriations Committee Sincerely,

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Jaclyn Albin, MD Chief Resident Baylor College of Medicine Houston, TX Maude Aldridge, MD Baystate Medical Center Springfield, MA D. Adam Algren, MD Assistant Professor of Pediatrics and Emergency Medicine University of Missouri-Kansas City Kansas City, MO Carole Allen, MD, FAAP District I Chair American Academy of Pediatrics Arlington, MA Erin Allen, MD, FAAP Assistant Professor of Pediatrics Baylor College of Medicine Pasadena, TX Joel J. Alpert, MD, FAAP Past President American Academy of Pediatrics Professor and Chair Emeritus of Pediatrics Boston University School of Medicine Boston, MA Mercedes Amado, MD, FAAP Associate Professor of Pediatrics Children’s Mercy Hospital University of Missouri- Kansas City School of Medicine Parag Amin, MD, FAAP Centre Pediatric Associates, PC Brookline, MA Deborah Archer, MD, FAAP Community Health Center Fort Collins, CO

Daniel Arnold, MD, FAAP Children’s Mercy Hospital Kansas City, MO Michael Artman, MD, FAAP Pediatrician-In-Chief Children’s Mercy Hospital Kansas City, MO Ghufran Babar, MD Children’s Mercy Hospital Kansas City, MO Sami Bahna, MD, DrPH, FAAP Professor of Pediatrics Louisiana State University Health Sciences Center Shreveport, LA Charles Barnes, PhD Children’s Mercy Hospital Kansas City, MO Valerie Barnes, MD Medical Director Archer Child Advocacy Center Associate Professor in Family Medicine UCSF Natividad Medical Center Salinas, CA Erich Batra, MD, FAAP Lebanon, PA Carl Baum, MD, FAAP Associate Professor of Pediatrics Yale University School of Medicine New Haven, CT Thomas Bender, MD, FAAP SSM Cardinal Glennon Children’s Medical Center St. Louis, MO

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Jay Berkelhamer, MD, FAAP Past President American Academy of Pediatrics Atlanta, GA Carol Berkowitz, MD, FAAP Past President American Academy of Pediatrics Professor and Executive Vice Chair David Geffen School of Medicine UCLA Torrance, CA Philip Black, MD, FAAP Kansas City, MO Gordon Bloomberg, MD, FAAP Professor of Pediatrics Washington University School of Medicine St. Louis, MO Aparna Bole, MD, FAAP UH Rainbow Babies and Children’s Hospital Cleveland, OH Hilary Branch, MD, FAAP Baystate Medical Center Springfield, MA Anne Brayer, MD, FAAP Professor, Emergency Medicine Pediatrics and Center for Community Health University of Rochester Rochester, NY Lorraine Brewer, DO, FAAP Kansas City, KS Patrick Brown, MD Baystate Health Springfield, MA

Marilyn Bull, MD, FAAP District V Chair Member of Board of Directors American Academy of Pediatrics Morris Green Professor of Pediatrics Riley Hospital for Children Indianapolis, IN Michele Burns, MD, MPH, FAAP Staff Physician Boston Children’s Hospital Harvard Medical School Boston, MA Marion Burton, MD, FAAP Past President American Academy of Pediatrics Director of Community of Affairs University of South Carolina School of Medicine Columbia, SC Carla Campbell, MD, MS, FAAP Associate Teaching Professor Drexel University of Public Health Philadelphia, PA Lisa Carney, MD, FAAP Kansas City, MO Beth Carter, MD Baystate Medical Center Springfield, MA Brian Carter, MD, FAAP Professor of Pediatrics and Bioethics University of Missouri- Kansas City Kansas City, MO Fernando Catalina, MD, PhD, FAAP Medical Associate Pediatrics Leominster, MA Ruby Chang, MD, FAAP Berkshire Health Systems Great Barrington, MA

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Victoria Chen, MD Developmental Behavioral Pediatrician NYUMC New York, NY Christina Ciaccio, MD Assistant Professor Children’s Mercy Hospital Kansas City, MO William Cochran, MD, FAAP Vice Chairman Department of Pediatrics Geisinger Clinic Danville, PA George Cohen, MD, FAAP Children’s National Medical Center Washington, DC Mark Corkins, MD, CNSC, FAAP Professor of Pediatrics University of Tennessee Health Science Center Memphis, TN Deborah Cory-Slechta, PhD Professor of Environmental Medicine and Pediatrics University of Rochester Rochester, NY Stephen Daniels, MD, PhD, FAAP Professor and Chairman Department of Pediatrics University of Colorado School of Medicine Aurora, CO Manuel Datiles, MD Baystate Tufts Pediatrics Department Springfield, MA Caroline de Roode-Wentz, MD Kansas City, MO

Teresa Del Moral, MD, FAAP University of Miami Miami, FL Chitra Dinakar, MD, FAAP Kansas City, MO Molly Droge, MD, FAAP Chair Subcommittee on Access to Care Committee on Federal Government Affairs American Academy of Pediatrics Parkville, MO April R. Dworetz, MD, MPH, FAAP Assistant Professor of Pediatrics Emory University School of Medicine Atlanta, GA Antoinette Eaton, MD, FAAP Past President American Academy of Pediatrics Columbus, OH Kathleen Farrell, MD, FAAP Children’s Mercy Hospital Kansas City, KS Mary Beth Fasano, MD, MSPH, FAAP Iowa City, IA Chris Feudtner, MD, PhD, MPH, FAAP Philadelphia, PA Clara Filice, MD, MPH, MHS, FAAP Pediatric Environmental Health and Food Policy Fellow AAP Department of Federal Affairs Washington, DC Gilbert Fisch, MD, FAAP Jupiter, FL

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Donna Fisher, MD, FAAP Chief, Pediatric Infectious Diseases Baystate Children’s Hospital Springfield, MA Eric Fleegler, MD, MPH, FAAP Attending, Pediatric Emergency Medicine Boston Children’s Hospital Harvard Medical School Boston, MA Allen Friedland, MD, FAAP Newark, DE Lorne Garrettson, MD, FAAP Professor Emeritus Emory University Sandy Spring, MD Mary Gealow, MD, FAAP Greater Lowell Pediatrics Lowell, MA Robert Geller, MD, FAAP Chair Committee on Injury, Violence and Poison Prevention AAP Georgia Chapter Atlanta, GA Emily Gertsch, MD, MPH Memphis, TN Michele Ghim, MD, FAAP Frederick Memorial Hospital Frederick, MD Philip Gioia, MD, MPH, FAAP, FACPM President Children’s Health Specialists Auburn, NY

Mike Gittelman, MD, FAAP Professor, Clinical Pediatrics Division of Emergency Medicine Cincinnati Children’s Hospital Cincinnati, OH Carolyn Goldstein, MD, FAAP Baystate Medical Center Springfield, MA Zachary Goode, DO, FAAP Springfield, MA Aimee Grace, MD, MPH, FAAP Fellow, Academic General Pediatics Children’s National Medical Center Washington, DC Kathryn Green, MD Tarboro, NC Tara Greendyk, MD, FAAP General Pediatrician Dell Children’s Medical Center UTSW Austin Residency Program Austin, TX Marc Grella, MD, FAAP Massachusetts General Hospital Boston, MA Gregory Hagan, MD, FAAP Interim Chief of Pediatrics The Cambridge Health Alliance Cambridge, MA Ara Hall, MD Pediatric Neurologist Kansas City, KS Sarah Hampl, MD, FAAP Kansas City, MO

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Marcus Hanfling, MD, FAAP Assistant Professor Baylor College of Medicine Houston, TX Anne Hanley, DO, FAAP Baystate Children’s Hospital Springfield, MA Robert Hanneman, MD, BSChE, FAAP Visiting Professor Biomedical and Chemical Engineering and Child Psychology Purdue University, IU Health-Arnett Clinic Lafayette and West Lafayette, IN Jill Hanson, MD Kansas City, MO Rochelle Harris, PhD, ABPP Licensed Psychologist Children’s Mercy Hospitals and Clinics Kansas City, MO Leslye Heilig, MD, FAAP Great Barrington, MA Laura Heimback-Graham, MD, FAAP Tampa, FL Marissa Hendrickson, MD, FAAP Minneapolis, MN Karl Hess, MD, FAAP Shaker Heights, OH Harry Hoar, MD, FAAP Baystate Children’s Hospital Springfield, MA Michael Hole, MD, MBA Stanford University of Medicine Stanford, CA Patricia Holtz, MD, FAAP Philadelphia, PA

Laurie Hornberger, MD, MPH, FAAP Kansas City, MO Maria Ibarra, MD, FAAP Kansas City, MO Anne-Marie Irani, MD Professor of Pediatrics and Internal Medicine Virginia Commonwealth University Richmond, VA Xochitl Jackson, MD, FAAP Los Angeles, CA Madhangi Jayaraman, MD, FAAP Bellflower, CA Karen Judy, MD, FAAP Cadence Health Glen Ellyn, IL Nandita Kapa-Kalahasty, MD, FAAP Clinical Associate Johns Hopkins Bayview Baltimore, MD Catherine Karr, MD, PhD, FAAP Associate Professor University of Washington Seattle, WA Mateusz Karwowski, MD, MPH Boston Children’s Hospital and Harvard School of Public Health Boston, MA Erica Kates, MD, FAAP Ludlow Pediatrics Ludlow, MA Ana Kato, MD Los Angeles, CA

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Aviva Katz, MD, MA, FAAP Pediatric Surgeon Children’s Hospital Pittsburgh Pittsburgh, PA David Keller, MD, FAAP President Academic Pediatrics Association Clinical Professor University of Colorado School of Medicine Aurora, CO John J. Killion, MD, FAAP Attleboro, MA Michael Klein, MD, FAAP Children’s Hospital of Michigan Detroit, MI Stephen Klem, MD Children’s Mercy Hospital Kansas City, MO Laura Koenigs, MD, FAAP Director Pediatric Residency Program Baystate Medical Center Springfield, MA Tracy Koogler, MD, FAAP Associate Professor of Pediatrics University of Chicago Chicago, IL Katie Krone, MD Springfield, MA Tarah Kruger, MD Developmental Pediatrician CMH Overland Park, KS Bruce Lanphear, MD, MPH, FAAP Professor of Health Sciences Simon Fraser University Vancouver, BC

Jean-Baptiste Le Pichon, MD, PhD Associate Professor Children’s Mercy Hospital Kansas City, MO Lori Legano, MD, FAAP New York, NY Despina Lekakis, DO, FAAP Holyoke, MA Tamra Lemley, MD Pediatric Associate in Emergency Medicine Children’s Mercy South Overland Park, KS William Lewis MD Candidate Boston, MA Katherine Lobach, MD, FAAP Professor Emerita of Pediatrics Montefiore Medical Center Bronx, NY Jennifer Lowry, MD, FAAP Director Mid America Pediatric Environmental Health Specialty Unit Children’s Mercy Hospital Kansas City, MO Sheela Magge, MD, MSCE, FAAP Children’s Hospital of Philadelphia Philadelphia, PA Stephanie Marton, MD Houston, TX Karen Maule, MD, FAAP East Greenwich Pediatrics East Greenwich, RI Mary McAteer, MD, FAAP Carmel, IN

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Valerie McDougall Kester, MD, FAAP Kansas City, MO Siobhan McNally, MD, MPH, FAAP Community Health Programs- Berkshires Great Barrington, MA Elizabeth McQuaid, MD, FAAP Taunton, MA Joan Meek, MD, FAAP Orlando, FL Marlene Melzer-Lange, MD, FAAP Milwaukee, WI Richard M. Miller, MD, FAAP Marblehead, MA Maureen Miller, MD, MPH (2014) NYU School of Medicine Harvard School of Public Health New York, NY Neil, Minikes, MD Allergist/Pediatrician Closter, NJ Ana Monterrey, MD Baylor College of Medicine Texas Children’s Hospital Houston, TX Emily Montgomery, MD, FAAP Kansas City, MO Dipesh Navsaria, MD, MSLIS, MPH, FAAP Assistant Professor of Pediatrics University of Wisconsin Madison, WI Elizabeth Neary, MD, MS, FAAP Madison, WI Jason Newland, MD, FAAP Kansas City, MO

Nicholas Newman, DO, MS, FAAP Director Pediatric Environmental Health and Lead Clinic Cincinnati Children’s Hospital Medical Center Cincinnati, OH Susan Nondahl, MD, FAAP Associated Physicians Clinic LLP Madison, WI Sarah Nyp, MD, FAAP Kansas City, MO Abiye Okah, MD, FAAP Kansas City, MO John O’Reilly, MD, FAAP Baystate Medical Center Springfield, MA Sean Palfrey, MD, FAAP Medical Director Boston Lead Poisoning Prevention Program Boston Medical Center MA American Academy of Pediatrics Boston, MA Emily Paprocki, DO Kansas City, MO Jerome Paulson, MD, FAAP Chair American Academy of Pediatrics Council on Environmental Health Professor of Pediatrics and Environmental and Occupational Health George Washington University Washington, DC Trina Peduzzi, MD, FAAP Pittsburgh, PA

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Janice Pelletier, MD, FAAP Eastern Maine Medical Center Bangor, ME Kieran Phelan, MD, MSc, FAAP Associate Professor of Pediatrics University of Cincinnati Cincinnati Children’s Hospital Medical Center Cincinnati, OH Eduardo Pino, MD, FAAP Associate Professor of Pediatrics Joan C Edwards School of Medicine Marshall University Huntington, WV Diane Plantz, MD Kansas City, MO Svetlana Pomeranets, MD, FAAP Cleveland Clinic Solon, OH Naomi, Priver, MD, FAAP Cambridge, MA Kyran Quinlan, MD, MPH, FAAP Associate Professor of Clinical Pediatrics Northwestern Feinberg School of Medicine Chicago, IL Angelika Rampal, MD, FAAP UCLA Reston, VA Peter Rappo, MD, FAAP Assistant Clinical Professor of Pediatrics Harvard University School of Medicine Brockton, MA Rebecca Reamy, MD Atlanta, GA

Routt Reigart, MD, FAAP Professor Emeritus of Pediatrics Medical University of South Carolina Charleston, SC Ana Revilla, MD, MPH, TM Stockton, CA Moira LM Richards, MD Medical Director of Children’s Services TMC for Children Tucson, AZ Annely Richardson, MD Springfield, MA Lynn Ringenberg, MD, MSS, FAAP President Physicians for Social Responsibility/Florida Emeritus Professor USF Health Tampa, FL Jerri Rose, MD, FAAP Pediatric Emergency Physician Rainbow Babies and Children’s Hospital Cleveland, OH Philip Rosenthal, MD, FAAP Professor of Pediatrics and Surgery UCSF San Francisco, CA Lainie Ross, MD, PhD, FAAP Carolyn and Matthew Bucksbaum Professor of Clinical Ethics University of Chicago Chicago, IL Eric Ruby, MD, FAAP Taunton, MA Grace Ryu, MD, FAAP Columbus, OH

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Megan Sandel, MD, MPH, FAAP Associate Professor of Pediatrics and Public Health Boston University School of Medicine Boston, MA Garima Sarda, MD, Springfield, MA Lydia Sarro, MD, FAAP Riverbend Medical Group Chicopee, MA Sheela Sathyanarayana, MD, MPH University of Washington Seattle, WA Benjamin Scheindlin, MD, FAAP Burlington Pediatrics, LLC Burlington, MA Leslie Scherl, MD, FAAP East Boston, MA Donald Schiff, MD, FAAP Past President American Academy of Pediatrics Professor Emeritus of Pediatrics University of Colorado School of Medicine Denver, CO Paul Schreiber, MD, FAAP Brockton, MA Robert Schremmer, MD, FAAP Pediatric Emergency Physician Children’s Mercy Hospitals and Clinics Kansas City, MO Kimberly Schwartz, MD, FAAP Shrewsbury, MA

Sarah Jane Schwarzenberg, MD, FAAP Chief Pediatric Gastroenterology, Hepatology, and Nutrition University of Minnesota Amplatz Children’s Hospital Minneapolis, MN Kathleen Senn, MD, FAAP Children’s Mercy Hospital Kansas City, MO Perry Sheffield, MD New York, NY Jeffrey Shenberger, MD Chief of Neonatology Baystate Children’s Hospital Springfield, MA Kim Shubert, MD Children’s Mercy Hospital Kansas City, MO Scott Sicherer, MD, FAAP New York, NY Benjamin Siegel, MD, FAAP Professor of Pediatrics Boston Medical Center Boston, MA Julie Silberman, MD Boston, MA Jimmy Simon, MD, FAAP Professor and Chair Emeritus Department of Pediatrics Wake Forest University Winston Salem, NC Rachana Singh, MD, MS, FAAP Baystate Children’s Hospital Springfield, MA

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John Snyder, MD, FAAP Tufts University School of Medicine Amherst, MA Peter Sodt, MD, FAAP Camano Island, WA Ricardo Sorensen, MD, FAAP Professor and Chairman LSU HSC- Pediatrics New Orleans, LA Robert Sprinkle, MD, PhD, FAAP University of Maryland School of Public Policy College Park, MD Janet Squires, MD, FAAP Pittsburgh, PA Amanda Stewart, MD, MPH Boston, MA E. Richard Stiehm, MD, FAAP Professor of Pediatrics David Geffen School of Medicine Los Angeles, CA Robert Stone, MD Associate Chair Department of Pediatrics Akron Children’s Hospital Akron, OH John Straus, MD, FAAP Massachusetts Behavioral Health Partnership Boston, MA Sharon Swindell, MD, MPD, FAAP Ypsilanti, MI David Tayloe, MD, FAAP, FAAP Past President American Academy of Pediatrics Goldsboro, NC

Joseph Telch, MD, FAAP Toronto, Ontario, Canada Robert Truckner, MD, MPH Spokane, WA Angela Turpin, MD Assistant Professor of Pediatrics Kansas City, MO Eileen Tyrala, MD, FAAP Philadelphia, PA Heather Underkofler, MD Kansas City, MO Girish Vitalpur, MD, FAAP Indianapolis, IN Thomas Wadzinski, MD, PhD Baystate Medical Center Springfield, MA Jacqueline Walker, MD Pediatric Hospitalist Children’s Mercy Hospital Kansas City, MO Jennifer Walter, MD, PhD, MS, FAAP Assistant Professor of Pediatrics Children’s Hospital of Philadelphia Philadelphia, PA Manoj Warrier, MD Saint Louis, MO Amy Whittle, MD, FAAP Assistant Clinical Professor of Pediatrics University of California San Francisco San Francisco, CA Yolanda Whyte, MD Dr. Yolanda Whyte Pediatrics Atlanta, GA

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Kenneth Wible, MD, FAAP Kansas City, MO Margaret Wilcots, MD, FAAP Madison, WI Nicole Wood, DO Pediatric Resident Children’s Mercy Hospital and Clinics Kansas City, MO Alan Woolf, MD, MPH, FAAP Professor Harvard Medical School Boston, MA

Robert Wright, MD, FAAP Professor of Pediatrics Mount Sinai School of Medicine New York, NY Lauren Zajac, MD, MPH New York, NY Joseph Zanga, MD Chief of Pediatrics Columbus Regional Health Columbus, GA Jessica Zina, MD, MA Springfield, MA