Over one third of PPERS visits were inappropriate, characterized by better functioning, low harm potential or severity of presenting complaint, and absent suicidality or psychosis. Development of and improved access to urgent child and adolescent psychiatric outpatient care services in the community and referral agent educational programs may minimize inappropriate PPERS visits.

Childhood lead poisoning is common, affects multiple organs and is preventable. Co-existence of plumbism and sickle cell disease (SCD) is uncommon, with major overlap in signs and symptoms. We describe a patient with SCD and plumbism. Dysfunctional eating patterns may cause ingestion and increased absorption of lead in these patients. Routine screening for pica and other dysfunctional eating habits with appropriate behavioral interventions is emphasized. Annual screening for lead in patients with SCD of all ages (1-21years) and supplementation of micronutrients like zinc and iron in deficient cases may help prevent plumbism in these patients.

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