Lead poisoning in children

CRISTA WARNIMENT, MD, University of Virginia School of Medicine và Family Medicine Residency Program, Charlottesville, Virginia

KATRINA TSANG, MB, ChB, University of Virginia Family Medicine Residency Program, Charlottesville, Virginia

SIM S. GALAZKA, MD, University of Virginia School of Medicine & Family Medicine Residency Program, Charlottesville, Virginia

Am Fam Physician. 2010 Mar 15;81(6):751-757.

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Patient information: See related handout on lead poisoning in children, written by the authors of this article.


The prevalence và severity of childhood lead poisoning have been greatly reduced since the removal of lead from paint & gasoline in the 1970s. Despite these efforts, approximately 310,000 U.S. children younger than five years have sầu elevated blood lead levels. Health care professionals should perform targeted screening for lead poisoning in children who are Medicaid-enrolled or -eligible, foreign born, or identified as high risk by the Centers for Disease Control and Prevention (CDC) location-specific recommendations or by a personal risk questionnaire. Venous sampling is the preferred method for measuring blood lead levels, but a carefully collected finger-stichồng sample is an acceptable alternative. Capillary samples of elevated levels should be confirmed by a venous sample. The CDC recommends that the threshold for follow-up và intervention of lead poisoning be a blood lead cấp độ of 10 μg per dL or higher. Recommendations for treatment of elevated blood levels include a thorough environmental investigation, laboratory testing when appropriate, iron supplementation for iron-deficient children, & chelation therapy for blood lead levels of 45 μg per dL or more. Prevention consists of education và avoidance of lead-contaminated products.


Lead is a metal that has been redistributed in the environment as a result of human activities over thousands of years. It has been used in construction, for decoration, và even as a food additive sầu. It also has been a known health risk for centuries. Hippocrates is thought khổng lồ have sầu written the first case report of lead poisoning in 600 BC. The Romans also were aware of the toxiđô thị of lead, with Pliny, Paulus Aegineta, and Vesuvius all commenting on its effects.1

There are no signs and symptoms specific lớn lead poisoning, making identification based solely on patient history & physical examination difficult. Symptoms that bởi occur are vague & commonly encountered in daily practice. These can include gastrointestinal issues (e.g., abdominal pain, constipation, nausea, vomiting), decreased growth in height, delayed sexual maturation, increased dental caries, và impaired neurologic development (e.g., behavioral changes, mental impairment, seizures, coma).2,3 In the United States, an estimated 310,000 children younger than five years have elevated blood lead levels.4 Primary preventive strategies such as eliminating lead as an additive from paint & gasoline have resulted in lower blood lead levels aao ước U.S. children.


SORT: KEY RECOMMENDATIONS FOR PRACTICEClinical recommendationEvidence ratingReferences

Targeted screening for elevated blood lead levels should be performed in children at one và two years of age who are Medicaid-enrolled or -eligible.

C

6, 8

Targeted screening for elevated blood lead levels should be performed in all children deemed to be at risk.

C

6

All foreign-born children, such as recent immigrants, refugees, and international adoptees, should be screened for elevated blood lead levels immediately on arrival in the United States.

C

6, 16–19

Measurement of blood lead level with a carefully collected finger-stick sample is an acceptable alternative to a venous sample.

C

6, 8, 23–25

Elevated blood lead levels from capillary samples should be confirmed by a venous sample.

C

26

Chelation therapy is recommended only for blood lead levels of 45 μg per dL (2.17 μmol per L) or greater.

C

3, 27, 31–33

Iron supplementation improves blood lead levels in anemic, iron-depleted children.

C

41, 42


A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-chất lượng patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, go to https://www.thitruongxemay.com/afpsort.xml.

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SORT: KEY RECOMMENDATIONS FOR PRACTICEClinical recommendationEvidence ratingReferences

Targeted screening for elevated blood lead levels should be performed in children at one and two years of age who are Medicaid-enrolled or -eligible.

C

6, 8

Targeted screening for elevated blood lead levels should be performed in all children deemed to lớn be at risk.

C

6

All foreign-born children, such as recent immigrants, refugees, & international adoptees, should be screened for elevated blood lead levels immediately on arrival in the United States.

C

6, 16–19

Measurement of blood lead level with a carefully collected finger-stick sample is an acceptable alternative to lớn a venous sample.

C

6, 8, 23–25

Elevated blood lead levels from capillary samples should be confirmed by a venous sample.

C

26

Chelation therapy is recommended only for blood lead levels of 45 μg per dL (2.17 μmol per L) or greater.

C

3, 27, 31–33

Iron supplementation improves blood lead levels in anemic, iron-depleted children.

C

41, 42


A = consistent, good-chất lượng patient-oriented evidence; B = inconsistent or limited-unique patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, go khổng lồ https://www.thitruongxemay.com/afpsort.xml.


The Centers for Disease Control and Prevention (CDC) currently designates a blood lead màn chơi of 10 μg per dL (0.48 μmol per L) or higher as abnormal & requiring follow-up và intervention.4 Even blood lead levels lower than 10 μg per dL can affect cognitive development.2,5 Thus, a current dilemma is the nearly impossible task of eliminating all lead exposure in children. For physicians, identifying children at high risk; eliminating exposure to known sources of lead; & ensuring adequate nutrition, including preventing & correcting iron deficiency, are key strategies in the care of all children.


Table 1 lists common sources of lead to be avoided.3,6,7 Lead poisoning in children is usually caused by exposure lớn dust & paint chips from interior surfaces of homes with deteriorating lead-based paint.6,8 The U.S. Consumer Product Safety Commission (http://www.cpsc.gov/) và the CDC (http://www.cdc.gov/nceh/lead/Recalls/default.htm) post recalls of products containing lead. Dust và soil have sầu been contaminated by decades of deposition of airborne lead from leaded gasoline and lead-based paint. Children playing on bare contaminated soil have demonstrated elevated blood lead levels.3 Traditional remedies and certain cultural items, such as folk herbal remedies or cosmetics imported from Asia, the Middle East, Africa, or Mexico, are other comtháng sources.8 Because lead crosses the placenta, mothers can be a source of exposure for infants in utero.9 Less comtháng sources include contaminated drinking water, imported food in soldered cans, imported chocolate & candy, ceramic pottery, và blood transfusions.6,7


Table 1.Comtháng Sources of Lead

Dust containing lead from renovations or remodeling

Folk remedies

Ayurvedic medicine (traditional medicine from Tibet)

Azarbé (bright orange powder thought khổng lồ be medicinal)

Ba-Baw-San (Chinese herbal medicine used for colic)

Bint Al Zahab (Iranian powder mixed with honey and butter for colic)

Bint Dahab (Saudi Arabian yellow powder used as a home page remedy)

Bokhoor (Kuwaiti fumes from wood và lead used khổng lồ calm infants)

Ghasard (brown powder to aid in digestion)

Greta (Mexican yellow powder to lớn treat gastrointestinal distress)

Jin Bu Huan (Chinese herbal medicinal pain reliever)

Pay-loo-ah (Vietnamese red powder to lớn treat fever or rash)

Po Ying Tan (Chinese herbal medicine)

Santrinj (Saudi Arabian red powder used for teething)

Saudi traditional medicine (orange powder for teething)

Surma (Indian black powder used for teething)

Tibetan herbal vitamin (used for brain health)

Imported candy

Imported cosmetics

Eye cosmetics from Pakistan

Kohl (a type of eyeliner from India, the Middle East, & Africa)

Surma (powder applied lớn the eyes, from India)

Imported jewelry

Imported toys

Paint chips from lead-based paint

Pottery and ceramics

Soil contaminated with lead

Take-home exposures (based on occupation of parents/family members)

Battery reclamation workers

Ceramics workers

Construction workers

Furniture refinishers

Radiator repair workers

Tea kettles

Vinyl mini blinds

Water contaminated by lead leaching from pipes, solder, valves, fixtures


Table 1.Comtháng Sources of Lead

Dust containing lead from renovations or remodeling

Folk remedies

Ayurvedic medicine (traditional medicine from Tibet)

Azarcon (bright orange powder thought lớn be medicinal)

Ba-Baw-San (Chinese herbal medicine used for colic)

Bint Al Zahab (Iranian powder mixed with honey & butter for colic)

Bint Dahab (Saudi Arabian yellow powder used as a trang chính remedy)

Bokhoor (Kuwaiti fumes from wood & lead used lớn calm infants)

Ghasard (brown powder lớn aid in digestion)

Greta (Mexican yellow powder lớn treat gastrointestinal distress)

Jin Bu Huan (Chinese herbal medicinal pain reliever)

Pay-loo-ah (Vietnamese red powder to lớn treat fever or rash)

Po Ying Tan (Chinese herbal medicine)

Santrinj (Saudi Arabian red powder used for teething)

Saudi traditional medicine (orange powder for teething)

Surma (Indian blaông chồng powder used for teething)

Tibechảy herbal Vi-Ta-Min (used for brain health)

Imported candy

Imported cosmetics

Eye cosmetics from Pakistan

Kohl (a type of eyeliner from India, the Middle East, and Africa)

Surma (powder applied khổng lồ the eyes, from India)

Imported jewelry

Imported toys

Paint chips from lead-based paint

Pottery & ceramics

Soil contaminated with lead

Take-trang chính exposures (based on occupation of parents/family members)

Battery reclamation workers

Ceramics workers

Construction workers

Furniture refinishers

Radiator repair workers

Tea kettles

Vinyl mini blinds

Water contaminated by lead leaching from pipes, solder, valves, fixtures


Information from references 3, 6, and 7.

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Children at Risk


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Effective sầu screening programs for lead poisoning depover on identifying children who are at risk because of their physical và social environment. Race & ethniđô thị have sầu been linked lớn higher rates of lead poisoning, with non-Hispanic blacks và Mexican Americans being at higher risk than non-Hispanic whites.7,10–12 Children from households below the federal poverty màn chơi are also more likely to lớn have sầu elevated blood lead levels, independent of housing age.13 Others at risk include those whose trang chủ is located in a zip code with a high prevalence of lead poisoning, or areas identified by state or local guidelines.14 Finally, risk can be identified through a short personal risk questionnaire8,15 (Table 2 6,8,14–19).


Table 2.Lead Poisoning Screening Criteria

Screen children who meet any of the following criteria:

All Medicaid-enrolled or -eligible children at one & two years of age

All children who are identified as high risk based on results of a personal risk questionnaire (if one of the following questions is answered “Yes” or “Don"t know”):

Does your child live in or regularly visit a house that was built before 1950 (this could apply khổng lồ a home day care center or the home page of a babysitter or relative)?

Does your child live sầu in or regularly visit a house built before 1978 with recent or ongoing renovations or remodeling (i.e., within the past six months)?

Does your child have sầu a sibling or playmate who has or has had lead poisoning?

All refugees, recent immigrants, và international adoptees on arrival in the United States; repeat screening three to six months later for children six months to lớn six years of age

All children who are identified to be at increased risk by the CDC"s state or local screening recommendations (i.e., high-risk zip codes)

In the absence of recommendations from the CDC, screen all children at one and two years of age, and screen children 36 lớn 72 months of age who have not been previously screened


Table 2.Lead Poisoning Screening Criteria

Screen children who meet any of the following criteria:

All Medicaid-enrolled or -eligible children at one và two years of age

All children who are identified as high risk based on results of a personal risk questionnaire (if one of the following questions is answered “Yes” or “Don"t know”):

Does your child live sầu in or regularly visit a house that was built before 1950 (this could apply to lớn a home page day care center or the home of a babysitter or relative)?

Does your child live sầu in or regularly visit a house built before 1978 with recent or ongoing renovations or remodeling (i.e., within the past six months)?

Does your child have a sibling or playmate who has or has had lead poisoning?

All refugees, recent immigrants, & international adoptees on arrival in the United States; repeat screening three khổng lồ six months later for children six months lớn six years of age

All children who are identified lớn be at increased risk by the CDC"s state or local screening recommendations (i.e., high-risk zip codes)

In the absence of recommendations from the CDC, screen all children at one và two years of age, và screen children 36 khổng lồ 72 months of age who have not been previously screened


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