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Lead Poisoning-Child

Lead Poisoning—Child

Definition

Lead is a toxic metal that is very common in the environment. Experts believe that no level of lead in the body is safe for children. Concern about lead poisoning in children occurs when lead reaches a level of 10 mcg/dL in the blood. Levels of 20 mcg/dL or more represent actual lead poisoning. This can lead to:
Lower levels of blood lead below currently accepted safe levels can lead to learning and/or behavioral difficulties. They can also delay puberty in boys.

Causes

Lead can be absorbed into the bloodstream by eating, drinking, or breathing contaminated particles.
Lead is used in many industrial processes and within the home. It can be found in:
  • Paint
  • Dust
  • Soil
  • Drinking water
  • Food—rarely
Most homes built before 1960 contain some lead-based paint. This was banned from residential use in 1978. Dust containing lead can linger on windowsills and in window wells. Drinking water that travels through lead pipes, or through pipes with lead-based soldering, may also be contaminated. Lead can become mixed with dirt after it peels from paint on building exteriors. Industrial sources and car exhaust also contribute to the problem. Lead levels in the air have dropped a lot since lead additives were banned from gasoline in the 1970s. Food produced outside of the United States can be contaminated if packaged in lead-soldered cans.

Risk Factors

Factors that increase your child's risk for lead poisoning include:
  • Age: 6 or younger
  • Ingesting non-food items, also known as pica—a behavior in most young children and some children with neurodevelopmental disorders
  • Living in a house or apartment built before 1960
  • Living in neighborhoods where homes were built before 1960
  • Living in a home with adults whose work or hobbies put them in contact with lead
  • Receiving transfusions from adults who have relatively high lead levels in the blood. This is a special risk for very small infants receiving newborn intensive care.
  • Being born to a mother who has high levels of lead stored in her bones. Pregnancy often causes this lead to move from the bones to the bloodstream. It may cross the placenta and affect a developing baby.
  • Breast milk may also contain lead. Nursing mothers who live in houses with lead hazards may transmit lead to their babies through breastfeeding .
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Symptoms

Children with lead poisoning often show no symptoms. However, the toxic metal can negatively affect nearly every system in the body.
One of the most serious concerns is lead's harmful effect on the neurological system. For every 10 mcg/dL increase in blood lead levels, there is a 2-3 point decline in IQ test scores. Lead poisoning is also associated with neurodevelopment problems, such as:
Other possible signs of lead poisoning include:
  • Headache
  • Pain or numbness in the extremities
  • Muscle weakness
  • Nausea and vomiting
  • Loss of appetite, abdominal pain
  • Impaired hearing
  • Memory loss
  • Fatigue
  • Sleep disturbances
  • Mood disorders
  • Dental and bone abnormalities

Diagnosis

The doctor will ask about your child's symptoms and medical history. A physical exam will be done. Lead poisoning is diagnosed with a blood test.
The Centers for Disease Control and Prevention (CDC) and the American Academy of Pediatrics recommend that children at high risk for lead poisoning have their blood levels tested. This should be done until the age of three for all children and until the age of four to five in areas of high risk. High-risk children are defined as those receiving Medicaid and those who live in high-areas. These include areas where 27% or more of housing units were built before 1950. Or, in which at least 12% of tested children have elevated lead levels. Testing is also indicated if a sibling has had lead poisoning or a parent has contact with lead through work or hobbies. For other children, the CDC recommends that each state develop its own testing plan. Each plan will be based on local experience with lead poisoning.I think we do it up to 3 in everybody and up to 4-5 in areas of high risk as you listed above.
If your child has lead levels higher than 10 mcg/dL of blood, seek immediate medical treatment.

Treatment

Treatment depends on the severity of lead poisoning.
Treatment may include:

Environmental Controls

If your child has mild-to-moderate lead poisoning (20-44 mcg/dL), medication may not be prescribed. Doctors will work with social workers and public health officials to eliminate lead at home and at school. They then carefully monitor blood levels until the lead naturally works its way out of your child's system.

Medications

If your child has moderate to severe lead poisoning (45-69 mcg/dL), medication will be needed. Medications may include oral or IV chelating agents that bind to lead and speed its removal from your child's body through urine. Blood levels above 70 mcg/dL are considered acute cases. Hospitalization and emergency medical treatment are necessary.

Prevention

Take the following steps to decrease the risk of lead poisoning for your children:

Avoid Lead

  • Have your home's paint and water tested if:
    • You live in a home built before 1960
    • You think your child is being exposed to lead
  • Safely remove any lead you find. Your state's Department of Public Health will help with this process.
  • Keep young children away from peeled or chipped paint.
  • Wash children's toys regularly.
  • Make sure children wash their hands before eating.

Keep It Clean

Try not to vacuum hard surfaces. Instead, use wet wipes or lead-absorbing detergents to avoid spreading lead-filled dust. Vacuuming with cleaners that use HEPA air filtration may be safe and effective for floors and other hard surfaces. Eliminating lead hazards usually requires window replacement and careful surface repainting. Lead-containing dust tends to build up in carpets. Until further evidence about effective carpet cleaning becomes available, replacement of carpets is the only known way to reduce risks from floor coverings. When outside dirt is contaminated, it may need to be dug up and replaced with clean soil.

Play in Safe Areas

Take the following precautions:
  • Encourage children to play in grassy areas instead of dirt.
  • Keep children away from foundations of older homes where peeling paint may have contaminated the surrounding soil.
  • If there is a chance of lead exposure outside the home, have everyone take off their shoes before coming inside.
  • Certain adult hobbies can expose children to lead poisoning. These include:
    • Making stained glass—where lead is involved
    • Soldering electrical devices with lead-containing solder
    • Fishing with lead-containing sinkers
Parents who work with lead or whose hobbies involve lead should take special precautions to protect themselves and their children from lead contact.

RESOURCES

National Safety Council's Environmental Health Center http://www.nsc.org

United States Environmental Protection Agency http://www.epa.gov

CANADIAN RESOURCES

About Kids Health http://www.aboutkidshealth.ca

Canadian Centre for Occupational Health and Safety http://www.ccohs.ca

References

Bearer CF, O'Riordan MA, et al. Lead exposure from blood transfusion to premature infants. J Pediatr. 2000;137:549-554.

Lead. Centers for Disease Control and Prevention website. Available at: http://www.cdc.gov/nceh/lead/. Updated April 4, 2013. Accessed May 30, 2013.

Lead. US Environmental Protection Agency website. Available at: http://www.epa.gov/lead. Updated February 26, 2013. Accessed May 30, 2013.

Lead poisoning. National Safety Council website. Available at: http://www.nsc.org/safety%5Fhome/HomeandRecreationalSafety/Poisoning/Pages/LeadPoisoning.aspx. Accessed May 30, 2013.

Lozoff B, Jimenez E, et al. Higher infant blood lead levels with longer duration of breastfeeding. J Pediatr. 2009 Nov;155(5):663-667.

Ronchetti R, Van Den Hazel P, et al. Lead neurotoxicity in children: is prenatal exposure more important than postnatal exposure? Acta Paediatr. 2006;95:45-49.

7/2/2010 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Williams PL, Sergeyev O, Lee MM, et al. Blood lead levels and delayed onset of puberty in a longitudinal study of Russian boys. Pediatrics. 2010;125(5):e1088-1096.

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