Lead Poisoning in Children

Lead is a naturally occurring, bluish-grey metal that exists in both organic and inorganic forms. It is soft, pliable, and resistant to corrosion. It has been used by humans for thousands of years in a variety of ways and is still widely used today. The consequences of lead toxicity have been recognized for millennia and are thought to have contributed to the fall of the Roman Empire.

Lead poisoning in children is a persistent worldwide problem. According to the World Health Organization (WHO), it accounts for about 0.6% of the global burden of disease.

The BLLs (blood lead levels) in the Chinese population aged 0-18 has gradually dropped in the past 10 years. This decline may be due to several factors, such as income level, gender, and age difference. Although China has made significant achievements in the control prevention of lead pollution, concerted efforts are still warranted to reduce lead poisoning in children.

How can my child get exposed to lead?

Young children spend a lot of time on the floor. They like to put their hands, toys, and other things in their mouths. This raises their chances of swallowing lead dust and paint chips. Only a tiny amount of lead is needed to harm a young, growing child.

Transplacental exposure and lead in human milk

Lead crosses the placenta, and the blood lead concentration of the infant is similar to that of the mother.

Lead appears in human milk. The concentration is closer to plasma lead and much lower than blood lead, so little is transferred. Women with commonly encountered blood lead concentrations who breastfeed their infants expose them.

Clinical manifestations

Children with blood lead concentrations greater than 60µg/dL may complain of headaches, abdominal pain, loss of appetite, and constipation. They may display clumsiness, agitation, and/or decreased activity and drowsiness. These are premonitory symptoms of central nervous system involvement and may rapidly proceed to vomiting, stupor, and convulsions.

Although lead can cause colic, peripheral neuropathy, and chronic renal disease in adults with occupational exposures, these symptoms are rare in children.

Management

The management of children with elevated blood lead concentrations is determined primarily by how high the concentration is. Children with concentrations 10 µg / dL, the situation requires investigation for a controllable source of lead exposure. Children who ever have a concentration >20 µg/dL or persistently (for >3 months) have a concentration >15 µg /dL require environmental and medical evaluation. If the blood lead concentration is greater than 45µg/dL, the patient should visit doctor immediately and may need hospitalization for parenteral therapy.

References：

1. American Academy of Pediatrics: Sources of Lead Exposure and Prevention Strategies

Environmental

Paint                                                                            Identify and abate

Dust                                                                             Wet mop (assuming abatement)

Soil                                                                              Restrict play in area, plant ground cover,

wash hands frequently

Drinking water                                                             Flush cold-water pipes by running the water until

–it becomes as cold as it will get (a few seconds

-to 2 minutes or more; use cold water for

–cooking and drinking

Folk remedies                                                             Avoid use

Cosmetics containing additives such as                     Avoid use

–kohl or surma

Old ceramic or pewter cookware, old                        Avoid use

–urns/kettles

Some imported cosmetics, toys, crayons                   Avoid use

Contaminated mineral supplements                           Avoid use

Parental occupations                                                  Remove work clothing at work; wash work

clothes separately

Hobbies                                                                      Proper use, storage, and ventilation

Home renovation                                                        Proper containment, ventilation

Buying or renting a new home                                   Inquire about lead hazards

Lead dust in carpet                                                     Cover or discard

Host

Hand-to-mouth activity (or pica)                              Frequent hand washing; minimize food on floor

Inadequate nutrition                                                  Adequate intake of calcium, iron, vitamin C

1. Saturnine gout among Roman aristocrats. Did lead poisoning contribute to the fall of the Empire? (Nriagu JO.N Engl J Med 1983; 308:660.)
2. Lead Poisoning in Children (Heda Dapul, et al; Advance in Pediatrics 61, 2014; 313-333)
3. The national trend of blood lead levels among Chinese children aged 0-18 years old, 1990-2012. (Li MM, et al.; Environ Int. 2014 Oct;71:109-17)
4. Determinants of elevated blood lead during pregnancy in a population surrounding a lead smelter in Kosovo, Yugoslavia. (Graziano JH, Popovac D, Factor-Litvak P, et al. Environ Health Perspect. 1990;89:95–100)
5. Relationships of lead in breast milk to lead in blood, urine, and diet of the infant and mother. (Gulson BL, Jameson CW, Mahaffey KR et al. Environ Health Perspect. 1998;106:667–674)
6. Lead poisoning in childhood—comprehensive management and prevention. (Chisolm JJ Jr, Kaplan E. J Pediatr. 1968;73:942–950)
7. Lead exposure and cardiovascular disease—A systematic review. (Navas-Acien et al.; Environ. Health Perspect. 2007; 115: 472–482.)
8. Advisory Committee on Childhood Lead Poisoning Prevention. Recommendations for blood lead screening of young children enrolled in Medicaid: targeting a group at high risk. (MMWR Recomm Rep. 2000; 49(RR-14):1–13)
9. Centers for Disease Control and Prevention. Managing Elevated Blood Lead Levels Among Young Children: Recommendations From the Advisory Committee on Childhood Lead Poisoning Prevention. Atlanta, GA: Centers for Disease Control and Prevention; 2002. Available at: www.cdc.gov/nceh/lead/CaseManagement/caseManage_main.htm. Accessed September 16, 2004
10. American Academy of Pediatrics, Committee on Environmental Health. (Pediatric Environmental Health. 2nd ed. Elk Grove Village, IL: American Academy of Pediatrics; 2003)