Published online November 1, 2007
PEDIATRICS Vol. 120 No. 5 November 2007, pp. e1285-e1298 (doi:10.1542/peds.2005-1770)
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SPECIAL ARTICLE

Interpreting and Managing Blood Lead Levels of Less Than 10 µg/dL in Children and Reducing Childhood Exposure to Lead: Recommendations of the Centers for Disease Control and Prevention Advisory Committee on Childhood Lead Poisoning Prevention

Helen J. Binns, MDa, Carla Campbell, MDb, Mary Jean Brown, ScD, RNc for the Advisory Committee on Childhood Lead Poisoning Prevention

a Feinberg School of Medicine, Northwestern University, Chicago, Illinois
b Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
c Division of Environmental and Emergency Health Services, National Center for Environmental Health/Agency for Toxic Substances and Disease Registry, Center for Disease Control and Prevention, Atlanta, Georgia

Lead is a common environmental contaminant. Lead exposure is a preventable risk that exists in all areas of the United States. In children, lead is associated with impaired cognitive, motor, behavioral, and physical abilities. In 1991, the Centers for Disease Control and Prevention defined the blood lead level that should prompt public health actions as 10 µg/dL. Concurrently, the Centers for Disease Control and Prevention also recognized that a blood lead level of 10 µg/dL did not define a threshold for the harmful effects of lead. Research conducted since 1991 has strengthened the evidence that children's physical and mental development can be affected at blood lead levels of <10 µg/dL. In this report we provide information to help clinicians understand blood lead levels < 10 µg/dL, identify gaps in knowledge concerning lead levels in this range, and outline strategies to reduce childhood exposures to lead. We also summarize scientific data relevant to counseling, blood lead screening, and lead-exposure risk assessment. To aid in the interpretation of blood lead levels, clinicians should understand the laboratory error range for blood lead values and, if possible, select a laboratory that achieves routine performance within ±2 µg/dL. Clinicians should obtain an environmental history on all children they examine, provide families with lead-prevention counseling, and follow blood lead screening recommendations established for their areas. As circumstances permit, clinicians should consider referral to developmental programs for children at high risk for exposure to lead and more frequent rescreening of children with blood lead levels approaching 10 µg/dL. In addition, clinicians should direct parents to agencies and sources of information that will help them establish a lead-safe environment for their children. For these preventive strategies to succeed, partnerships between health care providers, families, and local public health and housing programs should be strengthened.

Key Words: blood lead levels • lead poisoning • screening • prevention

Abbreviations: BLL—blood lead level • CDC—Centers for Disease Control and Prevention • ACCLPP—Advisory Committee on Childhood Lead Poisoning Prevention • EPA—Environmental Protection Agency

Accepted Apr 30, 2007.




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C. Campbell and H. J. Binns
CDC guideline focuses on management of children with blood lead levels <10 {micro}g/dL
AAP News, March 1, 2008; 29(3): 1 - 1.
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