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American Academy of Pediatrics

A statement of reaffirmation for this policy was published at

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A statement of retirement for this policy was published at

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This policy is a revision of the policy in

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AMERICAN ACADEMY OF PEDIATRICS

Lead Exposure in Children: Prevention, Detection, and Management

Committee on Environmental Health
Pediatrics October 2005, 116 (4) 1036-1046; DOI: https://doi.org/10.1542/peds.2005-1947
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    TABLE 1.

    Suggested Clinical Evaluation for Lead Exposure

    Medical history
        Ask about
            Symptoms
            Developmental history
            Mouthing activities
            Pica
            Previous blood lead concentration measurements
            Family history of lead poisoning
        Environmental history
        Paint and soil exposure
            What is the age and general condition of the residence or other structure in which the child spends time?
            Is there evidence of chewed or peeling paint on woodwork, furniture, or toys?
            How long has the family lived at that residence?
            Have there been recent renovations or repairs to the house?
            Are the windows new?
            Are there other sites at which the child spends significant amounts of time?
            What is the condition/make-up of indoor play areas?
            Do outdoor play areas contain bare soil that may be contaminated?
            How does the family attempt to control dust and dirt?
        Relevant behavioral characteristics of the child
            To what degree does the child exhibit hand-to-mouth activity?
            Does the child exhibit pica?
            Are the child's hands washed before meals and snacks?
        Exposures to and behaviors of household members
            What are the occupations of adult household members?
            What are the hobbies of household members? (Fishing, working with ceramics or stained glass, and hunting are examples of hobbies that involve risk for lead exposure.)
            Are painted materials or unusual materials burned in household fireplaces?
        Miscellaneous
            Does the home contain vinyl miniblinds made overseas and purchased before 1997?
            Does the child receive or have access to imported food, cosmetics, or folk remedies?
            Is food prepared or stored in imported pottery or metal vessels?
            Does the family use imported foods in soldered cans?
    Nutritional history
        Take a dietary history
        Evaluate the child's iron status by using the appropriate laboratory tests
        Ask about history of food stamps or participation in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC)
    Physical examination
        Pay particular attention to the neurologic examination and the child's psychosocial and language development
    • View popup
    TABLE 2.

    Summary of Recommendations for Children With Confirmed (Venous) Elevated Blood Lead Concentrations16

    Blood Lead ConcentrationRecommendations
    10–14 μg/dLLead education
        Dietary
        Environmental
    Follow-up blood lead monitoring
    15–19 μg/dLLead education
        Dietary
        Environmental
    Follow-up blood lead monitoring
    Proceed according to actions for 20–44 μg/dL if
        A follow-up blood lead concentration is in this range at least 3 months after initial venous test; or
        Blood lead concentration increases
    20–44 μg/dLLead education
        Dietary
        Environmental
    Follow-up blood lead monitoring
    Complete history and physical examination
    Lab work
        Hemoglobin or hematocrit
        Iron status
    Environmental investigation
    Lead hazard reduction
    Neurodevelopmental monitoring
    Abdominal radiography (if particulate lead ingestion is suspected) with bowel decontamination if indicated
    45–69 μg/dLLead education
        Dietary
        Environmental
    Follow-up blood lead monitoring
    Complete history and physical examination
    Lab work
        Hemoglobin or hematocrit
        Iron status
        Free EP or ZPP
    Environmental investigation
    Lead hazard reduction
    Neurodevelopmental monitoring
    Abdominal radiography with bowel decontamination if indicated
    Chelation therapy
    ≥70 μg/dLHospitalize and commence chelation therapy
    Proceed according to actions for 45–69 μg/dL
    Not Recommended at Any Blood Lead Concentration
    Searching for gingival lead lines
    Evaluation of renal function (except during chelation with EDTA)
    Testing of hair, teeth, or fingernails for lead
    Radiographic imaging of long bones
    X-ray fluorescence of long bones
    • ZPP indicates zinc protoporphyrin.

    • View popup
    TABLE 3.

    Sources of Lead Exposure and Prevention Strategies59

    SourcePrevention Strategy
    Environmental
        PaintIdentify and abate
        DustWet mop (assuming abatement)
        SoilRestrict play in area, plant ground cover, wash hands frequently
        Drinking waterFlush 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 remediesAvoid use
        Cosmetics containing additives such as kohl or surmaAvoid use
        Old ceramic or pewter cookware, old urns/kettlesAvoid use
        Some imported cosmetics, toys, crayonsAvoid use
        Contaminated mineral supplementsAvoid use
        Parental occupationsRemove work clothing at work; wash work clothes separately
        HobbiesProper use, storage, and ventilation
        Home renovationProper containment, ventilation
        Buying or renting a new homeInquire about lead hazards
        Lead dust in carpetCover or discard
    Host
        Hand-to-mouth activity (or pica)Frequent hand washing; minimize food on floor
        Inadequate nutritionAdequate intake of calcium, iron, vitamin C
        Developmental disabilitiesEnrichment programs
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Pediatrics
Vol. 116, Issue 4
1 Oct 2005
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Lead Exposure in Children: Prevention, Detection, and Management
Committee on Environmental Health
Pediatrics Oct 2005, 116 (4) 1036-1046; DOI: 10.1542/peds.2005-1947

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Lead Exposure in Children: Prevention, Detection, and Management
Committee on Environmental Health
Pediatrics Oct 2005, 116 (4) 1036-1046; DOI: 10.1542/peds.2005-1947
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  • Table of Contents

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  • Article
    • Abstract
    • BACKGROUND
    • DECLINE OF LEAD POISONING IN THE UNITED STATES
    • SOURCES OF LEAD EXPOSURE
    • TOXICITY OF LEAD
    • COSTS OF CHILDHOOD LEAD POISONING AND BENEFITS OF PREVENTION
    • DIAGNOSTIC MEASURES
    • MANAGEMENT OF CHILDREN WITH ELEVATED BLOOD LEAD CONCENTRATIONS
    • RECOMMENDATIONS FOR PEDIATRICIANS
    • RECOMMENDATIONS FOR GOVERNMENT
    • Committee on Environmental Health, 2004–2005
    • Liaisons
    • Staff
    • Footnotes
    • REFERENCES
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