Article Figures & Data
Tables
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 - TABLE 2.
Summary of Recommendations for Children With Confirmed (Venous) Elevated Blood Lead Concentrations16
Blood Lead Concentration Recommendations 10–14 μg/dL Lead education Dietary Environmental Follow-up blood lead monitoring 15–19 μg/dL Lead 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/dL Lead 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/dL Lead 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/dL Hospitalize 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.
Source Prevention Strategy 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 kohl or surma Avoid use Old ceramic or pewter cookware, old urns/kettles Avoid use 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 Developmental disabilities Enrichment programs
In this issue
Jump to section
- 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
- Figures & Data
- Info & Metrics
- Comments
Related Articles
Cited By...
- Early Life Exposure in Mexico to ENvironmental Toxicants (ELEMENT) Project
- Standardizing Clinical Response to Results of Lead Screening: A Quality Improvement Study
- Screenings during Well-Child Visits in Primary Care: A Quality Improvement Study
- Intellectual Disabilities
- Continuity of Care in Infancy and Early Childhood Health Outcomes
- Assessing Child Lead Poisoning Case Ascertainment in the US, 1999-2010
- Effects of wheat-flour biscuits fortified with iron and EDTA, alone and in combination, on blood lead concentration, iron status, and cognition in children: a double-blind randomized controlled trial
- Prevention of Childhood Lead Toxicity
- Preterm Infant Attendance at Health Supervision Visits
- Lead Poisoning: Basics and New Developments
- Lead and children: Clinical management for family physicians
- The Built Environment: Designing Communities to Promote Physical Activity in Children
- Trends in Blood Lead Levels and Blood Lead Testing Among US Children Aged 1 to 5 Years, 1988-2004
- Interpreting and Managing Blood Lead Levels of Less Than 10 {micro}g/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
- Blood Lead Misclassification Due to Defective LeadCare(R) Blood Lead Testing Equipment
- Lead toxicity and chelation therapy
- Screening for Elevated Lead Levels in Childhood and Pregnancy: An Updated Summary of Evidence for the US Preventive Services Task Force
- Screening for Elevated Blood Lead Levels in Children and Pregnant Women
- Home Visiting and Childhood Lead Poisoning Prevention: In Reply
- Home Visiting and Childhood Lead Poisoning Prevention