Childhood lead poisoning: Exposure and prevention
- Jennifer A Lowry, MD
Jennifer A Lowry, MD
- Professor of Pediatrics
- University of Missouri- Kansas City School of Medicine
- Chief, Section of Clinical Toxicology
- Medical Director, Division of Clinical Pharmacology, Toxicology and Therapeutic Innovation
- Medical Director, Center for Environmental Health
- Children's Mercy Kansas City
- Section Editors
- Donald H Mahoney, Jr, MD
Donald H Mahoney, Jr, MD
- Section Editor — Pediatric Hematology
- Professor of Pediatrics
- Baylor College of Medicine
- Michele M Burns, MD, MPH
Michele M Burns, MD, MPH
- Section Editor — Pediatric Toxicology
- Assistant Professor of Pediatrics and Emergency Medicine
- Harvard Medical School
- Jan E Drutz, MD
Jan E Drutz, MD
- Section Editor — General Pediatrics
- Professor of Pediatrics
- Baylor College of Medicine
- Deputy Editor
- James F Wiley, II, MD, MPH
James F Wiley, II, MD, MPH
- Senior Deputy Editor — UpToDate
- Deputy Editor — Adult and Pediatric Emergency Medicine
- Deputy Editor — Primary Care Sports Medicine (Adolescents and Adults)
- Clinical Professor of Pediatrics and Emergency Medicine/Traumatology
- University of Connecticut School of Medicine
The sources of childhood lead exposure and strategies for primary and secondary prevention of exposure are reviewed here. The clinical manifestations, diagnosis, and treatment of lead poisoning are discussed separately. (See "Childhood lead poisoning: Clinical manifestations and diagnosis" and "Childhood lead poisoning: Management".)
Children are exposed to lead in a variety of ways. Despite the removal of lead from gasoline and paint in the late 1970s, ingestion of chips and dust from the continued presence of lead paint remains the primary source of lead poisoning in children. In addition, contaminated soil from gasoline emissions continues as an important source. Other important pediatric exposures include elevated maternal blood lead levels (BLLs) during pregnancy and breastfeeding, food, or water contamination and excess lead in parental occupations, toys, cosmetics, and herbal/ayurvedic remedies.
Prenatal exposure — Lead exposure during fetal development may result from mobilization of bone lead stored from past exposure into the maternal bloodstream and/or from direct elevation of maternal BLLs caused by acute or chronic environmental lead exposure during pregnancy [1,2]. In utero lead exposure is associated with impairment of postnatal neurodevelopment with an increased risk for developmental delay, lowering of IQ, and behavioral abnormalities .
In the United States, blood lead screening is recommended for pregnant women with important risk factors for lead exposure (table 1). (See "Prenatal care: Initial assessment", section on 'Lead level'.)
A maternal BLL over 5 mcg/dL is a marker of significant exposure to lead above background levels for pregnant women in the United States population. Because lead crosses the placenta readily and a toxicologic threshold for adverse effects to the fetus or newborn has not been identified, maternal BLLs elevated above background warrant follow-up testing in the mother during and after pregnancy and in the newborn infant. Providers for pregnant women with elevated BLLs should ensure that the maternal lead level is known by the provider managing the newborn infant. Levels of both the mother and infants should be documented in both of their medical records. (See "Adult occupational lead poisoning", section on 'Pregnancy and breastfeeding' and "Childhood lead poisoning: Management", section on 'Prenatal exposure'.)
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- Prenatal exposure
- - Paint
- - Soil
- - Water
- - Food
- - Leaded objects
- Children's products and toys
- Ethnic products
- Artificial athletic fields
- Paint and soil
- - Abatement
- - Education and dust control
- Children's products
- Artificial athletic fields
- Abatement funding