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Childhood lead poisoning: Exposure and prevention

Authors
Dean A Lee, MD, PhD
Richard L Hurwitz, MD
Section Editors
Donald H Mahoney, Jr, MD
Michele M Burns, MD, MPH
Jan E Drutz, MD
Deputy Editor
James F Wiley, II, MD, MPH

INTRODUCTION

The elimination of lead from the environment is essential to the prevention of lead poisoning and its sequelae. Primary prevention efforts focus on removal of lead from the environment so that exposure cannot occur. Secondary prevention efforts are designed to minimize absorption of lead and deposition in the mineralizing tissues, where it functions as a source of chronic exposure. Tertiary prevention reduces the morbidity associated with lead intoxication through chelation of lead from the blood and soft tissues of an exposed individual. Chelation can reduce the immediate toxicity associated with acute lead ingestion, but has limited ability to reverse the neurocognitive effects of chronic exposure [1]. Primary prevention is the only way to reduce the neurocognitive effects of lead poisoning.

Aggressive environmental remediation has the potential to benefit children by reducing their exposure to lead. However, the efficacy of aggressive environmental remediation largely is unproven, the methods are controversial, and the costs are high. In addition, political and economic considerations to environmental remediation exist that are beyond the scope of this review. Nonetheless, complete removal of lead from the child's environment is considered to be the only effective preventive measure [2].

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".)

EXPOSURE

Children are exposed to lead in a variety of ways. Since the removal of lead from gasoline, lead-based paint has become the major source of lead exposure for children in the United States. Other important pediatric exposures include elevated maternal blood lead levels during pregnancy and breastfeeding, soil, food, or water contamination and excess lead in toys.

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 blood lead levels caused by acute or chronic environmental lead exposure during pregnancy [3]. In utero lead exposure is associated with impairment of postnatal neurodevelopment with an increased risk for developmental delay, lowering of IQ, and behavioral abnormalities [3].

                       

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Literature review current through: Nov 2016. | This topic last updated: Mon Sep 26 00:00:00 GMT+00:00 2016.
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