Childhood lead poisoning: Management
- 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 — Adult and Pediatric Emergency Medicine
- Senior Deputy Editor — Primary Care Sports Medicine (Adolescents and Adults)
- Clinical Professor of Pediatrics and Emergency Medicine/Traumatology
- University of Connecticut School of Medicine
The management of lead poisoning in children will be reviewed here.
Clinical manifestations, diagnosis, exposure and prevention of childhood lead poisoning are discussed separately. (See "Childhood lead poisoning: Clinical manifestations and diagnosis" and "Childhood lead poisoning: Exposure and prevention".)
The identification of a neonate, infant, or child who has been exposed to lead must be viewed as a public health emergency. The only effective long-term treatment is ending further lead exposure by eradication of environmental lead contamination. Because the cognitive and behavioral effects of lead toxicity are not reversible, primary prevention of lead exposures is the single most important strategy in the management of childhood lead poisoning. (See "Childhood lead poisoning: Exposure and prevention", section on 'Prevention'.)
However, children at risk because of lead in their environment are often not found until the lead exposure is diagnosed through elevated blood lead levels (BLLs) during screening. At this point, secondary prevention of further lead exposure becomes the main treatment (table 1). Unfortunately, by the time a child is found with an elevated BLL, the neurodevelopmental harm from the exposure may have already occurred .
Chelation therapy may be necessary depending upon the degree of blood lead elevation (see 'Lead level 45 to 69 mcg/dL' below and 'Symptomatic lead poisoning' below). However, it has limited efficacy. With chronic ingestion or inhalation, lead can be incorporated into the skeletal system and become an endogenous reservoir of lead exposure that is resistant to elimination. While chelating agents can bind to lead in blood, they are ineffective in removing lead from the deep bone stores.
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- GENERAL MANAGEMENT
- ASYMPTOMATIC LEAD EXPOSURE AND POISONING
- Detectable BLL <5 mcg/dL (current reference level)
- Lead level 5 to 14 mcg/dL
- Lead level 15 to 44 mcg/dL
- Lead level 45 to 69 mcg/dL
- Lead level ≥70 mcg/dL
- SYMPTOMATIC LEAD POISONING
- Initial evaluation
- Initial stabilization
- - Encephalopathy
- - Seizures
- - Fluid administration
- Gastrointestinal decontamination
- Ensure lead-safe housing
- PHARMACOLOGIC AGENTS FOR CHELATION
- Calcium disodium edetate
- PERINATAL LEAD EXPOSURE
- Prenatal exposure
- ADDITIONAL RESOURCES
- SUMMARY AND RECOMMENDATIONS