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 Vol. 26 No. 12, December 2005
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(Pediatrics in Review. 2005;26:435-443.)
© 2005 American Academy of Pediatrics

Lead Poisoning

Successes and 21st Century Challenges


Danielle Laraque, MD*
Leonardo Trasande, MD, MPP{dagger}
 * Editorial Board
{dagger} Assistant Professor, Division of General Pediatrics, Center for Children’s Health and the Environment, Mt. Sinai School of Medicine, New York, NY

The first 300 words of the full text of this article appear below.


   Objectives
 
After completing this article, readers should be able to:

  1. Describe the sources of lead exposure and their changes over time.
  2. Delineate the cognitive difficulties associated with lead exposure and uptake.
  3. Describe the screening recommendations and the tests available for determining blood lead levels.
  4. Discuss how to manage an increased blood lead level.


   Introduction
 
An 8-month-old Latino male is seen for an initial visit to a pediatric practice. Blood is obtained via fingerstick for routine complete blood count and blood lead level (BLL). The hemoglobin concentration is 12.9 g/dL (129 g/L), and the BLL is 17 mcg/dL (0.82 mcmol/L). The family is called back for confirmatory testing. Detailed environmental history reveals that the child’s father works with leaded glass and reports coming home in his work clothes in the past several months. BLL obtained on the father is 37 mcg/dL (1.8 mcmol/L), and he is referred to the occupational medicine service. The child’s repeat venous blood lead result is 9 mcg/dL (0.43 mcmol/L). Specific risk reduction is reviewed with the family, and the child is monitored carefully over time for any re-exposure and progress of growth and development.

This illustrative case is not atypical in the 21st century. Over the past generation, epidemiologic studies have provided the foundation for efforts to combat children’s exposure to lead through primary prevention, early identification via detailed environmental history and blood lead screening, and various treatment modalities. Although a BLL of 40 mcg/dL (1.9 mcmol/L) was considered commonplace and healthy in the 1940s, and the absence of obvious symptoms reassured pediatricians of that era, this no longer is the case. With improved understanding of the subclinical toxicity of lead and other environmental hazards, the standard of care has become proactive screening and environmental intervention to prevent any elevation in BLL. Landmark work by Herbert L. Needleman . . . [Full Text of this Article]






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