Lead is a metal that was once a common additive to household paint and leaded gasoline and was used in water pipes and as a solder in canned foods. Although these uses have been limited in the U.S., the interiors of many houses built before 1978 contain peeling lead paint chips and dust and lead-contaminated water. Soil surrounding these houses may also be contaminated with lead. Children who live, play, or spend time in these environments are at risk of exposure to this metal and can bring lead into their bodies by inhaling or ingesting contaminated dust, water, paint chips, or lead-contaminated items. Other local sources of lead may be areas near industrial or manufacturing sites.
A young child's exposure to lead can damage the brain and other organs and cause behavioral problems and developmental delays. Even at low levels, lead can cause irreversible damage without causing physical symptoms, and impaired cognitive development may not be noticed until the child enters school.
Poisoning from this environmental hazard usually occurs in early childhood and many children in the United States need to be screened for lead poisoning.
The American Academy of Pediatrics (AAP) recommends that a risk assessment be performed for lead exposure at well-child visits at 6 months, 9 months, 12 months, 18 months, 24 months, and at 3, 4, 5, and 6 years of age. A blood lead level test should be done only if the risk assessment comes back positive. According to the AAP and the U.S. Centers for Disease Control and Prevention (CDC), universal screening or blood lead level tests are no longer recommended, except for children in high prevalence areas with increased risk factors.
Pediatricians may also offer screening to:
- Medicaid-eligible children at age 1 and again at 2 years of age
- Children of all ages who are recent immigrants, refugees, or adoptees at the earliest opportunity
- A child whose parent, guardian, or provider requests blood lead testing due to suspected exposure
People should check with their healthcare practitioner and/or local health department regarding lead screening guidelines specific to the risks in their area.
The CDC uses a threshold blood lead level (BLL) of 5 mcg/dL (five micrograms per deciliter) to identify children living in environments that expose them to lead hazards. Any test results above this level should trigger lead management and monitoring. Any child who has an elevated blood lead level needs to have his or her home or other environment evaluated. Other people at the residence should be tested as well. Without the elimination or reduction of the source of the exposure - a lead hazard in the environment - the elevated lead level will likely recur.
Sources Used in Current Review
Centers for Disease Control and Prevention. Low Level Lead Exposure Harms Children: A Renewed Call of Primary Prevention. PDF available for download at http://www.cdc.gov/nceh/lead/acclpp/final_document_030712.pdf. Accessed 10/6/2015.
(Updated 6/19/2014) Centers for Disease Control and Prevention. What Do Parents Need to Know to Protect Their Children? Available online at http://www.cdc.gov/nceh/lead/acclpp/blood_lead_levels.htm. Accessed 10/6/2015.
(April 2015) Centers for Disease Control and Prevention. Educational Interventions for Children Affected by Lead. Available online at http://www.cdc.gov/nceh/lead/publications/educational_interventions_children_affected_by_lead.pdf. Accessed 10/6/2015.
American Academy of Pediatrics. Detection of Lead Poisoning. Available online at https://www.aap.org/en-us/advocacy-and-policy/aap-health-initiatives/lead-exposure/Pages/Detection-of-Lead-Poisoning.aspx?nfstatus=401&nftoken=00000000-0000-0000-0000-000000000000&nfstatusdescription=ERROR:+No+local+token. Accessed October 2016.