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 banned, the interiors of many houses built before 1978 contain peeling lead paint chips and dust and lead-contaminated water. The soils around the houses and near adjacent roadways may also be affected. Children who live, play, or spend time in these environments are at risk and can bring lead into their bodies by inhaling or ingesting contaminated dust, water, paint chips, and food. 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. Poisoning from this environmental hazard usually occurs in early childhood. In the majority of cases, exposure does not cause physical symptoms, and impaired cognitive development may not be noticed until the child enters school.
Many children in the United States need to be screened for lead poisoning during early childhood (around 2 years of age). Elevated blood lead levels are a sign of significant lead exposure. A simple questionnaire helps health care providers identify children at high risk. Even so, many children who are at high risk have not been screened. According to the U.S. Centers for Disease Control and Prevention (CDC), about 250,000 children in the United States between 1 and 5 years of age have blood lead concentrations that are higher than 10 micrograms per deciliter (mcg/dL), the concentration at which the CDC, until recently, had recommended public health measures be taken. The CDC notes, however, that there is no apparent threshold below which harmful effects of lead do not occur. In 2012, the CDC's Advisory Committee on Childhood Lead Poisoning Prevention (ACCLPP) made the recommendation that the threshold for blood lead levels be lowered to 5 mcg/dL due to mounting evidence of the detrimental effect of even minute amounts of lead. The CDC announced acceptance of this recommendation in May 2012.
Currently, lead levels are monitored on a local level based on state and national standards. The CDC recommends that each state develop a plan to detect children who may have been exposed to lead. Some states test every child at least once, while others focus on the children in older neighborhoods who are considered at highest risk. Some local health departments recommend blood lead screening at younger ages or more frequently whereas other areas lack any state or local screening plan.
The American Academy of Pediatrics (AAP) recommend that screening be offered at least to the following:
- Every Medicaid-eligible child at 1 year of age and again at 2 years of age
For children not eligible for Medicaid, AAP also recommends following any local recommendations for screening and, if there are none, health care providers should consider screening all children at least once at age 2 and preferably also at age 1, unless lead exposure can be confidently excluded.
Both the CDC and AAP also recommend that health care providers and state screening programs consider screening children of parents who work with lead as well as immigrant, refugee, and other foreign-born children of any age when they enter the United States.
Sources Used in Current Review
APHA. CDC Accepts Advisory Committee Recommendation to Replace "Level of Concern" for Lead Poisoning with New Reference Value. Washington, D.C. May 16, 2012. Available online at http://www.apha.org/about/news/pressreleases/2012/cdc+advisory+new+reference+value.htm through http://www.apha.org. Accessed May 2012.
Centers for Disease Control and Prevention. CDC Response to Advisory Committee on Childhood Lead Poisoning Prevention Recommendations in "Low Level Lead Exposure Harms Children: A Renewed Call of Primary Prevention." PDF available for download at http://www.cdc.gov/nceh/lead/ACCLPP/CDC_Response_Lead_Exposure_Recs.pdf through http://www.cdc.gov. Accessed May 2012.
(January 4, 2012) Report of the Advisory Committee on Childhood Lead Poisoning Prevention of the Centers for Disease Control and Prevention, Low Level Lead Exposure Harms Children: A Renewed Call for Primary Prevention. PDF available for download at http://www.cdc.gov/nceh/lead/ACCLPP/Final_Document_011212.pdf through http://www.cdc.gov. Accessed Jan 31, 2012.
(June 1, 2009) Centers for Disease Control and Prevention. Lead. Available online at http://www.cdc.gov/nceh/lead/ through http://www.cdc.gov. Accessed Jan 31, 2012.
HealthyChildren.org. Lead Poisoning. Available online through http://www.healthychildren.org. Accessed February 2012.
American Academy of Pediatrics. Lead Exposure in Children: Prevention, Detection, and Management. Pediatrics Vol. 116 No. 4 October 1, 2005, Pp 1036 -1046. Available online at http://aappolicy.aappublications.org/cgi/content/full/pediatrics;116/4/1036#SEC7 through http://aappolicy.aappublications.org. Accessed February 2012.
MayoClinic.com. Lead poisoning. Available online at http://www.mayoclinic.com/health/lead-poisoning/FL00068/DSECTION=tests%2Dand%2Ddiagnosis through http://www.mayoclinic.com. Accessed February 2012.
Anne M. Wengrovitz, MPH, Mary Jean Brown, ScD. Recommendations for Blood Lead Screening of Medicaid-Eligible Children Aged 1--5 Years: an Updated Approach to Targeting a Group at High Risk. MMWR August 7, 2009. Available online at http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5809a1.htm through http://www.cdc.gov. Accessed June 2012.