June 12, 2024

Before You Order Lead Testing for Your Patient

12 minutes

In this episode, we discuss lead toxicity and lead screening. We will talk about what lead is, what happens when a child is exposed to lead, what to ask parents about if you’re worried about lead exposure, how to screen for lead toxicity, and what to do if your patient has an elevated lead level.

Sources of lead exposure

Ingestion of contaminated food or water

Ingestion or breathing in of lead dust

Other sources: lead-acid batteries, ammunition, lead-based pigments and paints, stained glass, lead crystal glasses, ceramic glazes, jewelry, toys

For families from other cultures, think about ceramic glazes, traditional cosmetics, traditional medicines

Government policies to decrease lead exposure

Unleaded gasoline

Lead-free paint

Lead-free solder in food cans

Lead-free water pipes

Why young children are at risk for lead toxicity

Hand-to-mouth behavior

Increased absorption of lead

Developing nervous system is vulnerable

Calcium or iron deficiency increase absorption of lead

Effects of lead toxicity in children can be seen at levels as low as 3.5 µg/dL

Growth and development delays

Lower IQ

Learning and behavior problems

Hearing and speech problems

School underperformance

At higher levels, you may see

Irritability

Loss of appetite, weight loss, fatigue

Abdominal pain, vomiting, and/or constipation

Anemia

Pica

Seizures, coma, death

Universal lead screening at 1 and 2 years

Screening questionnaires are not very sensitive or specific

Blood lead test

Capillary – get results quickly, but can be falsely elevated

Venous – results more accurate, but may take some time to come back

Management of elevated lead level

Repeat it if it was a capillary sample

Review results with family

Ask about potential exposures – may need to contact health department, landlord, or independent certified lead inspector to test home for lead

Assess risk factors for iron or calcium deficiency

Ask about developmental milestones – may need to refer to early intervention services

Consider abdominal xray if history of pica

For levels >45, may need chelation therapy

Resources/Links:

CDC, Childhood Lead Poisoning Prevention, https://www.cdc.gov/nceh/lead/default.htm

AAP policy statement. Prevention of Childhood Lead Toxicity, Pediatrics 2016: 138(1):e20161493. https://publications.aap.org/pediatrics/article/138/1/e20161493/52600/Prevention-of-Childhood-Lead-Toxicity

Mona Hanna-Attisha, What the Eyes Don't See: A Story of Crisis, Resistance, and Hope in an American City, 2018. https://www.amazon.com/What-Eyes-Dont-See-Resistance/dp/0399590838

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