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.
Ingestion of contaminated food or waterIngestion or breathing in of lead dustOther sources: lead-acid batteries, ammunition, lead-based pigments and paints, stained glass, lead crystal glasses, ceramic glazes, jewelry, toysFor families from other cultures, think about ceramic glazes, traditional cosmetics, traditional medicinesGovernment policies to decrease lead exposure
Unleaded gasolineLead-free paintLead-free solder in food cansLead-free water pipesWhy young children are at risk for lead toxicity
Hand-to-mouth behaviorIncreased absorption of leadDeveloping nervous system is vulnerableCalcium or iron deficiency increase absorption of leadEffects of lead toxicity in children can be seen at levels as low as 3.5 µg/dL
Growth and development delaysLower IQLearning and behavior problemsHearing and speech problemsSchool underperformanceAt higher levels, you may see
IrritabilityLoss of appetite, weight loss, fatigueAbdominal pain, vomiting, and/or constipationAnemiaPicaSeizures, coma, deathUniversal lead screening at 1 and 2 years
Screening questionnaires are not very sensitive or specific Capillary – get results quickly, but can be falsely elevatedVenous – results more accurate, but may take some time to come backManagement of elevated lead level
Repeat it if it was a capillary sampleReview results with familyAsk about potential exposures – may need to contact health department, landlord, or independent certified lead inspector to test home for leadAssess risk factors for iron or calcium deficiencyAsk about developmental milestones – may need to refer to early intervention servicesConsider abdominal xray if history of picaFor levels >45, may need chelation therapy CDC, Childhood Lead Poisoning Prevention, https://www.cdc.gov/nceh/lead/default.htmAAP 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-ToxicityMona 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