Childhood lead poisoning

Introduction
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By Jose Porras BS, Brandon Root MD, Robert J Singer MD

Childhood lead poisoning is also known as or subsumes Lead encephalopathy and Plumbism. -ed.

Childhood lead poisoning is a growing concern, particularly because new findings have shown that low-level, typical-population lead exposures are associated with the development of cognitive and behavioral deficits. In response to these findings, the United States Centers for Disease Control and Prevention has set the lead level greater than 5 µg/dl as the minimum value for intervention. The mechanisms of action of lead depend on the time of exposure and the degree of CNS maturation. Early-life lead exposure may lead to disease susceptibility throughout the life course. In this article, the authors discuss lead as an environmental risk factor, its effects on health, and its management. They also discuss new trends in research describing how lead leads to epigenetic alterations that may underlie many of the behavioral phenotypes observed in patients exposed to even minimal amounts of lead.

Key Points

  • The toxic lead reference level is currently 5 µg/dL as determined by the Centers for Disease Control and Prevention (CDC), which reflects the lead blood levels of children age 1 to 5 in the United States who are in the highest 2.5%.
  • Cognitive and behavioral deficits have been linked with population-typical lead exposures.
  • Management is generally aimed at preventing further exposure. Chelation therapy is only indicated for very high levels (> 45 µg/dL).
  • Lead influences fetal epigenetic programming that may alter phenotype and consequential disease susceptibility, and maternal bone lead is a marker for adverse fetal outcome.
  • Calcium supplementation during pregnancy and lactation is associated with reduced lead levels.

In This Article

Introduction
Historical note and nomenclature
Clinical manifestations
Etiology
Pathogenesis and pathophysiology
Epidemiology
Prevention
Differential diagnosis
Diagnostic workup
Prognosis and complications
Management
Pregnancy
References cited
Contributors