Childhood lead poisoning and the new Centers for Disease Control and Prevention guidelines for lead exposure

Abstract

Purpose This article will give a brief history, review the latest guidelines, discuss risk factors and sources, and discuss screening, diagnosis, and management of lead poisoning in children. Additionally, the role of the nurse practitioner (NP) caring for children will be reviewed. Data sources Review of published literature on lead poisoning and the 2012 lead prevention guidelines of the Advisory Committee on Childhood Lead Poisoning Prevention (ACCLPP) of the Centers for Disease Control and Prevention (CDC). Conclusions While lead poisoning levels have decreased over the past several decades, newer research has shown that even low levels of lead in the blood can have negative effects on children's intelligence and neurodevelopment. As a result, ACCLPP of the CDC issued new, stricter lead prevention guidelines in 2012. Implications for practice Lead exposure and lead poisoning are pediatric public health risks. Studies have shown that no level of lead is considered safe, and the emphasis has shifted to primary prevention of lead exposure. Despite the focus on primary prevention, the NP must remain vigilant in history taking, exploring risk factors, and screening children in order to assure the best possible outcome.

Lead Exposure and Environmental Health

“…Studies have shown that no level of lead is considered safe, and the emphasis has shifted to primary prevention of lead exposure. Despite the focus on primary preventiv (Schnur et al, 2014). Lead is highly toxic to children, causing intellectual and behavioral deficits, hyperactivity, fine motor function deficits, decreased intelligence quotient, alteration of handeye coordination, and problems in reaction time.…”

Childhood lead poisoning: an overview

“…25 At the same time, with reference to the level of 'lead toxicity' in children, ACCLPP eliminated the term 'level of concern' for blood lead level (previously defined as 10 μg/dL) and replaced it with a reference level of 5 μg/dL, based on the 97.5th percentile of the population blood lead level in children aged between 1 and 5 years. 2,13,24 This was supported by the American Academy of Pediatrics who acknowledged that even the lowest degree of lead exposure might harm children, 13,23,26 and echoed the European Food Safety Authority who concluded that there is no known safe exposure to lead as evidenced by international studies in Europe. [27][28][29] In other words, there is no safe or 'non-toxic' blood lead level.…”

“…21,22 According to the latest guideline in 2012 from the Centers for Disease Control and Prevention (CDC)'s Advisory Committee on Childhood Lead Poisoning Prevention (ACCLPP), clinicians should perform an environmental assessment before screening children for lead poisoning. 13,23 This changed the practice of universal screening of all children for elevated blood lead levels 2,23,24 to targeted screening after mathematical simulations suggested that such screening among 1-year-old children may not be cost-effective, especially in communities with a lower prevalence of lead poisoning. 25 At the same time, with reference to the level of 'lead toxicity' in children, ACCLPP eliminated the term 'level of concern' for blood lead level (previously defined as 10 μg/dL) and replaced it with a reference level of 5 μg/dL, based on the 97.5th percentile of the population blood lead level in children aged between 1 and 5 years.…”

“…11 In this situation, lead in drinking water is absorbed to a greater extent than lead in food and may account for more than 50% of the lead ingested by children. 13 The US Environmental Protection Agency recommended taking actions when lead in drinking water exceeds 15 parts per billion, including taking further steps to optimise their corrosion-control treatment (for water REVIEW ARTICLE treatment is indicated if the child is symptomatic. For blood levels below 20 μg/dL in otherwise asymptomatic children, the principle of treatment is to provide long-term neurodevelopmental follow-up and counselling.…”

The Role of Heavy Metal Pollution in Neurobehavioral Disorders: a Focus on Autism

“…Ingestion of lead paint and dust has been estimated to account for 70 % cases with elevated blood lead levels (BLLs) (Levin et al 2008;Warniment et al 2010). Dust particles that are composed of soil, paints, and industrial or automotive emissions are absorbed more easily in comparison to soil into the gastrointestinal tract of children (Schnur and John 2014). An updated list of the major sources of exposure to lead is shown in Fig.…”