How is Lead Poisoning Treated?
Primary prevention is the optimal treatment. However, as children are not found to have lead in their environment until they have an elevated blood lead level, treatment for lead exposure should be provided to all children with a blood lead level of 5 micrograms per deciliter or greater. The primary management includes:
- finding and eliminating the source of the lead,
- instruction in personal and household hygiene measures,
- optimizing the child's diet and nutritional status,
- and close follow-up.
Because most children with higher blood lead levels live in or visit regularly a home with deteriorating lead paint, successful therapy depends on eliminating the child's exposure. Any treatment regimen that does not control environmental exposure to lead is considered inadequate. Pediatricians should refer poisoned children to local public health offices for environmental assessment of the child's residence(s). Public health staff should conduct a thorough investigation of the child's environment and family lifestyle for sources of lead.
Deteriorated lead paint is the most common source of exposure. However, other sources that should be considered include tableware, cosmetics such as surma and kohl, home remedies, dietary supplements of calcium, tap water, and exposure from parents who have been exposed to lead in the workplace. Blood lead levels should decrease as the child passes the age of 2 years or so, and a stable or increasing blood lead level past that age is likely to be attributable to ongoing exposure. In children who have spent prolonged periods in a leaded environment, blood lead levels will decrease more slowly after exposure ceases, probably because bone stores are greater.
The CDC Advisory Committee on Childhood Lead Poisoning Prevention issued case management guidelines for children with lead poisoning, which should be consulted as needed. Although there are no studies that have identified effective strategies to reduce blood lead levels less than 5 micrograms per deciliter, guidelines for potential strategies for managing blood lead levels in that range have been published by the CDC Advisory Committee on Childhood Lead Poisoning Prevention. Because nutritional deficiencies can influence lead absorption and may have their own associations with health outcomes independent of lead exposures, specific attention should be paid to identifying and treating iron deficiency and ensuring adequate calcium and zinc intake.
Chelation therapy for children with blood lead levels of 20 to 44 micrograms per deciliter can be expected to lower blood lead levels, but it has not been shown to reverse or diminish cognitive impairment or other behavioral or neuropsychological effects of lead. If the blood lead level is greater than 45 micrograms per deciliter and the exposure has been controlled, treatment should begin. A pediatrician experienced in managing children with lead poisoning should be consulted. These physicians may be found through the AAP Council on Environmental Health, at hospitals that participated in the clinical trial of succimer, at Pediatric Environmental Health Specialty Units, or through lead programs at state health departments.
American Academy of Pediatrics