Lead Poisoning in Children

Asymptomatic lead poisoning has become more common in children. Lead poisoning is known to affect many systems on body including neuropsychiatric symptoms of insomnia, loss of appetite, depression and irritability. 


Iron deficiency is one of the important risk factor for lead poisoning.

Which of the following threshold lead level warrants initiation of following workup:

Check hb/hematocrit, iron status and abdominal X ray.


This post will be summarized by answering the following questions:

(Q.1): What are the Neurological and Non-Neurological Symptoms of Lead Poisoning?

(Q.2): What are the risk factors for Lead Poisoning?

(Q.3): Who should be screened for lead poisoning?

(Q.4) What is the preferred initial screening method?

(Q.5) How can you manage the case of lead poisoning?

(Q.6) How can you prevent the risk of lead poisoning?

(Q.7)What are the important websites/resources to check for more information on lead poisoning?

(Q.1): What are the Neurological and Non-Neurological Symptoms of Lead Poisoning?

Neurological (and Psychiatric) Symptoms of Lead Poisoning:

  • Psychiatric: insomnia, loss of appetite, depression, irritability, decreased libido, cognitive deficits, hallucinations (visual).
  • Neurological: tremors, loss of coordination, weakness, tingling, convulsions.

Non- Neurological Symptoms of Lead Poisoning:

  • Optic: Blindness, hallucinations
  • Auditory: Hearing loss
  • Mouth: Unusual taste, blue line along gums.
  • GI: Nausea, constipation.
  • Hematologic: Anemia.

NOTE: In children, lead poisoning can affect growth and neurodevelopment.

(Q.2): What are the Risk Factors for Lead Poisoning?

1. Age: Children < 5 years age:

  • levels rise between 6-24 months and peak at 18 and 36 months.

2. Community/House: built before 1978.

  • Zipcode within known elevated blood levels and living in high poverty areas.
  • Residing in communities with lead-containing water service lines.

3. Occupation: Parents in high-risk occupation exposing to lead.

4. Iron deficiency:

  • Iron and lead absorption by the same transporter in the GI tract.
  • deficiency of iron causes increases in the absorption of lead.

(Q.3): Who should be screened for lead poisoning?

(1) In the absence of local guidelines, screen all Medicaid eligible children at:

  • 12 months and then at 24 months or
  • at least once between 36 and 72 months if not screened.

(2) Universal screening in areas where:

  • more than 27% of houses built before 1950 or
  • where 12% of children between 12 to 36 months age blood lead level > 10ug/dl.

(Q.4) What is the preferred initial screening method?

Check lead level with a capillary blood test, if positive follow with a venous blood test.

(Q.5) How can you manage the case of lead poisoning?

Management is based on Lead levels:

  • <5: none
  • 5 to 9: Formal environmental investigation
  • 10 to 19: Assess iron status and Formal environmental investigation.
  • 20 to 44: Check Hb/hematocrit, iron status, abdominal X-ray to evaluate ingestion
  • 45 to 69: All above, chelation therapy, consider hospitalization.
  • >70: Hospitalize, consult medical toxicology, chelation therapy.

(Q.6) How can you prevent the risk of lead poisoning?

(a) Counsel parents to have older homes test before moving in.

(b) Counsel parents to regularly wash children’s hands and toys.

(c) Floors and windowsills should be regularly wet mopped at least every 2 weeks.

(d) Shoes should be removed before entering the house.

(e) Caution about the risk of folk remedies, imported medicines, food from developing countries.

(f) Use only cold tap water or bottled water for making infant formula.

(Q.7)What are the important websites/resources to check for more information on lead poisoning?

(a) Check area water quality through the US environmental protection agency: https://www.epa.gov/ground-water-and-drinking-water/basic-information-about-lead-drinking-water

(b) CDC about lead poisoning: https://www.cdc.gov/nceh/lead.

(c) US consumer product safety commission for recall of lead-containing goods:  https://www.cpsc.gov/

(d) US Environmental Protection Agency maintains renovation, repair and painting rule, and database of certified contractors at https://www.epa.gov/lead

(e) AAFP website: https://www.aafp.org/afp/2019/0701/p24.html


Post summarized by Dr. Satinderpal Kaur, MD. (Family Medicine)


This post is also available as one of the chapter in Physician’s Guide for Clinical Psychiatry course:

https://psychiatryeducationforum.teachable.com/courses/451404/lectures/11303169

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