Lead poisoning: How long to worry?

The Pediatric Insider

© 2012 Roy Benaroch, MD

This is a question I answered on the WebMD parenting community, edited, expanded, and obfuscated for your enjoyment here!

“My 3 year-old daughter was diagnosed with lead poisoning a little over a year ago. Her initial lead level was 33. The previous residents of our home didn’t follow regulations when they changed the windows, filling the yard with lead. She hasn’t had any symptoms, and her levels are within safe levels at this point, but I haven’t been able to find much information for parents after children are diagnosed with lead poisoning. What is her prognosis? She seems fine now, but how long do I need to worry?”
I’d like to give you a clear, unequivocal answer. But unfortunately, there’s no way to predict for sure whether your daughter is likely to have problems from this level of lead exposure.

Lead can cause symptoms both from acute exposure to high levels, and also from chronic, low-level exposures. Children with acute lead intoxication can have irritability or sluggishness, plus GI symptoms like vomiting or constipation. More common, though, are prolonged, lower-level exposures that may not have any obvious symptoms at first. In the long run, children (including not-yet-born babies) exposed to even relatively low levels of lead can have behavior and learning problems.

Unfortunately, it’s difficult to know exactly what the cut-off for safe exposure is, or if an individual child with a mildly raised lead level is likely to have problems. The effects of lead poisoning depend on many things other than the lead level. Different people have different susceptibility to the effects of lead (that’s probably genetically determined.) Certain other health conditions, like iron deficiency, seem to have an additive effect on lead poisoning. Effects also depend on how long the level was elevated—the longer a child is exposed to lead in the environment, the worse it can be. Earlier exposures seem to cause more problems than exposures in later childhood.

The best treatment for lead exposure is the prevention of exposure by limiting the lead in our environment. Lead paint has been banned in The United States and most other countries since the 1970s, but might still be found in layers of older paint in homes. During renovation, old layers of paint can be chipped off or turned into dust that can contaminate a home. Lead paint also occasionally is found in toys produced overseas, and lead contamination has been found in herbal and other medical products. Some hobbies (like stained glass and ceramics) and occupations involve exposure to lead in solder and glazes. Leaded gasoline had been a significant source of environmental lead exposures until it was phased on in the 1990s; however, lead is still used as an additive in some aviation fuels.

Going back to the original question, there is a very good possibility that a lead level of 33 will lead to no permanent harm whatsoever, but no one can predict that at age 3. Certainly we know that there are no severe or marked problems– that would be noticed  already. Subtle issues can’t be ruled out at this age, so continued watchfulness is still needed at least until the child is well into the school years.

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