Any Lead Is Too Much Lead

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The CDC's Advisory Committee on Childhood Lead Poisoning Prevention has proposed radical changes to the way we identify, prevent, and treat this toxic substance in our kids.

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Environmental lead has been known to be a health and developmental hazard for young children for years. Elevated blood lead levels during the preschool years have been linked to lower IQ, attention deficit disorder, and learning disabilities. There are mandated blood tests for young children to check their lead levels. Depending on the results, a variety of interventions may be recommended, including improved nutrition, correction of iron deficiency, family education, chemical chelation, and attempts to remove lead sources from the child's environment.

The current lead guidelines have been based on the premise that there is a threshold level which defines when lead is toxic and when it is too low to pose a health risk. The current lead level which prompts a child's entry into the lead response algorithm is 10 micrograms/deciliter (ug/dl). If a child's blood lead level is below 10, no intervention, beyond routine monitoring, is indicated.

The Centers for Disease Control (CDC), which sets the national policy regarding childhood lead levels, established an Advisory Committee on Childhood Lead Poisoning Prevention (ACCLPP) to assess new scientific knowledge and to provide advice regarding the prevention of childhood lead poisoning. The Committee was asked to assist in the development of policies and procedures based on the most recent evidence and technology and provide periodic updates on their investigations.

On January 4, 2012, the ACCLPP voted to present a series of recommendations to the CDC based on their new report. The recommendations are non-binding until accepted by the CDC and formed into public policy, but if accepted, they will have far-reaching implications for national health policy.

The committee's data challenged the long-held notion that there is a threshold below which lead is not toxic. They also made strong recommendations for sweeping changes in the CDC's approach to the detection, prevention, and treatment of lead in children's systems. Their report stresses aggressive primary prevention, or stopping the problem before it becomes one, as the key approach.

Based on new information as well as new understanding of old data, the committee's report asserts that there is no safe lead level for children -- that many of the consequences of early lead exposure are irreversible. The adverse effects extend beyond the neurodevelopmental realm into cardiovascular, immunological, and endocrine effects. The report documents numerous studies that show the negative effects of lead levels as low as five.

Because many of the effects of lead on young children are irreversible, they have troubling implications for the potential children will reach as adults. They stress that the only way to avoid the dangerous health consequences of lead poisoning in children is to stop exposing them to environmental lead. Primarily, this means they must not live in housing with lead-based paint, since house paint is the main culprit in childhood lead poisoning.

The committee recommends extensive prevention strategies to reduce environmental exposures from soil, dust, paint, and water. Other important components of prevention include increasing awareness of lead hazards and ensuring optimal nutrition, including adequate calcium, vitamin C, and iron.

The advisory committee points out that using the current benchmark lead level of 10 micrograms per deciliter as a "level of concern" is no longer consistent with available scientific evidence and will miss the opportunity to intervene in the physical and developmental health of thousands of children with levels that are less than 10. Research has clearly shown that lead levels between five ug/dl and 10 ug/dl have negative effects on children in multiple cognitive areas.

The committee's recommendation that a value based on the 97.5th percentile of the current population of children one to five years old be used to identify children as having an elevated blood lead level would significantly increase the number of children identified for intervention and monitoring. There are approximately 450,000 U.S. children with blood lead levels above five ug/dl as compared to 250,000 children with the current cut off value of 10 ug/dl.

The CDC says it is "carefully reviewing the AACLPP's recommendations" and will decide whether or not they agree with them. The process may take several months and also involves the U.S. Department of Health and Human Services (HHS). Once this process has concluded, and if CDC concurs with ACCLPP's findings, they will become official recommendations of CDC.

Parents who are concerned about their children's lead levels should discuss them with their physicians. Local health departments can provide guidance for testing paint, water, soil, and other sources of lead contamination. Nutritionists and health care providers can supply information to help ensure that children's nutritional status is optimal for protection against absorption of environmental lead. Additional information about lead screening and treatment can be found here and here.

Image: artur gabrysiak/Shutterstock.


This article originally appeared on TheDoctorWillSeeYouNow.com, an Atlantic partner site.

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Esther Entin, M.D., is a pediatrician and clinical associate professor of Family Medicine at Brown University's Warren Alpert School of Medicine. She writes for TheDoctorWillSeeYouNow.com.

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