Recent Developments in Low-Level Lead Exposure and Intellectual Impairment in Children

Karin Koller; Terry Brown; Anne Spurgeon; Len Levy

Disclosures

Environ Health Perspect. 2004;112(9) 

In This Article

Abstract and Introduction

In the last decade children's blood lead levels have fallen significantly in a number of countries, and current mean levels in developed countries are in the region of 3 µg/dL. Despite this reduction, childhood lead poisoning continues to be a major public health problem for certain at-risk groups of children, and concerns remain over the effects of lead on intellectual development in infants and children. The evidence for lowered cognitive ability in children exposed to lead has come largely from prospective epidemiologic studies. The current World Health Organization/Centers for Disease Control and Prevention blood level of concern reflects this and stands at 10 µg/dL. However, a recent study on a cohort of children whose lifetime peak blood levels were consistently < 10 µg/dL has extended the association of blood lead and intellectual impairment to lower levels of lead exposure and suggests there is no safety margin at existing exposures. Because of the importance of this finding, we reviewed this study in detail along with other recent developments in the field of low-level lead exposure and children's cognitive development. We conclude that these findings are important scientifically, and efforts should continue to reduce childhood exposure. However, from a public health perspective, exposure to lead should be seen within the many other risk factors impacting on normal childhood development, in particular the influence of the learning environment itself. Current lead exposure accounts for a very small amount of variance in cognitive ability (1-4%), whereas social and parenting factors account for 40% or more.

The effects of lead poisoning have been known since ancient times. In 200 BC the Greek physician Dioscorides observed that "lead makes the mind give way." Until the beginning of the 20th century, lead poisoning was viewed largely as an occupational disease of adults. In the 1890s lead paint poisoning in children was first recognized, and childhood lead poisoning is now well documented and persists as a major public health problem throughout the world. Clinical features of acute lead poisoning include abdominal pain and neurologic symptoms of lead encephalopathy including headache and confusion. In severe cases renal failure and convulsions can occur (Lewis 1997), and extremely high levels may lead to coma and death (Meyer et al. 2003b). Features of chronic lead poisoning include behavioral changes, nephritis, and peripheral neuropathy [Lewis 1997; World Health Organization (WHO) 1995]. Children are more vulnerable to lead exposure for three reasons: young children are more at risk of ingesting environmental lead through normal mouthing behaviors (Lanphear et al. 2002), absorption from the gastrointestinal tract is higher in children than adults (Ziegler et al. 1978), and the developing nervous system is thought to be far more vulnerable to the toxic effects of lead than the mature brain (Lidsky and Schneider 2003).

Although there appears to be no dispute about the effects of high levels of lead, there has been uncertainty about the effects of low levels of lead exposure on children's health. The debate has been particularly heated in the United States (Ferber 2002; Wakefield 2002), where data used to support laws and policies relating to lead exposure have become the subject of a number of lawsuits (Bellinger and Dietrich 2002; Mushak 2002; Needleman 2002; Nelson 2002; O'Dowd 2002; Pinder 2002). A special issue of Archives of Clinical Neuropsychology in 2001 was devoted to the topic of intelligence quotient (IQ) and low-level lead exposure in children. Five groups of scientists were invited to reply to an article by Kaufman (2001a) who posed the question "Do low levels of lead produce IQ loss in children?" (Brown 2001; Hebben 2001; Nation and Gleaves 2001; Needleman and Bellinger 2001; Wasserman and Factor-Litvak 2001). Kaufman argues that parental variables are far more important to a child's cognitive development than is low-level lead exposure, and that the loss of a few IQ points (if true) is unlikely to have meaningful consequences for society (Kaufman 2001a, 2001b). In contrast, Needleman argues that lead-induced neurotoxicity has a causal role not only in cognitive loss but also in the subsequent development of juvenile delinquency and socially disruptive behavior (Needleman 1995; Needleman and Bellinger 2001; Needleman et al. 2002). These two positions represent the opposite ends of a spectrum of opinion on the relationship between low-level lead exposure and child development.

In contrast, debate in European countries has been muted with an overriding feeling that since the banning of leaded gasoline and lead-containing paints, lead exposure no longer poses a significant environmental threat to health. Publication of a study by Canfield and colleagues in 2003 (Canfield et al. 2003) challenged this view. Their study showed a dose-dependent decline in cognitive function in a cohort of children whose lifetime peak blood levels never rose above the current World Health Organization/Centers for Disease Control and Prevention (WHO/CDC) blood lead level of concern (10 µg/dL) and suggests there is no safety margin at existing exposures. Since its publication in April 2003, the Canfield study has been widely quoted and has extended the debate beyond the United States. With this in mind, the U.K. Department for Environment, Food and Rural Affairs commissioned the Medical Research Council Institute for Environment and Health to examine in detail the findings of Canfield and colleagues and to place their study within the context of other recent developments, not just in the area of low-level lead exposure but also in the wider context of normal childhood development. Our findings form the basis of this review.

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