AAP Statement Targets Lead Toxicity in Childhood

Diana Swift

June 21, 2016

A new policy statement from the Council on Environmental Health of the American Academy of Pediatrics (AAP) aims to prevent lead toxicity in US children.

The statement, published online June 20 in Pediatrics, especially targets US preschoolers who have lead blood level concentrations of 5μg/dL or higher. Although both mean blood lead levels and the prevalence of high blood levels have dropped during the last 4 decades, the National Health and Nutrition Examination Survey found that in 2007 to 2012, about 2.6% of preschoolers, or 535,000 children aged 1 to 5 years, had lead levels at or above this threshold.

No blood lead concentration is considered safe. "Blood lead levels in children have declined dramatically, but new studies have shown that lead exposure still accounts for 24 million lost IQ points and about one in five cases of attention-deficit hyperactivity disorder in US children," lead author Bruce Perrin Lanphear, MD, MPH, a professor of health sciences at Simon Fraser University in Burnaby, British Columbia, Canada, told Medscape Medical News. "Lead has been phased out or banned in gasoline, paint, and water pipes, but children continue to be exposed to the lead remaining in their environment, particularly in paint, dust, soil, and water in and around their homes."

The risk for exposure is greatest in the first 2 years of life, and there are no effective treatments for the permanent developmental and cognitive effects of lead toxicity. The estimated annual cost of childhood lead exposure in the United States is $50 billion, according to the APA document.

"For every $1 invested to reduce lead hazards in housing units, society would benefit by an estimated $17 to $221, a cost– benefit ratio that is comparable with the cost–benefit ratio for childhood vaccines," the statement notes, citing a 2009 study.

According to previous research by Dr Lanphear and colleagues, lead dust is the greatest driver of elevated blood concentrations in children, accounting for almost 40% of the increase, followed by water lead, at nearly 20%.

Other sources of exposure are industrial emissions, transmission from parental worksites, the water supply, food, costume jewelry, toys, ceramics, folk medicines, cosmetics, and various consumer products that slip through the regulatory cracks.

According to the policy paper, pediatricians are well positioned to make a difference. In many instances, their clinical histories can provide important case management information by offering clues to potential contamination sources in patients' living environments. Appropriate management will require investigation of these sources, with a questionnaire and visual inspection for other potential exposures, the statement said.

Although the routine screening questionnaires used in primary care do not detect children with elevated blood lead concentrations, the authors add, they may help identify environmental hazards for children with concentrations of 5 μg/dL or higher (≥50 ppb). In clinical practice, prevention begins with counseling parents to undertake environmental assessments if their housing was built before 1960 and has been recently renovated.

In addition to several funding, monitoring, and regulatory recommendations aimed at government, the policy paper had suggestions for pediatricians and other healthcare providers. Among these:

  • collaborate with public health officials to regularly survey blood lead concentrations in randomly selected children,

  • recommend environmental assessments of older housing,

  • advocate for strict and well-enforced legal standards for allowable levels of lead in common sources,

  • be familiar with government and professional recommendations for screening children and pregnant women for lead poisoning, and

  • conduct targeted screening of toddlers ages 12 to 24 months if they reside in housing communities with at least 25% of units built before 1960 or with a prevalence of child blood lead concentrations of 5 μg/dL or higher (≥50 ppb).

"Reducing sources of lead is the most reliable, cost-effective way to protect children," Dr Lanphear said. "We need to provide landlords with incentives, like tax credits, for making their housing units safe, and impose fines if they fail."

But although landlords have often been blamed for the problem, they really just inherited it. "The real culprits are the lead industries who misled us about the dangers of lead. They put their profit over people's health," Dr Lanphear said.

This study received no external funding. Dr Lanphear has disclosed no relevant financial relationships.

Pediatrics. Published online June 20, 2016. Full text

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