What is the best management to eliminate toxic metal exposure in a 7-year-old child who has been sucking on a 'CHARM IT' necklace for several hours each day over the past 3–4 days?

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Last updated: September 22, 2026 • View editorial policy

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Immediate Management: Stop Exposure and Check Blood Lead Level

The most important action is to immediately remove the necklace from the child and obtain a venous blood lead level test to determine if any significant absorption has occurred 1. Given the brief exposure duration (3-4 days, several hours daily) and that CHARM IT jewelry is typically manufactured to meet U.S. safety standards, significant toxicity is unlikely, but testing is warranted to guide further management.

Initial Steps

1. Immediately Stop the Exposure

  • Remove and secure the necklace permanently
  • Prevent access to similar items
  • Document the brand, product details, and exposure timeline

2. Obtain Blood Lead Testing

Get a venous blood lead level within the next few days 1. This is critical because:

  • Capillary (fingerstick) samples can be contaminated and are less reliable
  • The test will determine if any lead absorption occurred
  • Management is entirely based on the blood lead concentration result

3. Do NOT Attempt "Detoxification" Before Testing

There is no home remedy or over-the-counter treatment to "get rid of metals." Management depends entirely on measured blood lead levels, not presumed exposure.

Management Based on Blood Lead Results

If Blood Lead Level <5 μg/dL (<50 ppb) 1

  • Reassure the family - this is within normal range (geometric mean for U.S. children is <2 μg/dL)
  • Provide nutritional counseling about iron and calcium-rich foods
  • Assess for iron deficiency with CBC and ferritin
  • No further lead-specific follow-up needed unless risk factors increase

If Blood Lead Level 5-14 μg/dL (50-140 ppb) 1

  • Retest venous blood in 1-3 months to ensure level is not rising
  • Nutritional intervention:
    • Encourage iron-enriched foods (cereals, meats)
    • Ensure adequate calcium intake
    • Consider multivitamin with iron
    • Screen for iron deficiency (CBC, ferritin, C-reactive protein)
  • Report to local health department (required in most states)
  • Monitor developmental milestones at routine visits

If Blood Lead Level 15-44 μg/dL (150-440 ppb) 1

  • Confirm with repeat venous sample within 1-4 weeks
  • Consider abdominal X-ray if the child has history of mouthing/chewing behaviors (to check if pieces were swallowed)
  • Consult Pediatric Environmental Health Specialty Unit (www.pehsu.net or 888-347-2632) or Poison Control (800-222-1222)
  • All interventions from lower levels apply

If Blood Lead Level >44 μg/dL (>440 ppb) 1

  • Confirm within 48 hours with repeat venous sample
  • Consider hospitalization and chelation therapy with expert consultation
  • Contact regional Poison Control Center immediately

Important Caveats

About Toy Jewelry and Lead Risk:

  • While CHARM IT is a recognized brand that should comply with U.S. safety standards, toy jewelry has been a documented source of severe lead poisoning 2, 3
  • A 2003 case involved a toy vending machine necklace medallion containing 38.8% lead that caused a blood lead level of 123 μg/dL 3
  • Even brief oral contact with high-lead items can cause toxicity if swallowed 2

Why You Cannot "Detoxify" Without Testing:

  • There is no evidence-based home treatment to eliminate absorbed lead
  • Chelation therapy (the only proven method to remove lead) is reserved for blood levels >44 μg/dL and requires expert management 1
  • Nutritional interventions (iron, calcium) help prevent further absorption but don't remove existing lead
  • The body naturally eliminates lead slowly over weeks to months once exposure stops 4

Critical Point About Swallowing: If any part of the necklace was swallowed (not just sucked on), this is a medical emergency requiring immediate evaluation. Metallic objects in the stomach can corrode and release massive amounts of lead 3, 5. An abdominal X-ray would be needed urgently.

Bottom Line Algorithm

  1. Stop exposure immediately (remove necklace)
  2. Get venous blood lead level within days
  3. Wait for results - do nothing else until you have the number
  4. Follow the specific protocol based on the measured level above
  5. If any piece was swallowed - go to emergency department for X-ray evaluation

The exposure duration described (3-4 days of mouthing) makes significant toxicity unlikely if the jewelry meets U.S. standards, but testing is the only way to know for certain and guide appropriate management 1.

References

2
Research

Lead poisoning from ingestion of a toy necklace--Oregon, 2003.

MMWR. Morbidity and mortality weekly report, 2004

3
Research

Lead poisoning from a toy necklace.

Pediatrics, 2004

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