From the Guidelines
Normal lead levels in children are considered to be less than 5 micrograms per deciliter (μg/dL), as indicated by the American Academy of Pediatrics (AAP) and the Centers for Disease Control and Prevention (CDC) 1.
Key Points to Consider
- The AAP has adopted a reference value of ≥5 μg/dL for case management of children with elevated blood lead concentrations 1.
- The geometric mean blood lead concentration for US children 1–5 years old is less than 2 μg/dL, with 2.5% having a blood lead concentration ≥5 μg/dL 1.
- There is no known safe blood lead level, as even low levels of lead exposure can cause harmful effects, particularly in children whose developing nervous systems are more vulnerable.
Recommendations for Lead Level Monitoring
- Children with blood lead concentrations <5 μg/dL should have their laboratory results reviewed with their family, and repeat testing should be considered in 6–12 months if the child is at high risk for lead exposure 1.
- Children with blood lead concentrations ≥5 μg/dL should be monitored closely, with environmental investigations and remediation efforts initiated to reduce lead exposure 1.
Importance of Early Detection and Intervention
- Early detection and intervention are critical to preventing long-term harm from lead exposure, particularly in children 1.
- Regular screening is recommended for those at risk of exposure, and any elevated levels should prompt investigation of exposure sources and appropriate medical intervention to reduce lead burden in the body.
From the Research
Normal Lead Levels
- The normal lead level in micrograms per deciliter (mcg/dL) is not explicitly defined, but various studies provide guidelines for blood lead levels that should prompt public health actions or further evaluation.
- According to 2, the Centers for Disease Control and Prevention defined the blood lead level that should prompt public health actions as 10 microg/dL in 1991.
- However, research conducted since 1991 has strengthened the evidence that children's physical and mental development can be affected at blood lead levels of < 10 microg/dL, as stated in 2.
- More recent studies, such as 3, suggest that blood lead levels of less than 5 µg per dL are associated with impairments in neurocognitive and behavioral development that are irreversible.
Blood Lead Level Guidelines
- The Centers for Disease Control and Prevention recommends screening all Medicaid-eligible children at 12 months and again at 24 months, or at least once between 36 and 72 months if not previously screened, as mentioned in 3.
- Universal screening is also recommended in areas where more than 27% of the housing was built before 1950, or where at least 12% of children 12 to 36 months of age have blood lead levels greater than 10 µg per dL, according to 3.
- For adults, a blood lead concentration of ≥ 45 µg/dL should undergo further evaluation, as stated in 4.
Chelation Therapy
- Chelation therapy is generally not indicated for adults with blood lead concentrations of < 45 µg/dL, due to the potential risk of adverse drug events and concerns about remobilized lead, as mentioned in 4.
- For children, chelation therapy is recommended for blood lead levels higher than 45 µg/dL, as stated in 5.