From the Guidelines
Infants are commonly exposed to lead through several sources in their environment, including lead-based paint, contaminated soil, lead in drinking water, imported toys and products, folk remedies, cosmetics, and lead dust brought home on parents' work clothes, as reported in the most recent study by 1. The most significant lead exposures for infants include:
- Lead-based paint in older homes built before 1978, which can create dust and chips when deteriorating
- Contaminated soil around homes, especially near busy roads or industrial areas
- Lead in drinking water from old plumbing fixtures or pipes
- Imported toys, jewelry, or other products that may contain lead
- Certain folk remedies or cosmetics like kohl or sindoor
- Lead dust brought home on parents' work clothes from occupations involving lead exposure, such as auto repair, mining, battery manufacture, pipe fitting and plumbing, welding, firing range use, ship building, painting, and construction, as noted in 1. Infants are particularly vulnerable to lead's harmful effects because their developing nervous systems absorb lead more readily than adults, and their hand-to-mouth behaviors increase ingestion risk. Even low levels of lead exposure can cause developmental delays, learning difficulties, behavioral problems, and reduced IQ, as highlighted in 1 and 1. To reduce exposure, parents should:
- Wet-clean surfaces regularly
- Wash children's hands frequently
- Use cold water for drinking and cooking
- Have their home tested for lead if it was built before 1978 Regular screening for lead levels is recommended at well-child visits, particularly at 12 and 24 months of age, as suggested in 1 and 1.
From the Research
Common Lead Exposures in Infants
- Infants are exposed to lead through various sources, including deteriorated urban housing 2
- Lead exposure can occur through ingestion of lead-based paint, contaminated soil, and lead-contaminated water
- Retained lead pellets from gunshot wounds can also cause chronic lead toxicity in adults, but this is less common in infants 3
- Other sources of lead exposure include traditional remedies and occupational exposure to lead-polluted ambient air, although these are less likely to affect infants directly
Lead Exposure in Urban Housing
- Thousands of children, especially poor children living in deteriorated urban housing, are exposed to enough lead to produce cognitive impairment 2
- Infants living in these conditions are at risk of lead exposure through ingestion of lead-based paint and contaminated soil
- The Centers for Disease Control and Prevention has redefined the threshold of concern for low-level lead toxicity, reducing it from a blood lead level of 25 micrograms per dL to a blood lead level of 10 micrograms per dL 4
Treatment and Prevention
- Succimer is an effective oral lead chelating agent that has been approved for outpatient treatment of children with blood lead levels higher than 45 micrograms per dL 5, 4
- Treatment with succimer can lower blood lead levels, but may not improve scores on tests of cognition, behavior, or neuropsychological function in children with blood lead levels below 45 micrograms per dL 2
- Weekly monitoring of complete blood counts and serum aminotransferase levels is recommended during treatment with succimer 4