The Centers for Disease Control and Prevention (CDC) has reduced its recommended upper limit for blood lead levels in young children by half. What are the implications of the revised recommendations for clinical practice? More >>
The Centers for Disease Control and Prevention (CDC) has reduced its recommended upper limit for blood lead levels in children aged 1 to 5 years to 5 μg/dL of blood from 10 μg/dL.
The change in the acceptable limit for childhood blood lead level (BLL) is the first in 20 years. The CDC estimates that 450,000 children have BLLs higher than 5 μg/dL.
The CDC adjusted the lead limits in response to recommendations passed in January by its Advisory Committee on Childhood Lead Poisoning Prevention (ACCLPP). The committee cited scientific evidence that even low BLLs are associated with attention deficits, impaired academic performance, and lower IQ.
The 5-μg/dL reference value is based on the BLL distribution among 97.5% of children aged 1 to 5 years in the United States. The ACCLPP recommendations call for updating the reference value every 4 years using data from the most recent population-based BLL surveys of young children.
Noting that no blood lead level has been found to be safe and that the adverse effects are irreversible, the recommendations stress the critical importance of primary prevention-a strategy of avoiding exposure to lead from such sources as paint, plumbing, toys, and jewelry rather than responding clinically once exposure has occurred.
Clinicians should take the lead role in educating families about prevention and recommend an environmental assessment before performing blood lead screening of children at risk of exposure, the CDC advises.
The CDC further advocates that clinicians monitor all children with a BLL of 5 μg/dL or greater for changes in blood lead levels until recommended environmental investigations and mitigation strategies have been carried out and promptly notify families of test results for affected children. Clinicians in areas without mandatory laboratory reporting requirements should report elevated lead levels to local and state health or housing departments.
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