Nutrition's Role in the Prevention and Treatment of Childhood Lead Poisoning

Lead exposure continues to be an environmental health problem for millions of households with children in the United States. Exposure to even low levels of lead over time can affect a child's development and result in learning and behavior problems.

The level of exposure deemed by the Centers for Disease Control and Prevention (CDC) to be a health risk for young children is 3.5 or more micrograms of lead per deciliter (mcg/dL). The reference level was updated in 2021 and is based on the 97.5th percentile of the blood lead value in children (ages 1 to 5) based on National Health and Nutrition Examination Survey (NHANES) data from the 2015-2016 and 2017-2018 cycles.

Primary prevention, reducing or eliminating sources of lead exposure to the extent possible for children before they are harmed is the focus of many organizations. It is also one of the objectives of the Healthy People 2030 initiative and the focus of a policy statement issued by the American Academy of Pediatrics (AAP) in 2016.

Lead exposure during pregnancy and while breastfeeding can also pose risks on both maternal and child health. The likelihood of a spontaneous abortion increases with exposure to high levels of lead, and there may be a risk of preterm delivery and low birth weight at lower levels. Lead exposure pre- and postnatally has also been shown to influence neurobehavioral development in children.

Sources of possible lead exposure include lead-based paints or dust particles that are contaminated with lead, both of which can be easily ingested or inhaled by children. Lead-contaminated water or the use of lead pipes in older homes, can also be influences. Other ways to reduce a child's exposure to lead is to avoid the following: folk remedies, candies imported from Mexico, toy jewelry, and the use of cookware and food containers that are not lead-free.

For children with elevated blood lead levels (EBLLs), there has been a lack of research relating to nutrition interventions; however, "children with EBLLs are often at risk for poor nutrition," according to the Advisory Committee on Childhood Lead Poisoning Prevention (ACCLPP). Evaluating a child's nutritional status is critical, since mineral deficiencies including calcium, iron, zinc, and magnesium are known to increase lead absorption.

"Calcium and iron supplementation have not consistently been shown to be efficacious in reducing blood lead concentrations of children" according to the AAP Council on Environmental Health, so the use of supplements is only recommended when a deficiency has been identified and under the supervision of a physician or dietitian.

Recommended actions from the CDC are based on the child's lead level and are derived from a resource developed for clinicians by the Pediatric Environmental Health Specialty Units. For the medical management of children with a lead level of <5 mcg/dL, screening for risk of iron deficiency is indicated; whereas children with a lead level of 5-14 mcg/dL are encouraged to consume fruit with every meal, along with dietary sources of iron. Nutrition counseling is also recommended for the caregivers with a focus on iron, calcium and vitamin D and referrals to services such as the Special Supplemental Nutrition Program for Women, Infants, and Children, if appropriate.

References:

• Centers for Disease Control and Prevention (CDC). Childhood Lead Poisoning Prevention: Guidelines and Recommendations. Accessed November 10, 2021.
• AAP Council on Environmental Health. Prevention of Childhood Lead Toxicity. Pediatrics. 2016;138(1):e20161493. Accessed November 10, 2021.
• Advisory Committee On Childhood Lead Poisoning Prevention (ACCLPP). Low Level Lead Exposure Harms Children: A Renewed Call for Primary Prevention. Published January 4, 2012. Accessed October 10, 2014.
• Centers for Disease Control and Prevention (CDC). Guidelines for the Identification and Management of Lead Exposure in Pregnant and Lactating Women. Published November 2010. Accessed October 10, 2014.
• Pediatric Environmental Health Specialty Units. Recommendations on Management of Childhood Lead Exposure: A Resource for Clinicians. Last Updated Sep 2021. Accessed November 10, 2021. Accessed October 10, 2014.