Amid growing evidence that even low levels of lead can cause permanent cognitive, academic and behavioral difficulties in children, the AAP urges national commitment to eliminating its sources before exposure occurs.
Even at half the levels previously considered safe, growing evidence shows a child's
exposure to lead can cause irreversible cognitive and
behavioral problems. In updated recommendations published online Monday, June 20, the American Academy of Pediatrics (AAP) urges policy makers and the medical community to take new action to protect children from this critical health threat.
The AAP calls for stricter regulations, expanded federal resources and joint action by government officials and pediatricians in the policy statement, "Prevention of Childhood Lead Toxicity," published in July 2016 Pediatrics. Identifying and eliminating sources before exposure occurs is the only reliable way to protect kids from lead poisoning.
"We now know that there is no safe
level of blood lead concentration for children, and the best 'treatment' for lead poisoning is to prevent any exposure before it happens," said Dr. Jennifer Lowry, MD, FAACT, FAAP, chair of the AAP Council on Environmental Health and an author of the policy statement. "Most existing lead standards fail to protect children. They provide only an illusion of safety. Instead we need to expand the funding and technical guidance for local and state governments to remove lead hazards from children's homes, and we need federal standards that will truly protect children."
The AAP calls for new federal standards defining and testing for lead hazards in house dust, water and soil. It also urges legal requirements that lead be removed from contaminated housing and child care facilities and to ensure water fountains in schools do not exceed
water lead concentrations of more than 1 part per billion.
Until recently, children were identified as having a blood lead "level of concern" if test results showed a concentration of 10 or more micrograms per deciliter. But extensive evidence now indicates problems begin at levels less than half that amount, including lower IQ scores and academic performance, inattention, impulsivity, aggression and hyperactivity.
Preventing young children from ever coming into contact with the metal would have substantial population-wide benefits -- saving more than 20 million total IQ points among U.S. children and billions of dollars in annual costs associated with lead exposure. For every $1 invested to reduce lead hazards in housing units, for example, society would benefit by an estimated $17 to $221–-a cost-benefit ratio comparable with that for
"Eliminating lead from anywhere children can be exposed to it should be a national priority," said AAP President Benard Dreyer, MD, FAAP. "The drinking water crisis in Flint was just one indication of how our country's aging infrastructure is jeopardizing children's health, especially in areas already dealing with
toxic effects of poverty," he said. An estimated 37 million homes in the United States still contain lead-based paint, for example.
Despite dramatic drops in children's blood lead concentrations after the U.S. eliminated lead from gasoline, paints and other consumer products, children are still exposed to lead in their homes and communities. Children's risk of lead exposure increases as soon as they begin crawling and teething. Children who live in older homes that are poorly maintained, or being renovated, are at particular risk. So are those who live near airports and factories, where lead-contaminated exhaust has settled into the soil, or where pollution from rivers and lakes have leached lead from aging pipes into the tap water. Some toys, dishware, vinyl miniblinds, imported aluminum cans, hobby materials and other consumer products also contain lead. Adults who work in certain settings such as
firearms ranges, where lead dust is prevalent from the use of lead bullets, also can expose children to lead on clothing.
The AAP recommends pediatricians and other primary care providers conduct targeted
screening of children for elevated blood lead concentrations if they are between 12 and 24 months of age and live in areas where 25 percent or more of housing was built before 1960. They should monitor children who have blood lead concentrations of more than 5 micrograms per deciliter and routinely recommend individual assessments of older housing, particularly if it is not well-maintained or has undergone renovation or repair within the past six months that may have generated lead-contaminated dust.