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Am Fam Physician. 2008;77(8):1175

Guideline source: Centers for Disease Control and Prevention

Literature search described? Yes

Evidence rating system used? No

Published source: Morbidity and Mortality Weekly Report, November 2, 2007

Lead is associated with impaired cognitive, motor, behavioral, and physical abilities in children. The Centers for Disease Control and Prevention (CDC) determined in 1991 that a blood lead level of 10 μg per dL (0.50 μmol per L) should prompt public health actions; however, lower levels may affect children's development. The CDC's Advisory Committee on Childhood Lead Poisoning Prevention reviewed the data on the clinical interpretation and management of blood lead levels less than 10 μg per dL and outlined recommendations to reduce childhood exposure to lead.

Physicians should advise parents of young children about sources of lead and help them identify sources in their child's environment. An environmental and family occupational history should be obtained, and parents should be educated about the most common sources of childhood lead exposure for their child and in their community. Physicians should encourage parents to identify lead hazards and sources in their homes and to reduce their child's potential for lead exposure. Physicians also should warn parents about the dangers of unsafe renovation methods and ask them to be aware of new or reemerging sources of lead. Parents should be directed to agencies and organizations for information about safely repairing lead hazards.

All children should be assessed for developmental and behavior status, with further evaluation and therapy to reduce developmental or behavioral problems as necessary. The potential influences of lead should be considered when conducting developmental screening. More frequent surveillance or more extensive evaluations should be considered for children with multiple developmental risk factors.

Physicians should discuss with parents the potential impact of lead on child development and should promote strategies that support optimal development. Participation in early enrichment programs should be promoted for all children from low-resource families living in areas where lead exposure is likely, regardless of the child's blood lead level.

Office policies and procedures should ensure that lead exposure risk assessment or blood lead screening is carried out for all children according to state or local requirements or CDC recommendations. Laboratories that can achieve routine performance of ± 2 μg per dL (0.10 μmol per L) for blood lead analysis should be used when possible. Physicians should help parents understand the uncertainty of blood lead values and possible reasons for variation.

The child's age, season of testing, and exposure history should be considered when deciding whether to obtain follow-up blood lead testing. More frequent blood lead screening (i.e., more than once per year) might be appropriate for children whose blood lead level is approaching 10 μg per dL, particularly those who are older than two years, who were tested at the start of warm weather, or who are at high risk for lead exposure.

Physicians should perform a diagnostic blood lead test on all children suspected of having lead exposure or an elevated blood lead level, and should follow recommended management guidelines if a child's blood lead level increases to greater than 10 μg per dL.

Coverage of guidelines from other organizations does not imply endorsement by AFP or the AAFP.

This series is coordinated by Michael J. Arnold, MD, Assistant Medical Editor.

A collection of Practice Guidelines published in AFP is available at

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