Childhood lead poisoning and its treatment.

Abstract

The 30-year federal war on childhood lead poisoning began in the activist days of the 1960s and was codified in the Lead Paint Poison Prevention Program of 1970 (1) introduced by Senator Edward Kennedy. Since that time the mean blood lead of US children has decreased from above 1 j.l.mollL (20.7 j.l.g/dL) to below .25 j.l.mollL (5.2 j.l.g/dL). With only two reported deaths in children from acute lead encephalopathy in the past 20 years (2), the politically attuned could call it a preordained triumph. The clinically oriented will credit early screening and diagnosis with the infrequency of life-threatening symp­ toms. The environmentalist can relate the elimination of leaded gasoline to the decline in mean blood lead. The skeptic might question the validity of current evidence for the neurobehavioral risk of low-level lead. The pharma­ cologist might express astonishment at the limited evidence for the therapeutic efficacy of chelation therapy acquired over all these years. To address the latter two concerns, this is a review of the current status of childhood lead poisoning and its treatment. To facilitate comparisons of data relating to blood lead, all subsequent values of blood lead are cited as the traditional j.l.gldL rather than as the molar concentration (1 j.l.g/dL = .0483 j.l.mollL)