The Need for Vigilance: The Persistence of Lead Poisoning in Children

Abstract

A recent report copublished in the Centers for Disease Control and Prevention’s Morbidity and Mortality Weekly Report and the Journal of the American Medical Association presented a case of lead poisoning associated with ingestion of a toy necklace in a 4-year-old child.1 Although there is reason to celebrate the great declines in the prevalence of lead poisoning in this country, this case report reinforces that lead poisoning remains a concerning problem for children and deserves appropriate attention in clinical settings. It therefore is essential that adequate and accurate information about childhood lead exposure continues to accompany such reminders. This report overlooks several significant biochemical and clinical details that are important for clinicians to understand in their care of the many children who continue to be exposed to and harmed by lead. The case presented was that of a 4-year-old boy who presented with several episodes of abdominal cramping, vomiting, and diarrhea without fever. The course worsened to include constipation and inability to sleep or eat because of abdominal pain. After radiographs demonstrated a metallic object in the stomach and laboratory studies showed persistent normocytic anemia, a medallion pendant and a quarter were retrieved by endoscopy. The boy presented 3 days later with edema of the left cheek and gingiva, suggesting a dental abscess or excessive biting … Address correspondence to Michael Weitzman, MD, Center for Child Health Research, University of Rochester School of Medicine and Dentistry, 1351 Mt Hope Ave, Rochester, NY 14620. E-mail: michael_weitzman{at}urmc.rochester.edu