Zhang et al. Respond

Abstract

We are delighted that our article has stimulated initiatives in pediatricians and specialists to form guidelines for clinical management of childhood lead exposure and poisoning. We applaud the Pediatric Environmental Health Specialty Unit (PEHSU) network for creating the “Recommendations on Medical Management of Childhood Lead Exposure and Poisoning” (The Recommendations, hereafter).1 The publication of The Recommendations is very timely, with the Centers for Disease Control and Prevention (CDC) officially adopted a new standard for “acceptable” blood lead levels in American children at 5 micrograms per deciliter in May 2012. Newman et al. provide a distinct perspective on preventing lead poisoning through educating medical students and health care professionals. The Recommendations has several contributions. First, it reduces the chance of delayed or missed identification of children with elevated lead levels. Second, discussing environmental exposures with parents and nutritional counseling will potentially protect the child from further environmental exposures. Moreover, The Recommendations also offers suggestions on treatment of blood lead levels greater than 14 micrograms per deciliter. However, The Recommendations is not a replacement for other primary preventions, such as control of industrial emissions, lead abatement in old housing, and enforcement of allowable levels of lead in toys and other consumer products. A combination of prevention measures might be taken to protect those children at highest risk for lead poisoning.2 The cost-effectiveness needs to be assessed to guide future prevention efforts.3 Lead is one of the many toxicants (biphenyls, phthalates, mercury, manganese, arsenic, etc.) that pose health threats to children, and The Recommendations may be adapted to other confirmed and suspected toxicants and chemicals of uncertain toxicity.4 These recommendations should be based on scientific evidence and be updated as new evidence emerges.