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Although the natural level of lead in children is zero, it is considered normal to have a blood lead level of less than 9 (mcg/dl). Your child should continue to be screen each year and testing should be repeated if he is still at risk for lead poisoning.
Treatment should always include an effort to decrease the child's exposure to lead (see the lead screening guide). You should also make sure that your child has a diet high in calcium and iron, since deficiencies in these minerals can increase the body's absorption of lead. If your child has recently ingested lead paint, glazes, or a lead weight, then he will need to undergo decontamination until it is removed from his body.
Treatment for levels > 10 depends on the lead level and includes:
- repeat testing and examination by a physician every 3-4 months for levels 10-14.
- a level of 15-19 should be repeated with a venous blood sample. If the lead level is still 15-19 on the repeat testing, then your child should have repeat testing and examination by a physician every 3-4 months. You should also review the lead poisoning prevention tips, including providing your child with a nutritious diet, cleaning the house with a damp mop (to minimize dust), encouraging frequent handwashing, and discouraging your child from ingesting nonfood substances. If repeat testing remains high, then your local health department will probably conduct a home visit to try and find the source of lead contamination. Testing of soil, paint, water and dust may be performed at this time.
- blood levels above 20 should be quickly repeated and if confirmed to be above 20, your child should be quickly evaluated by a professional that has experience in treating children with lead poisoning. In addition to trying to find the source of lead poisoning, your child may require an oral medication to decrease his blood lead level. It is controversial of whether or not asymptomatic children with a blood level below 44 need to be treated. The American Academy of Pediatrics policy statement on Screening for Elevated Blood Lead Levels states that "Chelation therapy may be considered, but is not recommended routinely at BLLs [Blood Lead Levels] <45mcg/dl."
- blood levels above 45 should be quickly repeated within 48 hours and if confirmed to be above 45, your child should be quickly evaluated by a professional that has experience in treating children with lead poisoning. In addition to trying to find the source of lead poisoning, your child will require an oral medication (DMSA) to decrease his blood lead level.
- levels above 69 or lower lead levels in children who have symptoms of lead poisoning are a medical emergency and requires immediate treatment by a professional that has experience in treating children with lead poisoning.
When required, elevated blood lead levels are treated with chelation therapy. These medications are chelating agents, which decrease blood lead levels by binding to them, so that they can be excreted in the urine. Medications include DMSA (also called Chemet, Succimer or Dimercaptosuccinic acid), an oral drug that binds to lead and mercury and is given every eight hours for five days and then every twelve hours for two more weeks. It is usually used for BLLs between 45 and 69. The lead level should be rechecked in 7 - 21 days after treatment is begun to determine if treatment has been adequate.
Other chelating agent that are used for treatment of symptomatic lead poisoning and for BLLs >69 is EDTA (Calcium Disodium EDTA) which is given as a continuous infusion or as intramuscular injections for 3-5 days and BAL (British anti-lewisite or dimercaprol) which is given as an injection.
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