Intended for healthcare professionals

Practice Clinical Updates

Lead exposure in children

BMJ 2022; 377 doi: (Published 07 April 2022) Cite this as: BMJ 2022;377:e063950
  1. David J Roberts, public health registrar1,
  2. Sally M Bradberry, director2,
  3. Frances Butcher, public health registrar1,
  4. Araceli Busby, consultant in health protection3
  1. 1Environmental hazards and emergencies department, Radiation Chemical and Environmental Hazards Directorate, UK Health Security Agency
  2. 2National Poisons Information Service (Birmingham Unit) and West Midlands Poisons Unit, City Hospital, Birmingham, UK
  3. 3UK Health Security Agency Office for London, London, UK
  1. Correspondence to DJ Roberts David.J.Roberts{at}

What you need to know

  • Lead is a persistent environmental contaminant that can cause toxicity even at low blood lead concentrations (BLC)

  • Young children and fetuses are most at risk of neurological damage, which may persist into adolescence and adulthood

  • Identifying and removing the exposure source are the mainstays of management in children with elevated BLC (≥0.1 μmol/L (≥2 μg/dL)).

  • Notify local public health teams about children with BLC denoting unusually high lead exposure (defined as ≥0.24 μmol/L (≥5 μg/dL)) for investigation and management

  • Chelation may be indicated in children who are symptomatic, or with very high BLC (≥2.4 μmol/L (≥50 μg/dL))

Lead exposure is particularly harmful to young children and fetuses. Symptoms of toxicity may develop acutely with substantial exposure, or insidiously with lower exposures as lead accumulates in the body. The sequelae may persist into adolescence and adulthood.1 The diagnosis may be missed or delayed2 as symptoms are not specific. About 48.5% of children in low and middle income countries have high exposure to lead (blood lead concentration (BLC) ≥5 μg/dL (0.24 μmol/L)) as per estimates using data collected since 2004.3 High levels of exposure are increasingly uncommon in high income countries, but vigilance is required owing to globalisation and increased migration, and the continued risk of exposure to lead from its widespread use in the past.

What are the sources of exposure?

Lead is a widespread and persistent environmental contaminant that arises primarily from mining, combustion of coal and oil, and waste incineration.45 Sources of exposure include food, water, soil, dust, and air.45

Young children are mainly exposed from direct ingestion of lead contaminated dust or soil through pica (the deliberate ingestion of non-nutritive substances) or hand-to-mouth behaviour.467 Other routes of exposure include ingestion of lead paint chips or flakes (from layers that predate the phase out of …

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