This guideline was written as part of information on Arsenic contamination of traditional Burmese medicines

Lead is a heavy metal. Routes of exposure to lead include contaminated air, water, soil and food.⁴ Hand-to-mouth activities in young children increase their risk of lead exposure. Well described sources include lead-based paint from imported toys and in older houses.⁶ Toxicity has also been linked to lead-contaminated traditonal remedies², imported candies/condiments, and fashion accessories.⁶

Elevated blood lead concentrations have been reported in up to 7 - 13% of African^{5, 6} South Asian^{7, 8} and Burmese^{2, 9} refugee children, especially in those aged <6 years; although rarely to a concentration requiring chelation therapy. Blood lead screening has been recommended for all refugee children (aged 6 months - 16 years) arriving in the United States from 2011.¹⁰ Blood lead screening is not part of routine post-arrival tests in Australian refugee health guidelines, but should be considered in any child with developmental delay, pica, or where there is a history suggesting exposure, including through traditional medicines.

Clinical features of lead toxicity

Clinical features vary depending on level of exposure and age of the child; they may be non-specific.

Investigations

• FBE (microcytic hypochromic anaemia, basophilic stippling, sideroblasts)
• Whole blood lead concentrations (specimen collection handbook)

Treatment

• Prevention of further lead exposure
  • Patient/family education
• Blood lead concentration 10-45 mcg/dL, patient well
  • Supportive therapy (treat any associated iron deficiency)
  • Recheck blood lead concentration at 1 and 3 months to ensure it is decreasing
  • If concentration not decreasing, consider ongoing exposure and look for source
• Blood lead concentration >45 mcg/dL, and/or patient acutely unwell with signs of lead toxicity
  • Supportive therapy
  • Consider chelation therapy (to bind lead and facilitate excretion)
    • Chelating agents used include: Dimercaprol, Edetate calcium disodium (calcium disodium versenate), succimer,  D-penicillamine
• Notify cases of lead toxicity: online written notification within 5 days by laboratory.

Further information

• CDC refugee health guidelines: lead screening
• NHMRC information blood lead levels
• AAP policy statement: Lead Exposure in Children: Prevention, Detection, and Management
• Emedicine overview: Pediatric lead toxicity
• Patient information (UK website). Still no translated handouts identified as of 2020(!)

References

• References - listed under Arsenic contamination of traditional Burmese medicines
  
  

_{Immigrant health resources. Authors: Dr Anthea Rhodes and Dr Georgie Paxton. Initial April 2012. Last review April 2020. Contact: georgia.paxton@rch.org.au}