1 of 29

Course: Pediatric Nursing

Topic: Nursing Management of Child with Lead Poisoning

The Nurses International Community

Contact info: info@nursesinternational.org

2 of 29

COPYRIGHT

NI Privacy Policy and Terms of Use.

Contact info: info@nursesinternational.org

3 of 29

Module Goals

Learners will be able to:

Define lead poisoning.
Identify the causes, diagnosis and risk factors for lead poisoning.
Discuss evidence-based management of lead poisoning.
Discuss the role of the nurse during pediatric emergencies.

Contact info: info@nursesinternational.org

4 of 29

Pediatric Emergencies: Lead Poisoning

Lead is a naturally occurring toxic metal found in the earth’s crust.
Lead poisoning may occur if an individual is exposed to very high levels of lead over a short period of time.
Individuals may become exposed to lead through occupational and environmental sources, and mainly from: inhalation and ingestion.

MSD Manual, 2022

NHS Inform, 2022

Wani, 2015

WHO, 2021

Contact info: info@nursesinternational.org

5 of 29

Lead Poisoning: Consequences

The fetus may be adversely affected at blood lead concentrations well below 25 μg per deciliter
Damage to the brain and nervous system
Slowed growth and development
Learning and behavior problems
Hearing and speech problems

MSD Manual, 2022

NHS Inform, 2022

Wani, 2015

WHO, 2021

Contact info: info@nursesinternational.org

6 of 29

Critical Thinking Question

Which of the following systems is most affected by the lead poisoning in children?

Respiratory
Cardiovascular
Gastrointestinal
Urinary
Nervous system

Contact info: info@nursesinternational.org

7 of 29

Lead Poisoning: Sources of Exposure

Putting objects containing lead in their mouth
Contact with paint chips, dust
Floor, toys, trinkets
Lead dust that emits from:

Building destruction or remodelling
Paint removal
Preparation of surfaces for repainting

MSD Manual, 2022

NHS Inform, 2022

Wani, 2015

WHO, 2021

Contact info: info@nursesinternational.org

Young children may be indirectly exposed to lead when they put objects containing lead dust, such as toys, trinkets, or their fingers, in their mouth as part of their normal development. Children may be exposed to lead through contact with paint chips and dust from lead paint in buildings and homes that may have landed on windowsills, the floor, toys, trinkets, or their fingers.

But their exposure is more common from swallowing house dust or soil contaminated by lead paint are the most common sources of lead exposure. Children may also be exposed to lead if they swallow chipped pieces of lead paint.

For example, old or worn lead paint peels and cracks, and tiny bits of lead dust settle on the dust and soil inside and around homes. This occurs on doors, windowsills, and wells. In addition, lead may be scattered when paint is disturbed during the following:

Building destruction or remodeling
Paint removal
Preparation of surfaces for repainting

8 of 29

Lead Poisoning: Source of Exposure (Continued)

Dust from soil contaminated with lead from leaded gasoline, mining
Drinking water delivered through lead-based pipes, faucets
Traditional medicines and cosmetics: Azarcon and greta
Candy and candy wrappers
Consumer products: Toys, jewelry, antiques, and collectible items
Lead-glazed pottery

MSD Manual, 2022

NHS Inform, 2022

Wani, 2015

WHO, 2021

Contact info: info@nursesinternational.org

9 of 29

Lead Poisoning: Risk Factors

Age:

Infants and young children are at the oral phase. They might chew paint that flakes off walls and woodwork, and their hands may be contaminated with lead dust.

Living in an older home:

Older homes and buildings built before 1970 often contain remnants of lead.
Renovating an older home or are living in older homes.

Mayoclinic, 2022

Contact info: info@nursesinternational.org

10 of 29

Lead Poisoning: Risk Factors

Certain hobbies:

Making stained glass and some jewelry requires the use of lead solder.
Refinishing old furniture might involve contact with layers of lead paint.

Living in developing countries:

Developing countries may have less strict rules regarding exposure to lead than do developed countries; lead might be used in common everyday items.

Mayoclinic, 2022

Contact info: info@nursesinternational.org

11 of 29

Critical Thinking Question

Which of the following is a risk factor for lead poisoning among children?

Living in the old building
Swimming in a community pool
Wearing old clothes
Eating month long stored food

Contact info: info@nursesinternational.org

12 of 29

Lead Poisoning: Signs and Symptoms

Irritability and fatigue
Loss of appetite and weight loss
Abdominal pain
Vomiting
Constipation
Hearing loss
Developmental delay and learning difficulties

CDC, 2021

NHS inform, 2022

Contact info: info@nursesinternational.org

13 of 29

Lead Poisoning: Diagnosis

Blood lead test (performed on a standard blood sample)

Levels as low as 5 micrograms per deciliter may be associated with health problems in children.

Additional tests could include:

Blood tests to look at the amount of iron storing cells in the blood
X-rays
Bone marrow biopsy

Contact info: info@nursesinternational.org

14 of 29

Critical Thinking Question

Where is Lead is stored in the body?

Lung tissues
Nerves
In heart tissue
In bones and teeth

Contact info: info@nursesinternational.org

15 of 29

Lead Poisoning: Treatment

There is no antidote for lead
Those seriously exposed may need to be hospitalized and undergo chelation therapy
Evaluate and support airway, breathing, and circulation(ABCs)
Eliminate the source of lead (Whole-bowel irrigation)
Chelation drugs for children with encephalopathy

CDC, 2014

MSD Manual, 2022

Contact info: info@nursesinternational.org

Treatment of Lead Poisoning

Chelation therapy uses special drugs that bind to metals in the blood. Chelating medicine is delivered through intravenous (IV) access. It’s also available in pill form. Once the drug has attached to the metal, the body removes them both through the urine. Metals that may be removed with chelation therapy include lead, mercury, and arsenic. Before treatment, the doctor will do a blood test to determine metal poisoning.

Source of lead eliminated (eg, whole-bowel irrigation if lead in gastrointestinal tract)
Chelation for adults with symptoms of poisoning plus whole blood lead level (PbB) > 70 mcg/dL (> 3.38 micromol/L)
Chelation for children with encephalopathy or PbB > 45 mcg/dL (> 2.17 micromol/L)

For all patients, the source of lead is eliminated. If lead chips are visible on abdominal x-ray, whole-bowel irrigation with a polyethylene glycol electrolyte solution at 1 to 2 L/h for adults or 25 to 40 mL/kg/h for children is done until repeat x-ray shows no lead. Administration via nasogastric tube may be necessary to deliver these large volumes and care must be taken to protect the airway; intubation may be necessary. If the cause is bullets, surgical removal should be considered. Children with PbB > 70 mcg/dL (> 3.38 micromol/L) and all patients with neurologic symptoms should be hospitalized. Patients with acute encephalopathy are admitted to an intensive care unit.

Chelating drugs (eg, succimer [meso-2,3-dimercaptosuccinic acid], CaNa₂EDTA [calcium disodium ethylenediaminetetraacetic acid] dimercaprol [British antilewisite, or BAL]) may be given to bind lead into forms that may be excreted. Chelation should be supervised by an experienced toxicologist. Chelation is indicated for children with encephalopathy or PbB > 45 mcg/dL (> 2.17 micromol/L). Liver and kidney disorders are relative contraindications for chelating drugs. Chelating drugs should not be given to any patient with ongoing exposure to lead because chelation may increase gastrointestinal absorption of lead. Chelation removes only relatively small amounts of metal. If total body burden of lead is very large, multiple chelations over many years may be required.

16 of 29

Lead Poisoning: Treatment

Ng tube may be needed to administer large volume of bowel irrigation solution
Intubation may be required
Hospitalization of children with neurological problems
ICU care for acute encephalopathy
Parenteral fluids along with the drugs (Dimercaprol, CaNa2)

CDC, 2014

MSD Manual, 2022

Contact info: info@nursesinternational.org

Treatment of Lead Poisoning

Source of lead eliminated (eg, whole-bowel irrigation if lead in gastrointestinal tract)
Chelation for adults with symptoms of poisoning plus whole blood lead level (PbB) > 70 mcg/dL (> 3.38 micromol/L)
Chelation for children with encephalopathy or PbB > 45 mcg/dL (> 2.17 micromol/L)

For all patients, the source of lead is eliminated. If lead chips are visible on abdominal x-ray, whole-bowel irrigation with a polyethylene glycol electrolyte solution at 1 to 2 L/h for adults or 25 to 40 mL/kg/h for children is done until repeat x-ray shows no lead. Administration via nasogastric tube may be necessary to deliver these large volumes and care must be taken to protect the airway; intubation may be necessary. If the cause is bullets, surgical removal should be considered. Children with PbB > 70 mcg/dL (> 3.38 micromol/L) and all patients with neurologic symptoms should be hospitalized. Patients with acute encephalopathy are admitted to an intensive care unit.

Chelating drugs (eg, succimer [meso-2,3-dimercaptosuccinic acid], CaNa₂EDTA [calcium disodium ethylenediaminetetraacetic acid] dimercaprol [British antilewisite, or BAL]) may be given to bind lead into forms that may be excreted. Chelation should be supervised by an experienced toxicologist. Chelation is indicated for children with encephalopathy or PbB > 45 mcg/dL (> 2.17 micromol/L). Liver and kidney disorders are relative contraindications for chelating drugs. Chelating drugs should not be given to any patient with ongoing exposure to lead because chelation may increase gastrointestinal absorption of lead. Chelation removes only relatively small amounts of metal. If total body burden of lead is very large, multiple chelations over many years may be required.

17 of 29

Diet for lead poisoning

Provide four to six small meals during the day
Provide Iron-Rich Foods:

Lean red meats, fish, and chicken Iron-fortified cereals Dried fruits (raisins, prunes)
Calcium-Rich Foods Milk Yogurt Cheese Green leafy vegetables (spinach, kale, collard greens)
Vitamin Vitamin C and iron-rich food (Oranges, orange juice Grapefruits, grapefruit juice Tomatoes, tomato juice Green peppers)
Zinc

Avoid foods high in fat as they lead to lead absorption

Contact info: info@nursesinternational.org

Regularly Eat Healthy Foods Children with empty stomachs absorb more lead than children with full stomachs. Provide the child with four to six small meals during the day. The following nutrients may help protect the child from lead poisoning: Iron-Rich Foods Normal levels of iron work to protect the body from the harmful effects of lead. Good sources of dietary iron include: Lean red meats, fish, and chicken Iron-fortified cereals Dried fruits (raisins, prunes) Calcium-Rich Foods Calcium reduces lead absorption and also helps make teeth and bones strong. Good sources of dietary calcium include: Milk Yogurt Cheese Green leafy vegetables (spinach, kale, collard greens) Vitamin C-Rich Foods Vitamin C and iron-rich foods work together to reduce lead absorption. Good sources of vitamin C include: Oranges, orange juice Grapefruits, grapefruit juice Tomatoes, tomato juice Green peppers

Limit foods that are high in fat because fat helps lead to absorb in the body

18 of 29

Lead Poisoning: Nurses’ Role

Reduce the lead exposure; remove the source of lead
Prepare child and family for chelation therapy
Administer medications as per prescription
Monitor the side effects
Ensure chelating drugs are not given to any child with ongoing exposure to lead because chelation may increase gastrointestinal absorption of lead
Education on preventive measures of lead poisoning

Belleza, 2021

Contact info: info@nursesinternational.org

19 of 29

Lead Poisoning: Preventive Measures

Avoid or throw away painted toys and canned goods from foreign countries
Keep the home free from dust
Use only cold water to prepare foods and drinks
Make sure everyone washes their hands before eating
Test the water source for lead; if lead levels are high, use a filtering device or drink bottled water
Clean faucets and aerators regularly

CDC, 202a

MSD manual, 2022

Contact info: info@nursesinternational.org

20 of 29

Lead Poisoning: Preventive Measures

Wash children’s toys and bottles regularly
Teach children to wash their hands after playing
Wash hands before preparing, handling, or eating food
Make sure any contractor doing work in the house is certified in lead control
Use lead-free paint in the home
Take young children for blood lead level screening at their pediatrician’s office; usually done around 1 to 2 years of age
Avoid areas where lead-based paint may have been used
Provide a diet that protects from lead poisoning

CDC, 202a

MSD manual, 2022

Contact info: info@nursesinternational.org

21 of 29

Lead Poisoning: Dietary Needs

A healthy nutrition can help fight and prevent lead poisoning
Provide the child with healthy meals regularly (least three times a day)
Empty stomach absorbs lead rapidly
Don’t let stomach stay empty longer, offer 4-6 snacks or meal a day
Provide food that contains iron, calcium, vitamin C and protein
Limit fat intake, deep fried food as it may aid in lead absorption
Offer healthy snacks, fruits and vegetables

Contact info: info@nursesinternational.org

Ways a healthy diet can decrease lead absorption:

A child with a full stomach is less likely to absorb lead. Offer 4-6 snacks or meals every day.
A child who takes in adequate amounts of iron, calcium, vitamin C and protein will absorb less lead.
Keep fat intake low. Offer healthy snacks like fruit, vegetable sticks (maybe with peanut butter, iron fortified cereal or bread, cheese or pudding instead of candy or chips.

Be sure to wash your hands and your child's hands before preparing, handling, or eating food.

Foods high in iron and protein

lean red meat, chicken, liver, or fish
dried beans, peas or lentils
leafy green vegetables, such as broccoli and spinach
fortified cereals and breads
peanuts, sunflower seeds
dried fruits, such as raisins, prunes and apricot
eggs

Foods high in vitamin C

citrus fruits and juices
bell peppers, collards, tomatoes, raw cabbage, cauliflower, broccoli and greens
potatoes with skins and sweet potatoes
strawberries, watermelon, cantaloupe

Foods high in calcium

milk, cheese, yogurt, ice milk, pudding
leafy green vegetables, such as kale, collard greens, turnip greens
tofu
peanuts and peanut butter
salmon and sardines
calcium enriched soy milk
dried fruits and raisins

Avoid high fat foods: (Bake or broil your food)

fried foods, such as French fries or potato chips.
sausage, bacon, lunch meats like bologna,
margarine, butter, shortening, lard or cooking oil
cakes, pies, pancakes

22 of 29

What Would the Nurse Do?

Discussion/Reflection:

Explain why children who are malnourished are more susceptible to lead poisoning.

What measures could the community nurse implement to reduce lead poisoning in the community where nutrition is a problem?

Contact info: info@nursesinternational.org

23 of 29

Red Flags

Eating things, such as paint chips, that aren't food (pica)
Seizures
Weight loss
Delayed growth
Loss of appetite

MSD Manual, 2022

NHS Inform, 2022

Wani, 2015

WHO, 2021

Contact info: info@nursesinternational.org

24 of 29

Cultural Considerations

Religion, culture, beliefs, and ethnic customs may influence how families understand and use health concepts:

Health beliefs: In some cultures talking about a possible poor health outcome will cause that outcome to occur.
Health customs: In some cultures family members play a large role in health care decision-making.
Ethnic customs: Differing gender roles may determine who makes decisions about accepting & following treatment recommendations.

AHRQ, 2020

Contact info: info@nursesinternational.org

25 of 29

Cultural Considerations (Continued):

Religion, culture, beliefs, and ethnic customs may influence how families understand and use health concepts:

Religious beliefs: Faith and spiritual beliefs may affect health seeking behavior and willingness to accept treatment.
Dietary customs: Dietary advice may be difficult to follow if it does not fit the foods or cooking methods of the family.
Interpersonal customs: Eye contact or physical touch may be ok in some cultures but inappropriate or offensive in others.

AHRQ, 2020

Contact info: info@nursesinternational.org

26 of 29

References:

Andrews, M.M., Boyle, J.S. & Collings, J. W. (2020). Transcultural Concepts in Nursing Care (8th Ed.). Wolters Kluwer, Philadelphia, PA.

Belleza, M. (2021, February 11). Lead Poisoning: https://nurseslabs.com/lead-poisoning/

CDC- Centre for Disease Control And Prevention. (2014, October 21). Medical Management Guidelines for Lead. https://wwwn.cdc.gov/TSP/MMG/MMGDetails.aspx?mmgid=1203&toxid=22

CDC- Centre for Disease Control And Prevention. (2021a, October 27). Prevent Children’s Exposure to Lead. https://www.cdc.gov/nceh/features/leadpoisoning/index.html

Contact info: info@nursesinternational.org

27 of 29

References:

CDC- Centre for Disease Control And Prevention. (2021b, December 8). Lead Health Problems Caused by Lead. https://www.cdc.gov/niosh/topics/lead/health.html

Mayoclinic. (2022, Jan 21). Lead Poisoning Overview. https://www.mayoclinic.org/diseases-conditions/lead-poisoning/symptoms-causes/syc-20354717#:~:text=Lead%20poisoning%20symptoms%20in%20children&text=Irritability,Sluggishness%20and%20fatigue

MSD Manual. (2022, June). Lead Poisoning. https://www.msdmanuals.com/professional/injuries-poisoning/poisoning/lead-poisoning

NHS Inform. (2022, May 26). Infections and Poisoning: Lead Poisoning. https://www.nhsinform.scot/illnesses-and-conditions/infections-and-poisoning/lead-poisoning

Contact info: info@nursesinternational.org

28 of 29

References:

Tennessee Department of Health. (n.d.). Healthy Diet & Lead Poisoning Prevention. https://www.tn.gov/health/health-program-areas/mch-lead/for-parents/lead-prevention.html

Wani, A. L., Ara, A., & Usmani, J. A. (2015). Lead toxicity: a review. Interdisciplinary toxicology, 8(2), 55–64. https://doi.org/10.1515/intox-2015-0009

World Health Organization. (2021, October 11). Lead Poisoning. https://www.who.int/news-room/fact-sheets/detail/lead-poisoning-and-health

Contact info: info@nursesinternational.org

29 of 29

Please go to

My Learning Experience

to provide feedback on your experience.

Thank you, and come back soon!

Contact info: info@nursesinternational.org