Children with learning or developmental difficulties are at higher risk of exposure to lead.
The UK Health Security Agency's (UKHSA) annual report on lead exposure in children has revealed that the number of reported cases increased in 2023 compared to 2022.
In England, the case definition of elevated blood lead concentrations (BLCs) was halved from 0.48 micromoles per litre (µmol/L) to 0.24 µmol/L in 2021, meaning that more children are receiving the necessary care and treatment they need. This lowering of the case definition for public health intervention resulted in an immediate and expected increase in cases, however, cases reported to the lead exposure in children surveillance system (LEICSS) have continued to increase each subsequent year.
The agency's latest annual report, which focuses on cases notified through voluntary reporting to LEICSS, highlights the importance of monitoring exposure to harmful metals and the factors affecting risk of exposure, with estimates suggesting that current detection in England may only represent a fraction of cases.
Amongst cases currently reported to LEICSS, the most affected are young males aged 1 to 4 years old, more commonly living in deprived areas and in older housing, with the main sources of exposure including contaminated soil and paint. Children with learning or developmental difficulties are at higher risk of exposure to lead; 82% of reported cases going through intervention displayed pica behaviour (the persistent eating of non-food items) and 69% experienced learning difficulties.
Exposure to lead can harm a child's health, including damage to the nervous system, delayed growth, hearing loss, and many other adverse health effects, as well as implications for social, economic, educational and social well-being.
Araceli Busby, Consultant in Health Protection at UKHSA, said:
There is no safe level of lead exposure, and early identification remains crucial for protecting children's health, so we urge pediatricians and other healthcare workers to continue to report any suspected cases to us.
The increased case numbers largely reflects our enhanced surveillance following the lowering of intervention thresholds in 2021, but it's vital that we continue this work to monitor levels, observe trends and behaviours and take public health measures to prevent further exposure in children.
As there may be no overt and definable symptoms at lower BLCs, identifying lead poisoning can be difficult, however, healthcare workers can take steps to identify cases. Asking the right questions is important in understanding if a child is showing any pica behaviour and clinicians are advised to have a low threshold for screening for lead poisoning in children with learning disabilities or behavioural disorders, especially where anemia is present.
Treatment is primarily focused on removal from exposure, however, in some cases of poisoning where blood lead is higher, chelation therapy in hospital may be considered.
