Therapeutics and toxicology: Edited by Robert O. WrightVery low lead exposures and children's neurodevelopmentBellinger, David CAuthor Information Children's Hospital Boston, Harvard Medical School, Harvard School of Public Health, Boston, Massachusetts, USA Correspondence to David C. Bellinger, Farley Basement Box 127, Children's Hospital Boston, 300 Longwood Avenue, Boston, MA 02115, USA Tel: +1 617 355 6565; fax: +1 617 730 0618; e-mail: [email protected] Current Opinion in Pediatrics: April 2008 - Volume 20 - Issue 2 - p 172-177 doi: 10.1097/MOP.0b013e3282f4f97b Buy Metrics Abstract Purpose of review We remain far from achieving the goal of eliminating lead-associated neurodevelopmental morbidities in children. New evidence regarding the blood lead levels at which morbidities occur have led to calls for the Centers for Disease Control and Prevention to reduce the current screening guideline of 10 μg/dl. The review evaluates the basis for these calls. Recent findings Adverse outcomes, such as reduced intelligence quotient and academic deficits, occur at levels below 10 μg/dl. Some studies suggest that the rate of decline in performance is greater at levels below 10 μg/dl than above 10 μg/dl, although a plausible mechanism has not been identified. Increased exposure is also associated with neuropsychiatric disorders such as attention deficit hyperactivity disorder and antisocial behavior. Functional imaging studies are beginning to provide insight into the neural substrate of lead's neurodevelopmental effects. Current protocols for chelation therapy appear ineffective in preventing such effects, although environmental enrichment might do so. Summary No level of lead exposure appears to be ‘safe’ and even the current ‘low’ levels of exposure in children are associated with neurodevelopmental deficits. Primary prevention of exposure provides the best hope of mitigating the impact of this preventable disease. © 2008 Lippincott Williams & Wilkins, Inc.