Expert Commentary

Lead and Other Toxic Agents Impacting Neural Development in Children

Phillip Landrigan, M.D., M.Sci

Frequently, pediatric public health concerns require an aggressive investigative and interventional approach. In the wake of several cases of environmental contamination with molecular lead ingested in unsafe domestic environments by young children, especially those aged 2 and 3, several years of pursuit, research and forced policy change were required to achieve major advances in public health and child protection. Lead poisoning has been a primary concern in this arena because it can lead acutely to coma, convulsions and death, and chronically to permanent CNS damage. One case, a largely unregulated lead smelter was found to be emitting high levels of particulate toxins (lead, cadmium, arsenic) into heavily populated areas. This had yielded blood-lead levels significantly (200 ug/dL) in excess of 40 ug/dL, the criterion for lead poisoning in both children and adults in several concentric assessment rings. Identifying the industrial source of these toxins and attempting to find some way to control it was step one of the public health process involved. Step two involved determining the long-term impact of chronic toxin exposure in apparently asymptomatic children, work which led to identification of subclinicial chronic CNS damage and lowered IQ. Step three involved forcing a national policy change, work which culminated in the eventual removal of tetraethyl lead from gasoline and a 50% to 95% reduction in overall blood/lead levels nationwide. Lessons learned included the establishment that subclinical levels of exposure to toxins can yield highly detrimental long-term CNS effects.



  1. Landrigan PJ, Needleman HL, Landrigan M. Raising Healthy Children in a Toxic World: 101 Smart Solutions for Every Family. Emmaus PA: Rodale Press, 2002
  2. Landrigan PJ. (Chair): Environmental Neurotoxicology. Commission on Life Sciences, National Research Council. Washington: National Academy Press, 1992.
  3. Leigh JP, Markowitz S, Fahs M, Landrigan P: Costs of Occupational Injuries and Illnesses. Ann Arbor: The University of Michigan Press, 2000.
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