Immigrant Health Service

Lead - further information

  • 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 remedies (2), 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 is now recommended for all refugee children (aged 6 months - 16 years) arriving in the United States(10). Blood lead screening is not part of Australian refugee guidelines, but should be considered in any child with developmental delay, pica, or where there is a history suggesting exposure.

    Clinical features of lead toxicity

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

     Low level exposure
     Moderate exposure
     High level exposure
    Decreased learning and memory, lowered IQ, cognitive dysfunction
    Behavioural disturbance (more marked in children) - irritability, restlessness, sleeplessness
    Fatigue, lethargy
    Abdominal discomfort

    Vomiting, weight loss, constipation, abdominal pain
    Poor concentration
    Muscle fatigue, tremor

    Lead line (blue discoloration) on gum margins
    Encephalopathy, seizures, coma, death


    • FBE (microcytic hypochromic anaemia, basophilic stippling, sideroblasts)
    • Whole blood lead concentrations (specimen collection handbook)
     Blood lead concentrations
     Associated outcomes
    <10 mcg/dL (normal)
    >10 mcg/dL
    >25 mcg/dL
    >45 mcg/dL
    >70 mcg/dL
    >100 mcg/dL

    Impaired cognitive development (children)
    GIT symptoms - consider chelation
    CNS symptoms - consider chelation
    Life threatening (encephalopathy, seizures, coma) - chelation


    • 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
    • Notify cases of lead toxicity: online notification.

    Further information


    Immigrant health resources. Authors: Dr Anthea Rhodes and Dr Georgie Paxton. Initial April 2012. Last review May 2015. Contact: