Lead - further information

  • This guideline was written as part of information on Arsenic contamination of traditional Burmese medicines

    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 remedies2, imported candies/condiments, and fashion accessories.6

    Elevated blood lead concentrations have been reported in up to 7 - 13% of African5, 6 South Asian7, 8 and Burmese2, 9 refugee children, especially in those aged <6 years; although rarely to a concentration requiring chelation therapy. Blood lead screening has been recommended for all refugee children (aged 6 months - 16 years) arriving in the United States from 2011.10 Blood lead screening is not part of routine post-arrival tests in Australian refugee health guidelines, but should be considered in any child with developmental delay, pica, or where there is a history suggesting exposure, including through traditional medicines.

    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


       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 written notification within 5 days by laboratory.

      Further information


      Immigrant health resources. Authors: Dr Anthea Rhodes and Dr Georgie Paxton. Initial April 2012. Last review April 2020. Contact: georgia.paxton@rch.org.au