CONTEXT: Lead exposures among school-age children are a major public health issue. Although the harmful effects of lead exposure during the first years of life are well known, there is not as much understanding of the effects of low levels of lead exposure during later childhood. OBJECTIVES: To review the effects of blood lead levels (BLLs) <10 µg/dL in school-age children and adolescents. DATA SOURCES: We searched Medline, Embase, Global health, CINAHL, Scopus, and Environmental Science Collection databases between January 1, 2000, and May 11, 2023. STUDY SELECTION: We included peer-reviewed English-language articles that presented data on the effects of BLLs <10 µg/dL in individuals ages 5 through 18 years. DATA EXTRACTION: Data on country, population, analytic design, sample size, age, BLLs, outcomes, covariates, and results were extracted. RESULTS: Overall, 115 of 3180 screened articles met the inclusion criteria. The reported mean or median BLL was <5 µg/dL in 98 articles (85%). Of the included articles, 89 (77%) presented some evidence of an association between BLLs <10 µg/dL during school age and detrimental outcomes in a wide range of categories. The strongest evidence of an association was for the outcomes of intelligence quotient and attention-deficit/hyperactivity disorder diagnoses or behaviors. LIMITATIONS: Few articles controlled for BLLs at age <5 years, limiting conclusions about the relation between later BLLs and outcomes. CONCLUSIONS: BLLs <10 µg/dL in school-age children and adolescents may be associated with negative outcomes. This review highlights areas that could benefit from additional investigation.

Just over 50 years ago, the Lead-Based Paint Poisoning Prevention Act of 1971 led to the establishment of the Childhood Lead Poisoning Prevention Program (CLPPP) at the Centers for Disease Control and Prevention (CDC). Since then, a broad, multifaceted environmental public health effort involving a wide array of government agencies and key stakeholders has led to marked declines in exposure levels and blood lead levels (BLLs) in the United States. Nevertheless, the effect of lead on young children and the resultant public health challenge remains. The scientific advances that have led to a better understanding of the deleterious effects of current lead exposures compel the ongoing public health efforts, with new shifts in emphasis and focus, to eliminate childhood lead poisoning. Although widely distributed in the environment, it is significantly related to poverty and inequity, particularly affecting Black and other minority children. Prevention has been a challenge only partially met, and lead poisoning still endures and remains to be fully eliminated.

Scholars have produced a flow of published research confirming the harmful effects of lead at lower and lower exposure levels. The Centers for Disease Control and Prevention currently uses a blood lead reference value of 3.5 micrograms of lead per deciliter of blood. Children with blood lead levels at or above the reference value are among the top 2.5% of US children with the highest blood lead levels. | Lead poisoning prevention is complex and requires a recalibration of current public health approaches and perspectives. Lead poisoning prevention, as a model for the future of public health, forces us to boldly confront health equity issues such as safe housing, clean drinking water, safe schools and childcare facilities, environmental justice, community infrastructure repair, occupational risks, and so on. We must protect young children from exposure to lead to ensure that future leaders have the mental capacity to confront the challenges ahead. Thus, childhood lead exposure prevention should be a national priority.