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Pica, lead poisoning and public health
  1. Kirsty McManus1,
  2. Hazel Henderson2
  1. 1 General Paediatrics, University Hospital Crosshouse, Kilmarnock, UK
  2. 2 Public Health, NHS Ayrshire and Arran, Ayr, UK
  1. Correspondence to Dr Kirsty McManus, C/o Hazel Henderson, Public Health, NHS Ayrshire and Arran, Ayr, UK; kirstymcmanus{at}

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A boy aged 2 years and 10 months was referred to the paediatric clinic by his general practitioner with pallor and pica. He predominantly consumed cow’s milk. Non-food items eaten included paint, plaster and wood. He lived with his parents and sibling in a 1970s housing association house.

Haemoglobin 80 g/L (100–140 g/L)

Mean corpuscular volume 49 fL (73–86 fL)

Ferritin 2.1 µg/L (12–300 µg/L)

Lead level 1.67 μmol/L (threshold 0.24 μmol/L for <5 years old)

The regional haematology team did not recommend chelation as the child was asymptomatic. Ferrous fumarate was commenced. The public health team was contacted; they have a role in identifying and addressing the source of lead exposure.

Question 1

What is the most likely source of lead exposure?

  1. Paint

  2. Plaster

  3. Soil

  4. Wood

  5. Water

Question 2

What is a safe paint lead level (total lead weight content % by weight)?

  1. ≤0.25%

  2. ≤0.15%

  3. ≤0.05%

Question 3

Which commonly contributes to iron deficiency …

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  • Contributors KM and HH were involved in the management of this patient. The manuscript was written by KM and edited by HH. Photographs taken by HH.

  • Competing interests None declared.

  • Patient consent Parental/guardian consent obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Not applicable.