Hidden threats: lead poisoning from unusual sources.

It has been estimated that 890 000 children in the United States have blood lead levels (BLLs) of 10 μg/dL, currently defined as a level of concern by the Centers for Disease Control and Prevention (CDC).1 The proportion of US children aged 1 to 5 years with BLLs ≥10 μg/dL has decreased from 88.2% during the period from 1976 through 1980, to 4.4% during the period from 1991 through 1994.2 Although several risk factors have been identified, lead-based paint is currently the most important source of lead exposure for children in the United States.2 As screening, education, and abatement programs result in decreased numbers of persons with lead poisoning, health care providers must remain alert for new or unusual sources of potential exposure in children. ### Case 1 A 2-year-old child was noted to have a BLL of 43 μg/dL on screening during a routine well-child examination. A physical examination was normal and the history indicated no obvious risk factors for lead poisoning. The health department thoroughly investigated all settings frequented by the child, and identified no potential sources of lead exposure to which the child had access. The child's mother, however, suspected the cause was a necklace that had been given to him approximately 10 weeks earlier. He had worn it on 3 days, and was noted to have the beads in his mouth frequently when wearing the necklace. The necklace had 5 metallic cubes stamped with letters on a string. It had been …