Childhood hyperleptinemia and lead poisoning are entirely preventable. Prevention, early detection and early intervention can be achieved through environmental intervention, health education, focused screening and monitoring. I. Health education Carrying out extensive health education is very important for the prevention of childhood high lead anemia and lead poisoning. Through face-to-face publicity and guidance, knowledge lectures, distribution of publicity materials, etc., disseminate the relevant scientific knowledge about the toxic effects of lead on children, change people’s knowledge, attitude and behavior, and prevent and reduce the harm of lead on children. Fan Hui, Department of Pediatrics, The First Affiliated Hospital of Henan College of Traditional Chinese Medicine (I) Knowledge introduction Medical personnel should explain to the public the causes of lead poisoning in children, the hazards of lead to children’s health, and what to do when blood lead is high, so that the public can understand the general knowledge of lead poisoning in children. (ii) Behavioral guidance Children’s poor hygiene habits and inappropriate behaviors can allow lead to enter the body. By providing guidance to parents and children, we cut off the channels through which lead enters children’s bodies from the environment. 1. Educate children to develop the good habit of washing hands frequently, especially washing hands before meals is very important. Lead dust in the environment can stain children’s hands when they play, and can easily enter the body with food or through habitual hand-to-mouth action, which will cause the lead load to increase for a long time. 2. Pay attention to children’s personal hygiene and cut nails frequently. Nail cracks are especially easy to hide lead dust. 3, often wash children’s toys and supplies. 4, often use a clean wet rag to clean the dust in the parts that children can reach. Children’s food and tableware should be covered to prevent dust. 5. Do not take children to walk or play near lead factories. 6. Family members directly engaged in lead work must change their work clothes and take a shower before leaving work. Work clothes and children’s clothes should not be washed together. Children should not be breastfed at the lead workplace (or between jobs). 7. Families using coal as fuel should open windows more often for ventilation. Pregnant women and children should avoid passive smoking as much as possible. 8.Purchasing children’s tableware should avoid colorful patterns and shoddy products. Children should be avoided to eat eggs and old-fashioned popcorn machine popping food and other food containing high lead. 9. Tap water that has been stagnant in the pipes for a long time should not be used to make milk powder or cooking for children. (iii) Nutritional Intervention Children suffering from malnutrition, especially the lack of calcium, iron and zinc in the body, can increase the absorption rate and susceptibility to lead. Therefore, in daily life, we should ensure that children have a balanced diet and a supply of various nutrients, and educate children to develop good eating habits. 1. Children should eat regularly and avoid excessively greasy food. Because fasting and excessively greasy food will increase the absorption of lead in the intestines. 2. Children should consume dairy products and soybean products with sufficient calcium; animal liver, blood, meat, eggs and seafood rich in iron and zinc; and fresh vegetables and fruits rich in Vitamin C. Screening and monitoring The development of lead poisoning in children is a slow process and there is no typical clinical manifestation in the early stage. Early detection of children with high lead anemia through screening and timely intervention can reduce the toxic effect of lead on children’s body. At the same time, the screening information is analyzed to evaluate the environmental lead pollution status and to conduct regular monitoring. In recent years, the blood lead level of children in China has been on a general downward trend, and the proportion of most urban and rural children with blood lead levels equal to or higher than 200 mg/L is very low, so there is no need to conduct universal screening for lead poisoning in children. However, for areas where industrial lead pollution exists or is suspected, screening for childhood lead poisoning may be considered. Regular monitoring should be conducted for children under 6 years of age and other high-risk groups living or residing in high-risk areas: (1) those who live near smelters, storage battery factories and other lead-working factories; (2) those whose parents or co-residents are engaged in lead-working labor; and (3) those whose compatriots or partners have been definitively diagnosed with childhood lead poisoning. Circular of the Ministry of Health on the Issuance of Guidelines for the Prevention of Childhood High Lead Blood Disease and Lead Poisoning and Principles for Grading and Treatment of Childhood High Lead Blood Disease and Lead Poisoning (for Trial Implementation) Principles for Grading and Treatment of Childhood High Lead Blood Disease and Lead Poisoning I. Diagnosis and Grading Childhood High Lead Blood Disease and Lead Poisoning are diagnosed based on the level of children’s venous blood lead. High lead anemia: two consecutive venous blood lead levels of 100~199mg/L; Lead poisoning: two consecutive venous blood lead levels equal to or higher than 200mg/L; and according to the blood lead level, they are divided into mild, moderate and severe lead poisoning. Mild lead poisoning: blood lead level is 200~249mg/L; Moderate lead poisoning: blood lead level is 250~449mg/L; Severe lead poisoning: blood lead level is equal to or higher than 450mg/L; Lead poisoning in children can be accompanied by certain non-specific clinical symptoms, such as abdominal pain, constipation, anemia, hyperactivity, impulsivity, etc.; Blood lead is equal to or higher than 700mg/L, can be accompanied by coma, When the blood lead is equal to or higher than 700mg/L, it can be accompanied by coma, convulsions and other lead poisoning encephalopathy. The treatment of children with high lead anemia and lead poisoning should be carried out in qualified medical and health institutions. Medical personnel should follow the basic principles of environmental intervention, health education and lead-expelling treatment in the process of treatment, help to find the source of lead contamination and tell the guardians of the children to get rid of the source of lead contamination as soon as possible; they should provide hygiene guidance for different situations and put forward the opinion of nutritional intervention; and the lead-poisoned children should be given timely and appropriate treatment. High lead anemia: detachment from the source of lead pollution, health guidance, nutritional intervention; mild lead poisoning: detachment from the source of lead pollution, health guidance, nutritional intervention; moderate and severe lead poisoning: detachment from the source of lead pollution, health guidance, nutritional intervention, and lead expulsion treatment. （Identifying and removing the source of lead contamination is the fundamental way to deal with children with high lead anemia and lead poisoning. Blood lead level can be significantly reduced after children are removed from the source of lead pollution. When children’s blood lead level is above 100mg/L, they should be carefully asked about the pollution status of their living environment, and whether their family members and peers have a history of long-term lead exposure and lead poisoning. When the blood lead level is 100~199mg/L, it is often difficult to find a clear source of lead contamination, but it should still be actively searched for, and strive to cut off the sources and pathways of lead contamination; when the blood lead level is 200mg/L or above, it is often possible to find a more clear source of lead contamination, and should be actively assisted to find a specific source of lead contamination, and to detach from it as soon as possible. (ii) Provide hygiene guidance Through health education and hygiene guidance on the prevention and treatment of lead poisoning in children, the general public will be made aware of the health hazards of lead, and avoid and minimize children’s exposure to sources of lead contamination. At the same time, educate children to develop good hygiene habits and correct bad behaviors. (iii) Nutritional intervention High lead anemia and lead poisoning can affect the body’s absorption of iron, zinc, calcium and other elements, and the body’s susceptibility to the toxic effects of lead increases when these elements are lacking. Therefore, children with high lead anemia and lead poisoning should receive timely nutritional intervention to supplement protein, vitamins and trace elements, and correct malnutrition and deficiencies of iron, calcium and zinc. (iv) Lead repellent treatment Lead repellent treatment is to prevent the toxic effect of lead on the body by combining lead repellent drugs with lead in the body and excreting it. Lead expulsion treatment is only used for lead poisoning with blood lead level of moderate or above. Attachment: Lead repellent treatment methods Lead repellent treatment should pay attention to: ① Before using oral lead repellent drugs should be sure to detach from the source of pollution, otherwise it will lead to increased absorption of lead in the digestive tract. Iron-deficient children should be supplemented with iron before lead repellent treatment, because iron deficiency will affect the effect of lead repellent treatment. 1.Moderate lead poisoning is used for those who have positive test for lead expulsion. The specific method of lead repellent test is as follows: before the test, ask the child to empty the bladder, inject calcium sodium edetate intramuscularly according to the dosage of 500~700mg/m2 body surface area, and add 2% Lidocaine 2ml to reduce the pain of intramuscular injection. The urine was collected continuously for 8 hours with a lead-free vessel, and the 8-hour urine volume (L) and urine lead concentration (mg/L) were measured, and the lead excretion ratio I per milligram of calcium edetate sodium was calculated by the following formula, I = urine volume (L) × urine lead concentration (mg/L) / calcium edetate sodium (mg).I ≥ 0.6 lead repellent test is positive; I < 0.6 lead repellent test is negative. Two issues should be noted when performing this test: (1) The urine collection vessel should be lead-free beforehand to ensure the accuracy of the urine lead measurement. (2) As much water as possible should be consumed during the 8 hours to ensure adequate urine output, and all urine should be collected during the 8 hours. Dimercaptosuccinic acid is the treatment of choice. Dosage: the dose is 350 mg/m2 body surface area per dose orally three times a day for 5 days, followed by twice-daily administration at the same dose for 14 days. Each course of treatment totaled 19 days. Children who cannot be completely removed from the lead-contaminated environment should be treated with calcium edetate sodium at a dosage of 1000 mg/m2 body surface area, intravenously or intramuscularly, for 5 days as a course of treatment. After stopping the medicine for 4~6 weeks, the blood lead should be rechecked, if it is equal to or higher than 250mg/L, the above treatment can be repeated in 1 month; if it is lower than 250mg/L, it will be treated as high lead anemia or mild lead poisoning. 2.Severe lead poisoning Choose dimercaptosuccinic acid treatment, the method is the same as before. The dosage of calcium sodium edetate is 1000-1500mg/m2 body surface area, injected intravenously or intramuscularly, with 5 days as a course of treatment. After the course of treatment, blood lead should be rechecked every 2~4 weeks, if it is equal to or higher than 450mg/L, the above treatment program can be repeated; if the blood lead is lower than 450mg/L and equal to or higher than 250mg/L in 2 consecutive rechecks, the patient should be treated as moderate lead poisoning. If the blood lead level is equal to or higher than 700mg/L, the venous blood lead should be rechecked immediately, and the child should be hospitalized in a hospital capable of treating the disease immediately after confirmation. Based on the child's medical history, oral ingestion should be excluded if large amounts of lead contaminants remain in the digestive tract, and enemas and gastric lavage should be given if necessary. Combined treatment with dimercaptosuccinic acid and calcium sodium edetate is used. Combined treatment should first be treated with dimercaptosuccinic acid for 4 hours, and when the child appears to urinate, then calcium sodium edetate can be used, otherwise it is easy to lead to excessive lead content in the brain cells, and lead poisoning encephalopathy occurs. Liver and kidney function, water electrolytes and other indicators should be tested during treatment. Review the blood lead after the end of the combined treatment, and if it is higher or equal to 700mg/L, the combined treatment program can be repeated immediately; if it is equal to or higher than 450mg/L, it will be treated as severe lead poisoning. After 3 consecutive courses of lead expulsion treatment, blood levels of iron, zinc, calcium and other trace elements should be tested and supplemented in time. And the treatment effect should be closely observed.