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Frontispiece. X-ray of a. 16-month-old girl showing paint chips containing lead in the gastro-intestinal tract. Repro- duced with the permission of Henrietta K. Sachs, M.D.

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Recommendations for the Prevention of Lead Poisoning in Children Committee on Toxicology Assembly of Life Sciences National Research Council Prepared for the Consumer Product Safety Commission National Academy of Sciences Washington, D.C. July 1976 NAS-NAE AUG24 1976

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c.\ NOTICE The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the Councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the Committee responsible for the report were chosen for their special competences and with regard for appropriate balance. This report has been reviewed by a group other than the authors according to procedures approved by a Report Review Committee consisting of members of the National Academy of sciences, the National Academy of Engineering, and the Institute of Medicine. Order from National Technical information Service, Springfield, Va.

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ACKNOWLEDGMENTS This report was prepared under Contract C-75-0018 between the U.S. Consumer Product Safety Commission and the National Academy of Sciences. Responsibility for the report was assigned to the Committee on Toxicology which was assisted by a Subcommittee. The Subcommittee wishes to acknowledge with thanks the assistance of Maureen B. Barrett and Thomas 0. Wilson who served as consultants in the preparation of this report.

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Ad hoc Committee on Lead in Paint J. Julian Chisolm, Jr., M.D., Baltimore City Hospitals, Chairman Eula Bingham, Ph.D., University of Cincinnati Robert A. Goyer, M.D., University of Western Ontario Paul B. Hammond, D.V.M., Ph.D., University of Cincinnati Vaun A. Newill, M.D., Exxon Research and Engineering Company Pearl L. Rosser, M.D., Howard University College of Medicine James G. Wilson, Ph.D., The Children's Hospital Research Foundation, Cincinnati Staff Officer: Ralph C. Wands Consultants: Maureen B. Barrett Thomas 0. Wilson Committee on Toxicology Bertram D. Dinman, M.D., Aluminum Company of America, Chairman Yves Alarie, Ph.D., University of Pittsburgh Mary 0. Amdur, Ph.D., School of Public Health, Harvard University Joseph F. Borzelleca, Ph.D., Medical College of Virginia, Virginia Commonwealth University John J. Burns, Jr., Ph.D., Hoffman-LaRoche, Inc. Arthur B. DuBois, M.D., John B. Pierce Foundation Laboratory, Yale University Seymour L. Friess, Ph.D., Naval Medical Research Institute Harold C. Grice, Ph.D., Department of National Health and Welfare, Canada Harold M. Peck, M.D., Merck Institute for Therapeutic Research Charles F. Reinhardt, M.D., E. I. duPont de Nemours and Company Frank G. Standaert, M.D., Georgetown University School of Medicine and Dentistry Robert G. Tardiff, Ph.D., Environmental Protection Agency vi

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Contents Introduction What are the Adverse Effects of Lead? ; What Dose of Lead is Required to Produce Adverse Effects? 3 What is the Estimated Lead Intake in a Child with 7 Pica for Paint? What is the Lead Content of Currently Available 8 Household Paints? What Future Research is Necessary or Desirable? 8 Conclusions and Recommendations 9 Appendices A. Dose-Effect, Dose-Response Concepts of Toxicology 13 B. Toxicology of Lead in Experimental Animals 19 C. CPSC-Supplied Animal Studies 29 D. Etiology and Consequences of Childhood Lead Poisoning 37 E. Evaluation of the Hazard of 0.5 Percent Lead Paint 45 F. Daily Permissible Intake (DPI), Reconsidered 49 G. Lead Contents of Current Household Paints 51 References 54 vii

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Preface This document was prepared by the ad hoc Committee on Lead in Paint of the National Research Council, National Academy of Sciences under contract CPSC-C-75-0018, from the Consumer Product Safety Commission. The CPSC requested that the Academy recommend a "safe level" of lead in paints and other coatings based on an evaluation of four studies submitted to the Academy by the CPSC. The Commission also requested additional ad- vice and recommentations related to the safety of lead in paints and coatings. The ad hoc Committee on Lead in Paint met December 13 and 14, 1974 to review the four studies in which lead coupounds used in paints were fed to rats and baboons. The studies reviewed were: 1. Purdy, Robert H. Southwest Foundation for Research (SWFRE). A Toxicological Investigation of Chronic Lead Paint Ingestion in the Juvenile Baboon (Nov. 1974). Contract No. CPSC-C-74-159. 2. Kneip, T.J., V.P. Rulon, E.A. Pfitzer, N. Cohen and D.H. Goldstein, New York University Institute of Environmental Medicine (NYU). Lead Toxicity Studies in Infant Baboons - A Toxicological Model for Childhood Lead Poisoning (Nov. 1974). Contract No. CPSC-C-74-153. 3. Castles, T.B. Midwest Research Institute (MRI) Lead Paint Ingestion Study (Feb. 1974). Contract No. 62-W-62GC and NPC. 4. Barltrop, D. St. Mary's Hospital Medical School (St. MHM's) Assessment of the Health Hazard of Various Lead Compounds Interim Report (Sept. 1974). Contract No. HSM-99-73-28. The first two studies were contracted by the CPSC, the third by the National Paint and Coating Association and the fourth by the Environ- mental Health Service Division of the Center for Disease Control, U.S. Department of Health, Education, and Welfare. Since the studies supplied insufficient data for recommending a "safe level" of lead in paint, the Committee sent a preliminary report to the CPSC on December 20, 1974 in which it stated ".... this Committee believes it is desirable to retain the present recommended level (0.5 per- cent) and to defer final action until data, adequate to support a change, have been obtained." A second meeting of the Committee was held on February 6 and 7, 1975 to determine a plan tor arriving at a recommended "safe level" of lead in paints and coatings. The Committee discussions centered on the etiology of childhood lead poisoning with particular reference to the role of lead paint ingestion. The Committee decided to institute a literature ix

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search for any data, in animals or humans, which would provide a basis for recommending a "safe level" of lead in paint. The accumulation and evaluation of data from over 200 studies has required approximately one year. This report is the result.